II92 



THE MALARIAL FEVERS 



The dosage of quinine in use in England and non-malarial countries 

 is perfectly useless in highly malarial tropical districts. 



An attempt is made in the above system of treatment to prevent 

 relapses and recurrences as far as is possible. 



Details of Treatment. — The various other points connected 

 with treatment may be considered as follows: — 



A. Quinine therapy. 



B. Symptomatic treatment. 



Quinine Therapy. — ^There are a number of details which require 

 elaboration with regard to quinine therapy, and these are: — (i) The 

 dose; (2) the time of administration; (3) the method of adminis^ 

 tration; (4) the duration of treatment. 



The Dose. — To adults we generally give three times a day by the 

 mouth 5 to 10 grains of the ordinary preparations (sulphate, hydro- 

 chloride, etc.). The routine mixture is composed of quinine sul- 

 phate, 5 to 10 grains; dilute sulphuric acid, 5 to 10 minims; syrup 

 of orange, i drachm ; distilled water, i ounce. We give euquinine in 

 sHghtly larger doses. 



By intramuscular or intravenous injections we give 15 grains, 

 by the rectum 30 grains ; but when given by the last method, some 

 tincture of opium should be added, to prevent irritation, which 

 otherwise is liable to occur. Five or ten grains of potassium bromide 

 added to each dose of quinine will, to a certain extent, prevent 

 tinnitus aurium. In cases in which the heart is weak a few minims 

 of tincture of digitalis should be prescribed. 



Children suffering from malaria stand quinine well, and the 

 minute doses advised in so many treatises on the diseases of children 

 are, in our experience, utterly inadequate in the tropics. Infants 

 under one year of age may receive from ^ grain to grains six 

 times a day; children between one and three years of age from 

 I grain to 2 grains six times a day, and those between three and 

 ten years 2 to 3 grains six times a day. 



Nocht has advised the administration in adults of quinine in small repeated 

 doses of 2| grains five times a day. This method is useful when there is a 

 tendency to haemoglobinuria and in pregnant women in whom the administra- 

 tion of full doses may induce abortion; but this action has been greatly exag- 

 gerated, many cases ascribed to quinine being due to some other cause. We 

 have often given 1 5 grains of quinine daily to pregnant women, but divided 

 into small doses of 2 to 3 grains, and in severe cases have pushed the drug 

 without bad effects. The addition of a little opium may prevent bad effects. 



In patients showing anaphylactic symptoms such as dyspnoea, dysphagia 

 urticaria, etc., Heran and Saint-Girons give quinine as follows: the first day 

 a ' defensive dose ' of gr. ^ quinine sulphate mixed with gr. 8 sodium bicar- 

 bonate is given, and two hours later, gr. The second day, two hours 

 after the ' defensive dose,' gr. 3 is administered. The third day, two hours 

 after the defensive dose, gr. 6 is given, and so on, gradually increasing the 

 amount of quinine. 



Time of Administration. — The best time to give quinine to a 

 healthy person for purposes of prophylaxis, or to a convalescent for 

 purposes of effecting a cure, will be at meal-times, and preferably 



