In order to suppress attack of typical intermittent an adult is to be given 25 grains of quinine. In cases of masked malaria it may become necessary to in crease thc dose, even up to 50 grains. Quinine is to be given, at the very least, six hours before the ensuing attack. J. Ballagi (Indian Lancet, Dee. 16, '97).
To master malaria, 15 grains of quinine should be given to the sufferer from ma laria in the afebrile intervals, therefore almost always in the morning hours, until the malarial parasites have disap peared from his blood; then follows an interval of seven days; then again 15 grains of quinine on each of two of suc cessive days; then another seven days' interval; again two days of drugg-ing with quinine, and so on, for at least two months. Robert Koch (Deut. med. Woch., Apr. 26 and May 3, 1900).
In the mstivo-autumnal fevers treat ment should be more actively pursued and larger doses of quinine employed. Owing to the irregularity in time with which the parasites undergo segmenta tion quinine should be given irrespective of the occurrence of the paroxysm, so that its administration may be com menced in doses of 5 grains every four hours as soon as the case comes under observation. If the case be very severe and pernicious manifestations feared, several larger doses of the drug (15 grains) may be given at intervals of a few hours either hypodermically or by intravenous injection, while subsequently its use may be continued in smaller doses. If pernicious symptoms have al ready occurred, no chances that the drug may be absorbed through the stomach should be taken; it is imperative under these circumstances to administer it un der those conditions most favorable to its rapid absorption; that is, by hypodermic or intravenous injection after the method of Baccelli.
In pernicious malaria cinchonisin should be produced as rapidly as pos sible, and, since the temperature-varia tions are exceedingly irregular, large doses are necessary. The stomach will rarely accept the necessary doses, and hypodermic and intravenous injections (Baccelli's method) are to be considered. Great depression should be combated by strychnine and digitalis, and patient sustained by enemas of whisky, pepto nized foods, and broths. Clarence J. Manly (Ther. Gaz., Dec., '97).
The exhibition of such large doses of quinine as were at one, time believed to be necessary deprecated; even in the tropics 30 to 45 grains of quinine per diem are sufficient, while here, in the northern half of the United States, the milder intermittents are often checked by a single dose of 5 grains, more certainly with 10. In general, however, 15 grains
may be looked on as an average dose in such cases. In the severe and more obsti nate stivo-autumnal forms 20 grains a day may be taken as the normal dose. It is best to administer that amount at one dose, or within a time not longer than two hours. Dock (Jour. Amer. Med. Assoc., July 29, '99).
Notwithstanding the fact that quinine is held by some observers to be directly responsible for the hmmorrhagic phe nomena characterizing malarial hmmo globinuria, no particular modification of the treatment should be made in the management of these cases. In a gen eral way, the same treatment that is ap plicable to the other forms of pernicious feyer is to be employed in malarial hamoglobinuria.
In treatment of hremoglobinuria in malaria persulphate of iron and inhala tions of oxygen are the most useful. If the malarial attack necessitates quinine its continuance is advised even in spite of laernoglobinuria. Baccel (I1 Poli elinieo, Jan. 15, '97).
Quinine objected to in malarial hInma turia, and following treatment recom mended: l. Sodium hyposulphite in drachm doses every two hours until the patient is thoroughly purged; continued in smaller doses until the system is satu rated with it. Free sulphurous acid is disengaged in the blood, and this agent is an antizymotic to such an extent that it destroys the micro-organisms that are the real cause of the disease, and thus arrests the process of corpuscular disin tegration. 2. Morphine and atropine hypodermically, sufficient to quiet the stomach; and blisters over the epigas trium, if necessary. 3. An abundance of water to wash out the coagula that must necessarily accumulate in the urinary tubules after a lixmorrhage. Hot water or hot lemonade is frequently better borne by the stomach than cold. Cup ping over the loins is also to be recom mended. 4. A mild diet; fresh butter milk is usually well borne. 5. The pa tient should remain in a strictly recum bent position. Meek (Then Gaz., May 15, '97).