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

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

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138 THE CHARLOTTE MKDICAL JOURNAL.<br />

sorbed and produced the ugliest abscess I and two hours before the next chill. In not<br />

hav-eev^r seen giving further tre<strong>at</strong>ment (antimalarial) mv<br />

It IS folly to <strong>at</strong>tempt to dissolve over ten motive was to determine the effectiveness <strong>of</strong><br />

grains <strong>of</strong> qunnne in the amount <strong>of</strong> w<strong>at</strong>er the hvpodermic tre<strong>at</strong>ment. Ten grains -iven<br />

th<strong>at</strong> the ordinary syringe will hold. To during the decline <strong>of</strong> the first chilK hvpoder<strong>at</strong>tempt<br />

a larger amount means a ropy solu- mically) has always in my cases prevented a<br />

tion th<strong>at</strong> IS hard to inject and too irrit<strong>at</strong>ing, return <strong>of</strong> malaria on the next chill dav but<br />

I am using the method described below, it may appear l<strong>at</strong>er. If a second hvpobince<br />

Its adoption I have escaped the qui- dermic is given on the next chill day an<br />

nine abscess. hour before the expected chill there is little<br />

U ) Clean the part selected for injection chance <strong>of</strong> the p<strong>at</strong>ient having a paroxysm<br />

with soap and w<strong>at</strong>er. Do not hesit<strong>at</strong>e to if <strong>at</strong> all it will be <strong>of</strong> little severity. In those<br />

scrub well, you will be suprised to find how cases where I have given it during the first<br />

much dirt you will get <strong>of</strong>f <strong>of</strong> the most aris- <strong>at</strong>tack I have not had to repe<strong>at</strong> the iniectocr<strong>at</strong>ic<br />

arm. Follow this with alcohol and tion, neither has the p<strong>at</strong>ient had a return<br />

instruct your p<strong>at</strong>ient to keep his hands <strong>of</strong>f <strong>of</strong> any symptom <strong>of</strong> malaria While I am<br />

<strong>of</strong> the place you have sterilized. Some enthusiastic over this tre<strong>at</strong>ment, I do not<br />

p<strong>at</strong>ients seemingly cannot resist the tempta- wish to be understood as savin"- th<strong>at</strong> after<br />

tion <strong>of</strong> rubbing the place in spite <strong>of</strong> your a hypodermic injection he is free or imdirections.<br />

Cover with a piece <strong>of</strong> gauze and mune from malaria the balance <strong>of</strong> his life<br />

It will save you lots <strong>of</strong> time. (2) Cleanse not <strong>at</strong> all; but I honestly believe th<strong>at</strong> he is<br />

your syringe by filling with alcohol and free from the original infection, if after the<br />

then with sterile w<strong>at</strong>er. Wipe the needle second injection he misses the second chill<br />

with a cloth s<strong>at</strong>ur<strong>at</strong>ed with alcohol and let The p<strong>at</strong>ient is <strong>of</strong> course susceptible to anthe<br />

needle remain m this cloth while you other <strong>at</strong>tack, but it will not be from the<br />

are preparing your quinine solution. (3) original malarial plasmodia, and must be<br />

Clean the yes.sel you are to use for holding bitten by another malaria-infected mosquito<br />

solution with alcohol and sterile w<strong>at</strong>er. In the tre<strong>at</strong>ment <strong>of</strong> the Aestivo-autumnai<br />

rut in the "umber <strong>of</strong> tablets you have de- type I usually give two hypodermics a dav<br />

cided upon. I- ill syringe two thirds full <strong>of</strong> one when the fever is <strong>at</strong> its highest and<br />

w<strong>at</strong>er (sterile) and spray tablets several vice versa. In givingit while thefeverislow<br />

times until they are entirely in solution. If we are able to prevent a troublesome hvperit<br />

