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To distinguish between the two forms of malignant malaria involves so many examinations of the same blood that we think it is sufficient to differentiate between the simple and malignant forms which is what we now attempt to do.
TREATMENT.
Though we have nothing new to bring forward under this head, a clinical report would hardly be complete without a few words on the subject.
PROPHYLACTIC.
This hardly comes within the scope of a report of this kind, but we think we have shown that, until the day dawns when the mosquito will cease from troubling, a good deal more attention must be paid to endeavouring to prevent such conditions arising as precipitate a second attack of the malady. Briefly this consists in good and cheap food, good water, well ventilated and dry houses and avoidance of all excesses.
CLINICAL TREATMENT.
Our experience in this direction has been solely with quinine. As far as we know none of the other drugs brought forward lately have fulfilled expectations and quinine will, we think, for a long time to come, be the sheet anchor in dealing with this tropical ailment in all its forms. Now and again
one, no doubt, meets with a case in which, in spite of the drug, the fever still continues and search, as carefully as one may, no cause can be found for the persistent rise of temperature. These cases are few and in our opinion most of them should be viewed with suspicion as cases of early phthisis. No less than four of our cases have, after repeated examination both of the lungs and sputum, at last given us the clue to the obstinate temperature chart.
We have only given quinine by mouth, hypodermically and by enema. Of the intravenous injec- tion we have no experience and we doubt it ever being extensively used save in the " coma forms where as we have already stated we have not had much success with quinine given in ordinary ways. It is certainly worth a trial and we propose, on the next opportunity, trying its efficacy in this man-
Der.
Quinine by the mouth will, we think, be the usual way of administering the drug for a long time to come and the only question is as to how and in what doses it is best used. First of all, there is no question that in all cases of fever the first drug to be used is calomel. The routine practice here is always to precede all treatment by a calomel purge and a saline draught and the benefit of this cannot be questioned.
We tried what, we believe, is known as the foreign method, viz., a large dose either at the fall of the fever or at its height and we gave 15, 20 and 30 grains in some cases in the morning and in others in the evening. As far as our fevers go this system is useless or not nearly as effectual as the old way in vogue in this hospital to which we have returned. This consists in giving quinine in 5-grain doses every 2, 3 or 4 hours irrespective of the fever or the condition of the parasites as seen in the blood. We have no hesitation in saying that for this country this is the best method and gives the best results. The use of antipyretics (ptenacetin, antipyrin, &c.) we have entirely given up as we think their employment depressing and of course quite useless as far as the destruction of the parasites go. In combination with the quinine we give a diaphnetic mixture (Liq. Ammon. Acet. 4 drs. and Pot. Acetat. gr. xx) every 4 hours whenever the temperature rises above 102° or 103°.
This acts as a diuretic and diaphoretic and is at any rate harmless though personally we have a high opinion of it as tending to the comfort of the patient.
We may add that given in the above frequent doses we have seen no ill-effects nor have any of the patients complained of anything more than a temporary deafness.
We may also state that we tried in one case iron in large doses and quinine in small (Tr. Ferr. Perchlor. . xx, Quinine gr. ii) every 3 hours, as recommended by a West Indian practitioner-and we certainly agree that it is worth a trial in those few cases which resist quinine.
fevers
Diet and the after use of tonics call for no remarks. Sir WILLIAM JENNER'S dictum
is as true of this fever as of any other.
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Feed your
J. BELL,
Acting Principal Civil Medical Officer.
G. E. STEWART, Lieut., I.M.S., Acting Assistant Superintendent.
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