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MALARIA TREATMENT BY QUININE INIECTIONS 105 PRELIMINAR OBSERVATION ON HE REATMENTO L3H CASES OF MALARIA BY THE INTRAVENOUS INIECTIONS OF QUININE
KHARTOUM is siluated jus nori of the 15th parallel os latitude
As a result during the autumni 1922 a severe epidemicis malaria occurred affectin ali classes of the population. Additiona factors hic helpe in the ovibrea were: a The increased rati a communication it theriouthern Prou inceS, resultins in an increas of malaria carriers in hartoum. b. The presence of a Britis Battalion recently arrived from India. many of whom had previousi suffered rom malaria. c. The presence of a cro os millet jus ouiside the precincts of the own whichired mosquitoec Anopheles p. costalis o ins to the heau rainfall, and rom hic a large number of the civit populationbecam infected. The cases reate represente soldier of the Egyptian Arm ad mitte to the hartoum Militar Hospitat. The folio in table hows the tota number of admissionS: -
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l06 MALARIA REATMENT BY QUIN INE INIECTIONS
Monti, Ausust September October November December Totais Totat admission
Tota admissionSos cases hic contracte malaria in hartoum
Tota admissionsos cases hic contracte malaria out of Khartoum
19 361117 83 The type of malaris. The l. 23 cases of malaria ho contracted the diseas in hartoum inere divide into the folio in types:
The admission for primarycases an relapses by monti, were: Monti Primam cases
The large percentas os relapses is put down to the insuffciencyonaster-treaiment. aliis illae discusse later.
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MALARIA REATMENT BY QUIN INE INIECTIONS 107
The relapse cases ere diagnosed by blood film examination buti cases here this a negative by the periodicit of the laver. spleni enlarsemen and the interva Since the revious attach. c. It was noted that the percentas os relapses amonsst the subtertiancases,as almos as histi a thos Amonus the benis tertia cases. This is of course an unusual feature There ere ut e cases of concomitant disease in ne case ith flve relapses the patientiadjus suffere previousi hom amoebic dysentery and one it three relapse had active bilitaretia. The spleen incidence was a follo S: -
The averas number of days in hospital for reaiment was 6.ydays. The veras number of intravenous injections sive Vbebore me temperature ' droppeda normat was 2.5, and theaverase totalamounto quinin administere to ac case intravenousi and by mouthdurin the sta in hospital was l879 gr.
saline aperient datly. The outine adopted in the treaimentis ali cases,as by the intra- venous injectionis quinine. l . . or 2 c. . Syringe was used Thesbihydrochloride os quinine in ealed ampoules of l .c. containins 9 gr. ori gr. o a fres steriliete solutio of the bihydrochloride was employed. Technique. The arm a prepare in the sua way, and the seper arm com pressedi a plece of rubber tubins. The contents of the L .c. ampoulewas Sucked umin the syringe and an injectio made into the median basili or eighbo in vein The quinin was injecte flowl and steadily the tota time of the injection aryinifrom 304,45 seconds.
The norma routine adopte was a follows Eac patient assiVen ne intravenous injectio of 9 gr. o quinine bihydrochloride datly unti the temperature felicio normal. Durins his time he also received 20 gr. quinine bisulphate solutio by the mouth, in t odoses of lysr ench.
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108 MALARIA TREATMENT BY QUIN INE INIECTIONS
Aster the temperature felicio norma the intravenous injections were topped, and 30 gr. of quinine bisulphate solution in three doses of l0 gr. each were sive by the mouth untii the patient was discharsed. Aiter discharse the patient attended the hospital daily, and received 104r quinine bisulphate solution by the mout for ne month. This outine was a times varied accordinaeto circumstances. If the temperature rematne hish, ct econ intravenous injectio of 9 gr. wouldae sive aster an intervat of Sichours in Such cases ninone dos o quinin was sive by the mouth. At times, is the temperature was ver his and the patient eVeret ill two ampoules o 18 gr. ouldhe siven intravenoustratince, follo ed by one dos of quinine by the mouili later in the aY.we have no sive more than 8 gr. of the bihydrochloride by the intravenous rout withi a periodi 2 hours although at timesa mentioned above this amount might be sive atine time.
