145
have a great prejudice against the use of quinine, and prefer to use some other
remedy; others make use of quinine, but in doses so ridiculously small as to
he almost of no value; and there are, as has been mentioned elsewhere, a
considerable number who use neither quinine nor any other remedy when,
attacked by intermittent fever.
421. Unfortunately many medical men appear to share the common
prejudice against the use of adequate doses of quinine, and prescribe doses of
two or three grains twice or three times daily. As a result the sufferer from
malaria derives little or no benefit from the treatment, and both patient and
physician become confirmed in their belief that quinine is of little value, or
that it is unsuited to the constitution of Indians.
422. As it is a matter of importance to determine the minimum amount of
quinine that will cure ordinary cases of malarial fever, the majority of which are
mild intermittents, advantage was taken of the fact that, during the investiga-
tion in the south of the island, a considerable number of people presented
themselves at the office of the enquiry and asked for treatment. Gratuitous
treatment was given to a number of cases in this way. The blood of the patient
being first examined, a supp]y of medicine sufficient for 3 or 4 days' treatment
was given to him, and he was instructed to return for a further supply of
medicine and to report progress as soon as the medicine was exhausted. The
preparation of quinine used was the bisulphate in the form of sugar-coated
tablets, 5 grains in each.
423. The routine treatment adopted for adults was four 5-grain tablets
a day for the first 3 or 4 days. At the end of this time they had to return for
a further supply of medicine. On the second visit they were told to continue
with 3 tablets a day for three days and then 2 tablets a day for three days, after
which they had to take 1 tablet a day for a month.
424. The mode of treatment gave excellent results in all the cases of
malaria who visited the office. In no case did the 20 grains of quinine daily
fail to check an intermittent. It must be pointed out, however, that the class
of case met with was not of the severe kind so often seen in hospitals. Serious
attacks of malaria immediately endangering the life of the patient form only a
very small proportion of the total cases of malaria, and the problem to be
solved is not so much the treatment of this class of cases as of the mild but
persistent intermittents.
425. In the treatment referred to above no great stress was laid upon
particular dosage, patients being told to take either 2 tablets twice a day or one
tablet four times a day as they felt disposed, the only thing that was impressed
upon them was that they must take the full four tablets daily until the fever
had ceased to return on the expected day.
426. As regards recurrences or relapses it may be pointed out that in no
case did a patient get a relapse while under treatment, but some who neglected
to continue the treatment after the first cessation of fever had relapses after an
interval of from ten days to three weeks. No very young children were
treated, but in the case of several, aged about 10 or 12 years, 15 grains a day
was given in place of 20 grains for the first three or four days, thereafter
10 grains for about a week and then 5 grains daily for a month.
427. A point in connexion with the treatment of malaria which frequently
arouses discussion is the form the remedy should take. It is frequently laid
down that quinine should not be administered in the form of pills or tablets but
in solution or powder ; and experience in regard to many serious hospital cases
leads physicians to insist on a dosage of from 30 to 50 or more grains of quinine
a day. Both these rules are excellent ones for the treatment of serious cases
of malaria, but insistence upon them in the case of the vast majority of mild
intermittents is a mistake, because it nauseates patients needlessly with the taste
of the drug and alarms them by the cinchonism induced.
428. Prom the observations described above it appears reasonable to
assume that for the treatment of mild intermittent malaria, which forms the
majority of the cases of the disease met with in Bombay, 20 grains of quinine
B 136—37