MALARIA.
Prophylaxis.—The most important and efficient of all methods of stamp ing out the disease consists in the destruction of the stagnant pools of the swamps which form the breeding-ground of the mosquito. Improved drainage, by levelling and planting the soil with trees in the neighbourhood of dwellings and the covering over of all collections of water by a film of kerosene or tarry liquid, cause the suffocation of their larvae.
Those suffering from malaria should he isolated by fine netting in order to prevent the insects becoming infected with the parasites, and the healthy can effectually protect themselves with similar netting from the bites of the insects, since Anopheles is always nocturnal in its feeding habits in bright weather.
As their range of flight is limited, a high degree of protection can he obtained by sleeping as far above the level of the ground as possible. Minor aids may be employed, as smearing the skin over with Eucalyptus, Peppermint Oil or Tincture of Pyrethrum, which prevents the insect biting, and also the burning of aromatic substances in the sleeping apart ments once the mosquitoes have obtained admission.
Quinine internally will often entirely protect the healthy individual for long periods from malaria, though bitten by infected insects, hut less than a daily dose of 5 grs. cannot be relied upon. Plehn's method of " double prophylaxis " consists in the administration of 8 grs. every fourth and fifth or every fifth and sixth day. Koch's plan was to give is to 24 grs. upon two consecutive days at intervals of 8 to io days, and is known as the " long-interval prophylaxis." When employed as a prophylactic the insoluble Sulphate should be used, but when quinine is administered as a curative agent the Acid Hydrochloride should be selected. Chundra saturates the system with Calcium Sulphide.
Once an attack of malaria has shown itself the patient should immediately be put to bed, and hot-water bottles and warm clothing freely supplied. Hot drinks or warmed stimulants are useful. Nitrite of Amyl and other nitrites very often stop the chill promptly, but do not appear to influence the succeeding stages. Pilocarpine hypodermically and a full dose of Chloroform by the mouth act in the same way. The hypodermic injec
tion of Morphia often gives great relief at this stage. Moderate purgation should generally he prescribed, as it undoubtedly increases the efficacy of the remedies to be afterwards given in the later stages.
In the hot stage considerable relief may he obtained by removal of the extra clothing and the free sponging of the skin with cold or tepid water. Cold compresses are grateful. Coma and hyperpyrexia should be met by the cold bath or cold pack as in sunstroke.
In the sweating stage gentle friction with hot towels and changes of underclothing may give some relief. After this stage is over, the patient may be permitted to get up and move about in the regular forms of inter mittent malaria.
For the treatment of malaria in all its forms and types Quinine is the sovereign remedy, and should always he resorted to. Much interest has been taken in its action upon the parasite in the blood, and we now perhaps know more about the therapeutic action of this drug than is known of almost any other internal remedy employed in disease. By withdrawing small quantities of blood at different stages of the malarial attack it has been determined that the young brood, when showered free into the circu lating plasma, are much more susceptible to its lethal influence than are the intracorpuscular forms. A single large dose (15 grs.) when given shortly before a paroxysm of the benign intermittent fevers will effect the destruction of the great majority of the young parasites, but the rigor is not prevented by this treatment, though another attack may not occur.
The parasites causing the malignant types of malaria are still less susceptible to quinine when in the intracorpuscular stage of existence. Though there cannot be any doubt about the ideal time for the full therapeutic action of the drug being 3 to 5 hours before the rigor, this should not dominate the situation. Quinine in all cases should be given as soon as the patient comes under observation, without waiting for the advent of any particular stage in the parasite's cycle of development. The object should be to saturate the patient's blood with the drug at once and to continue its administration for 3 or 4 weeks in smaller closes.