totali 2.58 injections ere GiVen. The injection a followe almost at nee by an accelerationis the pulse rate. hic varie lao 5 tora beat a minute within aperiod of three minutes the acceleration had passed offPatient complainedis a tinstins sensation especialty in the mouth, rinsin in the ears, and a times a Delingi constrictio in the chest accompanted by one or two coughs. aliis rapidi passed off
it vomiting. weatins rapi respiration and pulse, an dizetineSS. These symptom passed οὐ ithi a se minutes. No cases of haemoslobinuria occurred. At relapse cases eretrealed by further intravenous injections o quinine. The record of three relapse cases are sive below:1. Case A. Subtertian. ad Six admission durins a perio ofthree an a half months. Temperatures on admission ere 104.8'.
intravenous injections and inalty one injectioni 606. Tota periodin hospital fifty-t o dayS. 2. Case B. Benis tertian. ad si admission durins a periodos three monilis, illi te intravenous injections Tota perio inhospital, hirty-Si d S. 3. Case C. Benis tertian Had three admissions. Fiseeen dayspreviousty ad amoebic dysentery Tota os fleen intravenous
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MALARIA TREATMENT BY QUIN INE INIECTIONS 109
Those,ith two admission an Verage Pq. injections. Clinica observationS. The uenera type of laver throushout the ovibrea was Severe,
and the majorit os cases haesio be conveyed to hospitalis stretcher cases There ere 7 cases admitte&with a temperaturei 105 F. and 2 cases,ith a temperature between 105 and 106 F. inclusive. These cases of his laver ere equali divide belween thei T.
The relapses totalled 367 or 2.5 per cent. As state previouSty, this large percentage a due chiefly Pthink, to insuffcienc of theaster-treaiment. Each case was ordere to receive lysr o quinine bisulphate dati forine month, but in many instances the orde Wasno emcienti carried ut The patient came rom many cattereduniis in hartoum and for different reasons great dissiculty was experience in Gettin prope attendances. The me themselves ha an aversion to takins quinine and would set out of it,heneve possibie. Neither ould ne expect that 10 gr. for ne mont would esumcient to prevent relapses in ali cases, ut the costi quinin inlars ovibrealis of this hind has tot considered. Prophylacti quinine as administere to ali troops in hartoum Dom themiddie of September onwards in doses of l0 gr. weekly ont o successive days. The emcac of this reaiment in reducin thecases of malaria was dissiculi to judse, and beyondinavinina favourable impression of this method o prophylaxis e re not prepare tomahe an definite Statement. It was of course instrumenta in makin the microscopic diasnosis dissiculi in many instances and the 5 undiasnose cases ere due
The adventage of intravenous injection. a. The technique is simple, an ca be effectivel carried ut in an hospitat. b. I is rapid. and ne medicat ossice single-hande canoreat a
c. The powerfui effect of the drus is applied in a minimum os time
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ll MALARIA TREATMENT BY QUIN INE INIECTIONS
d It is es barbarous than intramusculct injection, there is a greater rapidit os effect the absence fiat an an after-effect such as abscessi sioushing. The patient on diScharse remo incapacitated by the resulis follo in on severat injections into the buttocks. e. y this method, claim that the period in hospital f shortened the averas sta was 6.ydaysi, alWcty ct consideratio Domin Armypoint of vie . and in an epidemi When there is likelylohe overcrowd- in o cases accommodationes more rapidi Set free, and the patientsare fit for dut in a horte time, hereb increasing the essiciency of
we have to than Li.-Col. B. Biustar, P.M. O. Egyptian ArmY, for permission to publis these notes and Major Archibata Director.wellcome Research Tropica Laboratories, hartoum for much
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sRADIOACTIVIDA DE LA QUININA SU MECANISMO ANTIPALUDICO
In fuit empyriciam. THE mysterious eners whic quinine diffuse in the organism
It manalmosti faid that ali that is known was atready known to the India Redskins, amely that the sat drus cures malaria. urea dea os time has passe howeve since a nobi Spanishlad madeanown in Europe the curative actio of the pulverised bar of this tree of the familY of the rubiaceae, hic Linnaeus himself studied and dedicate to the Spanis lady creatins in her honour the genus inchona 1632-39ὶ.To-da it is sal that quinin is a protoplasmi polson and withthis, apparenti true, amrmation the troublesome question is considere tot setiled. There are howeve many protoplasmi solsons whic mill not cure
Protoplasmi polsons are the aromatic acids and many of their derivatives Marsoro: tannin is a localine and also the salicylic acid about
The mos important properi os salicyli scisis iis actioni the protoplasms in extremel dilute solutionis 1:q.000 it prevenis diapedesis in the mesenter of the fros an in i per cent i discolour the re bloo corpuscies Binet). Salicylateis sodalike is possesses, though in aciesse defree, the fame action: thus 1 per cent. Solutions enisebi the activit of the protoplasm of the lymphoid celis and the paramecia: Meselabi protoplasm illes sensitive unde the influence of odium salicylate in respecto the active oxysen resin os suaYBcum .
