CHAPTER VIII
MALARIA: TREATMENT
Quinine.—— Many drugs have been employed in the treatment of malarial disease, and many drugs have some influence on it; all sink into insignificance in comparison with quinine. In serious cases, to use any drug to the exclusion of quinine is culpable trifling. Therefore, so soon as a diagnosis of malaria has been arrived at, unless there be some very manifest contraindication, the first duty of the practitioner is to set about giving quinine. There are many ways of exhibiting the drug; however given, care must be taken that it is so administered that there can be no mistake about its being absorbed. If the patient for any reason, such as inability to swallow or persistent vomiting, cannot take quinine by the mouth, and the existing condition be grave, it may be injected by the rectum; but if the circumstances of the case are such that neither of these channels for administration is available, and a rapid action of the drug is imperative, it must be injected at once intramuscularly, or into a vein.
When and in what dose to give quinine in ordinary cases.—— During a paroxysm of ordinary intermittent fever it is better, before giving quinine, to wait until the rigor and hot stages are over and the patient is beginning to perspire. A fever fit, once begun, cannot be cut short by quinine, and to give quinine during the early stages aggravates the headache and general distress; but so soon as the skin is moist and the temperature begins to fall, the earlier the drug is commenced the better. Ten gr., preferably in solution, should be administered at the commencement of sweating, and thereafter 5 gr. every six or eight hours for the next week. This is an almost certain cure. The quinine may not always