IS convenient he<strong>at</strong> solution until perfectly pyrexia and destroy numbers <strong>of</strong> plasmodia<br />

clear. Alter expelling air from the syringe I think the gre<strong>at</strong>est benefit is seen when<br />

wipe the needle with alcohol and sterile given during the decline <strong>of</strong> the paroxysm,<br />

w<strong>at</strong>er. I would suggest especial care here, Quinine is described in the text-books as<br />

as any <strong>of</strong> the quinine solution on the needle having some antipyretic action, thouoh<br />

will act as an irritant to the wound the feeble compared with the coal tar product's<br />

needle makes m passing through the skin. This is not true when given hypodermic-<br />

K^) i usually give the hypodermic iujec- ally. You will be pleased with the rapidity<br />

tion .11 the posterior part <strong>of</strong> the arm, the with which the fever leaves the p<strong>at</strong>ient after<br />

place does not m<strong>at</strong>ter so much as the tech- a hypodermic <strong>of</strong> quinine. I know the -re<strong>at</strong>nique.<br />

Lift the skin well and let the fluid e.st destruction <strong>of</strong> plasmodia results when<br />

flow under ,t. Do not inject into muscle, but given <strong>at</strong> this stage(decliiie <strong>of</strong> paroxvsmlfor<br />

deeply under the,skin. Allow theneedle tore- they are more susceptible to the action <strong>of</strong><br />

main a tew seconds and be sure th<strong>at</strong> the con- quinine. In this class <strong>of</strong> malaria 10 to 15<br />

tentsotthesyniigehavebeenexpelled. Then grains should be given twice a dav Tlie<br />

exert a little pressure <strong>at</strong> the point <strong>of</strong> punc- addition <strong>of</strong> one-eighth to one-fourth <strong>of</strong> a<br />

lire and withdraw the needle gently. Do grain <strong>of</strong> morphine aids in the comfort <strong>of</strong><br />

this and you will not through suction bring your p<strong>at</strong>ient.<br />

any fluid with the needle, thus lessening I am reminded <strong>of</strong> two cases which I think<br />

tlie chance <strong>of</strong> the solution irrit<strong>at</strong>ing the skin tested the value <strong>of</strong> this method. The first<br />

the<br />

LT u \, ^ffl<br />

puncture with iodo- case was th<strong>at</strong> <strong>of</strong> a negro woman<br />

form<br />

who was<br />

collodion (10% iod<strong>of</strong>orm). suffering with the Aestivo- autumnal type<br />

Lxpenencehastaughtmeth<strong>at</strong>theverybest (the so-called swamp fever or slow fever)<br />

time to give an injection is during the de- She gave a history <strong>of</strong> two weeks <strong>of</strong> fever<br />

"1 ''"'^•"°,^ ^' °,\ ^ °"" ^'^""S^t ^^^thout<br />

f<br />

a chill. A blood examin<strong>at</strong>ion re<br />

when the fever is <strong>at</strong> its highest. In several vealed crescents. P<strong>at</strong>ient had been takiir.<br />

li'-'ve had an opportunity to ad- twenty to twenty-five grains <strong>of</strong> quinine sul-<br />

l^t^L7<br />

m oxvs,Wl""' "h "", ""• "^ "'" P^^^^ ' ^^y<br />

'^'f''' ^y mouth for two leeks and<br />

,'"''';<br />

^^^« ""^'^le to<br />

^f.J?H,i<br />

continue<br />

t'^^?,^"''^^"''^''^''^"''- the tre<strong>at</strong>ment on<br />

account <strong>of</strong> nausea. Other p<strong>at</strong>ients <strong>at</strong> this<br />

his r"^ ;^T"•^^^'1'^'^'''^^°"^<br />

'f/^e^'dedly better to in- time 1<br />

ltr,^'.t T f; ? prevented me from seeing her but once<br />

structp<strong>at</strong>ieuttotakelOgrams<strong>of</strong>quiniuefour a day. The fever was <strong>at</strong> its highest in the

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