THE MALARIAL FEVERS 



we have used this in bad cases, we have no experience of it as a 

 routine practice. 



Diarrhcea is at first useful in ridding the body of excess of bile 

 and other waste products. Prolonged diarrhoea must be treated 

 with astringents (bismuth! subnitratis or salol gr. x. every four 

 hours). Meanwhile it should be borne in mind that though quinine 

 is absorbed by the stomach, still, with much diarrhoea there is often 

 gastric disturbance, and therefore, if the drug is given by the 

 mouth in these conditions, its utility may be small. 



Splenic pain and liver pain are not, as a rule, severe enough to 

 make special treatment needful, but occasionally the splenic pain 

 may be severe (due to perisplenitis), when hot fomentations will 

 relieve it, if it is thought necessary to use them. 



Hyperpyrexia must be treated by cold sponging — if possible, with 

 ice; if not, with the mixture mentioned above, or by cold packs, 

 cold baths, and cold enemata. 



Cerebral Malaria. — Give large hypodermic saline infusions to 

 wash out the toxins [vide Algidity). 



Algidity requires special treatment with hypodermic saline in- 

 jections and warm applications to the body, and especially to 

 the region of the heart. The saline injections consist of sterile 

 normal saline solution, and are injected by gravity from the ordinary 

 glass reservoir via a long piece of indiarubber tubing and a stout 

 hollow needle, such as those in the Potain's aspirator-case. The 

 usual sites for the injection are the sides of the chest, just below 

 the armpit, and the outer aspect of the thighs. At least a pint 

 should be injected in one place. Oxygen inhalations, if available, 

 may also be used. 



Diaphoretic pernicious fever requires stimulants, hypodermics of 

 atropine, and ether or strychnine, and treatment as for algidity. 



HcBmorrhagic perniciosa may be treated with calcium chloride, 

 and with local applications or injections of adrenalin. 



Scarlatiniform perniciosa obviously calls for dilution of the toxins 

 by saline injections. 



In pernicious cases, when the patient becomes delirious or coma- 

 tose, the practitioner must be careful that the attendants in whose 

 charge he is left are really trustworthy, as unfortunate accidents 

 have been known to happen. Particularly we warn the practitioner 

 to make sure that the bladder has been emptied, especially in 

 delirious patients, not by mere causal inquiry, but by percussion of 

 the abdomen. 



In choleraic perniciosa the treatment for cholera should be adopted 

 in addition to quinine. In dysenteric perniciosa the treatment must 

 be that suggested for mild dysentery, and, in addition, quinine, 

 while the pseudo- Addison's disease is best treated in our experience 

 by 10 minims of adrenalin, given twice daily in addition to quinine. 



Treatment of Convalescence. — -The important point to be 

 remembered in convalescence is to continue the quinine in smaller 

 doses for at least three months after the attack. The patient 



