The treatment of malaria.

Hyperinfection in Malignant Tertian Infection Where there is hyperinfection associated with cerebral features, where algid malaria is found, where the patient cannot swallow or when vomiting and diarrhoea are severe, anti-malaria drugs should be given intravenously. For this purpose, quinine hydrochloride gr. I0 in I0 to 20 ml. of isotonic saline may be slowly injected at the rate of i gr. per minute and repeated in six hours if necessary. The injection must be given slowly owing to the severe drop of blood pressure resulting from rapid injection. Never more than three injections should be given in the first 24 hours. If the blood pressure is unduly low or algid symptoms are present, quinine hydrochloride may be given slowly in one pint of saline rather than in concentrated form. Chloroquine hydrochloride in a dosage of 200 to 300 mg. may be injected intramuscularly and repeated in eight hours, or 400 mg. of base in 500 ml. normal saline may be given slowly by intravenous drip, taking one hour for the injection. The sulphate in a dosage of 200 mg. base may be given intravenously and repeated in eight hours. Parenteral medication is stopped when the patient regains consciousness and when shock and symptoms of collapse improve. It is often necessary in this condition to combat dehydration and to maintain blood volume by intravenous injections of isotonic saline (o.85 per cent.) or glucose (5 per cent.) given by continuous drip or intermittently. Mepacrine hydrochloride (0.3 g.) may also be administered intramuscularly if other drugs given by the intravenous route are not available. A total of i.o g. mepacrine parenterally should not be exceeded in the first 24 hours of treatment. Lumbar puncture with the withdrawal of 20 ml. of cerebrospinal fluid may be helpful. In addition, should hyperpyrexia be present, the naked patient is placed under a fan on a wire mattress and covered with a sheet sprayed with ice-cold water. When the rectal temperature reaches Io02F. hydrotherapy should be stopped. Finally, if haemolytic anaemia be severe the patient should be transfused; in severe cases several pints of blood may be given. Oral medication with iron should follow.