Vol. 60, 1909 - University of North Carolina at Chapel Hill

138 THE CHARLOTTE MKDICAL JOURNAL.
sorbed and produced the ugliest abscess I and two hours before the next chill. In not
hav-eev^r seen giving further treatment (antimalarial) mv
It IS folly to attempt to dissolve over ten motive was to determine the effectiveness of
grains of qunnne in the amount of water the hvpodermic treatment. Ten grains -iven
that the ordinary syringe will hold. To during the decline of the first chilK hvpoderattempt
a larger amount means a ropy solu- mically) has always in my cases prevented a
tion that IS hard to inject and too irritating, return of malaria on the next chill dav but
I am using the method described below, it may appear later. If a second hvpobince
Its adoption I have escaped the qui- dermic is given on the next chill day an
nine abscess. hour before the expected chill there is little
U ) Clean the part selected for injection chance of the patient having a paroxysm
with soap and water. Do not hesitate to if at all it will be of little severity. In those
scrub well, you will be suprised to find how cases where I have given it during the first
much dirt you will get off of the most aris- attack I have not had to repeat the iniectocratic
arm. Follow this with alcohol and tion, neither has the patient had a return
instruct your patient to keep his hands off of any symptom of malaria While I am
of the place you have sterilized. Some enthusiastic over this treatment, I do not
patients seemingly cannot resist the tempta- wish to be understood as savin"- that after
tion of rubbing the place in spite of your a hypodermic injection he is free or imdirections.
Cover with a piece of gauze and mune from malaria the balance of his life
It will save you lots of time. (2) Cleanse not at all; but I honestly believe that he is
your syringe by filling with alcohol and free from the original infection, if after the
then with sterile water. Wipe the needle second injection he misses the second chill
with a cloth saturated with alcohol and let The patient is of course susceptible to anthe
needle remain m this cloth while you other attack, but it will not be from the
are preparing your quinine solution. (3) original malarial plasmodia, and must be
Clean the yes.sel you are to use for holding bitten by another malaria-infected mosquito
solution with alcohol and sterile water. In the treatment of the Aestivo-autumnai
rut in the "umber of tablets you have de- type I usually give two hypodermics a dav
cided upon. I- ill syringe two thirds full of one when the fever is at its highest and
water (sterile) and spray tablets several vice versa. In givingit while thefeverislow
times until they are entirely in solution. If we are able to prevent a troublesome hvperit
IS convenient heat solution until perfectly pyrexia and destroy numbers of plasmodia
clear. Alter expelling air from the syringe I think the greatest benefit is seen when
wipe the needle with alcohol and sterile given during the decline of the paroxysm,
water. I would suggest especial care here, Quinine is described in the text-books as
as any of the quinine solution on the needle having some antipyretic action, thouoh
will act as an irritant to the wound the feeble compared with the coal tar product's
needle makes m passing through the skin. This is not true when given hypodermic-
K^) i usually give the hypodermic iujec- ally. You will be pleased with the rapidity
tion .11 the posterior part of the arm, the with which the fever leaves the patient after
place does not matter so much as the tech- a hypodermic of quinine. I know the -reatnique.
Lift the skin well and let the fluid e.st destruction of plasmodia results when
flow under ,t. Do not inject into muscle, but given at this stage(decliiie of paroxvsmlfor
deeply under the,skin. Allow theneedle tore- they are more susceptible to the action of
main a tew seconds and be sure that the con- quinine. In this class of malaria 10 to 15
tentsotthesyniigehavebeenexpelled. Then grains should be given twice a dav Tlie
exert a little pressure at the point of punc- addition of one-eighth to one-fourth of a
lire and withdraw the needle gently. Do grain of morphine aids in the comfort of
this and you will not through suction bring your patient.
any fluid with the needle, thus lessening I am reminded of two cases which I think
tlie chance of the solution irritating the skin tested the value of this method. The first
the
LT u \, ^ffl
puncture with iodo- case was that of a negro woman
form
who was
collodion (10% iodoform). suffering with the Aestivo- autumnal type
Lxpenencehastaughtmethattheverybest (the so-called swamp fever or slow fever)
time to give an injection is during the de- She gave a history of two weeks of fever
"1 ''"'^•"°,^ ^' °,\ ^ °"" ^'^""S^t ^^^thout
f
a chill. A blood examination re
when the fever is at its highest. In several vealed crescents. Patient had been takiir.
li'-'ve had an opportunity to ad- twenty to twenty-five grains of quinine sul-
l^t^L7
m oxvs,Wl""' "h "", ""• "^ "'" P^^^^ ' ^^y
'^'f''' ^y mouth for two leeks and
,'"''';
^^^« ""^'^le to
^f.J?H,i
continue
t'^^?,^"''^^"''^''^''^"''- the treatment on
account of nausea. Other patients at this
his r"^ ;^T"•^^^'1'^'^'''^^°"^
'f/^e^'dedly better to in- time 1
ltr,^'.t T f; ? prevented me from seeing her but once
structpatieuttotakelOgramsofquiniuefour a day. The fever was at its highest in the