II96 



THE MALARIAL FEVERS 



into the median basilic or median cephalic veins, and not less than 

 I gramme (15 grains) of the bihydrochloride dissolved in five or 

 ten cubic centimetres of sterile physiological salt solution should be 

 injected at a time. The skin over the selected vein should be ren- 

 dered thoroughly aseptic by soap and water and carbolic lotion, 

 or by tr. iodi, and then a bandage tied round the arm, so as to 

 retard the flow of venous blood and make the selected vein stand 

 out. Then the needle should be inserted into the vein (care being 

 taken that there is no air in needle or syringe) in a sloping direc- 

 tion, with the point towards the heart, so that the injection can 

 flow with the circulation. The point of the needle should be felt 

 to be loose {i.e., in the vein). The bandage must now be loosened 

 and the injection made slowly, the effect on the pulse being noted. 

 The needle is now withdrawn, and an aseptic pad fixed in position 

 by a bandage. 



Duration of Treatment.— When the fever has subsided and the 

 patient is feeling better, the administration of quinine must not be 

 discontinued, because there is the fear of a relapse, caused by 

 parasites which have not yet been destroyed, and which may be 

 living in the spleen ; or, again, there is the fear of the parthenogenesis 

 of the macrogametocyte. In order that the treatment may be suc- 

 cessful, the quinine must be continued for a long time. Our routine 

 practice has been to continue with 10 grains three times a day 

 for a month after the cessation of the fever, 5 grains three times a 

 day during the second month, then 5 grains twice a day during the 

 third month. In some cases when the fever has ceased it is advis- 

 able to associate some iron and arsenic with the quinine, but these 

 drugs should not be administered during the febrile attack. 



Symptomatic Treatment. — ^The symptomatic treatment may be 

 considered under the following headings: — 



1. Symptomatic treatment of acute malaria. 



2. Diet in acute malaria. 



3. Treatment of symptoms and special conditions. 



4. Treatment of convalescence. 



5. Treatment of chronic malaria. 



6. Treatment of malarial cachexia. 



Symptomatic Treatment of Acute Malaria.— The practitioner 

 who works in the tropics must often be prepared to do the nursing as 

 well as the medical treatment . When the attack begins, the patient 

 must go to bed, and in the cold stage wrap up well with blankets. 

 At the same time arrangements must be made in case of sickness 

 or diarrhoea. The treatment of this and the warm stage must be 

 to encourage perspiration, by warm lime-drinks, hot tea, etc., in 

 order that the toxins may be passed out as quickly as possible. 

 Ziemann recommends hot-air baths to bring on the perspiration. 

 We have tried this method a few times, but have not been greatly 

 impressed with the advantages. 



The headache may be relieved by cold applications, and where 