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etoe in i l. 500 it prevenis the development of the baccilli os carbuncte. in per .000 it revenis the putrefactionis urine B Cello. Sali late of soda in terra 000 stops the development of bacteria in
culture liquids. On the enzymes likewise. sali lic aciditio fritSelf,owerfultractive. ascit prevenis the actionis the emulsine n amygdaline, o sucronineo Sinigrine, and of pepsin o the albuminoici. Finalty salicylic acid is endo e wit energeti loca actions Inconcentraled solutions it coagulate albumen and acts o the tissuesas an irritant an cauStic.
Accordin to Manquat, Ouchet ouilines the senerat actionis sali lic acidama happy way wheni say that this substanc reduces
bein a good disinfectant. Ouinin is a baci disinfectant. Quintne hemit acis direct is a ba disinfectant in vitro it has an actionis litile ners o bacteria There are required accordin to Bin l867ὶ concentrations of 2 per l,000 to prevent putrefaction. On ferment ita action is simila to that whichat developsin bacteria. O the ther hand it is more energetic against the lower animais.
Experiment of Rosin. Rosin cited by Professor Hernando of adrid. Mund that plasmodium an live en hour in a solutionis quinine of l: 5.000 whil a solution os methylene lue paralyses them atra l0.30, toppingalmost instantaneousty the ameboid movements of the parasites. Moeriheless, quinin is much more effective than methylene luein the treaiment of malaris. Therefore against the hematoeto os malaria quinine apparently has a much more energeti actio in Dio than in vitro. I say apparent*,aecause experiment carriefout subsequently by me prove that
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quinin in ostro, place unde certain conditions hicli Pshali explain
To hat then is his apparent difference due what ne factor intervenes in the organism to increas so considerabi the lethai properties hic quinine develops against the hematoetoaywh does his protoplasin polaon increas it Selectivit Asainst the plasmodium in the mysterious laboratories here live matterappear to orde rather than to obeYΤwithout an doubi the factor hic intervenes the force hichdestroy the parasites in the blood, is no a chemica factor it is notin direct contact, hecause methylene lue is seen to ac directi in vitro mitti more efficac than quinine, et in the livin organism quite the contrarwhBPPenS. This is the more strikins he we observe that quinin circulates through the organism,ithout undersoin an chans incit characteristic hemica composition is eliminate throush almost ali thesland and principali throus the kidney, and is found unaltere in
large quantities in the urine. Consequently it is permissibi to belleve thalin the absorptionis quinine and iis circulatio thro h the organism the molecula struct ure of the aid substanc undersoes strons vibrations the hydrations and ehydrations polymerietations et . ali the numerou and various pomers of the organism ould intervene forcibly, causing the atoms
Experiment of Gustave Leton. The experiments hicli I shali cite helow were carriefout in ordert enforce a theor of scientific philosoplinas to the constitutionis matte and thei author sive them no application in the medicat held. The eminent renc scientist Gustave L Bon, in his fine orkentilled Levolation de a mallere p. 385 etc. says a follo S:
V Among the various reactions hic I have indicate on other occasion HS Rccompanie by radio-activit os matter, there is the hydration and dehydrationis sulphateo quinine This Substance, as aiknown ome time aso. comes phosphoreScent by
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the actio of heat but what was entiret unknown is that he it has tost iis hosphorescen e after havin been sussicienti heated itiecomes brishil luminous owinsto coolins, and at the Same time radio-active Aster havin sought for the cause of thelast two phenomena I found that the were due to a very Slight hydration. The radio- activit is ni manifested at the besinnius of hydration nn lastainina se minutes. The phosphores ence, o the contrary persista for a quarteris an hour. The propers of sulphate os quinine of be min9 Phosphores ne hy molirimis Completela contram to has is observeci in the various hosphorescent substances, hich
In orde to carr out the experiments of PhoSphorescencei coolin and of radio- activit wit sulphat os quinine it is heated to 125 C. on a metalitate untii the complete disappearance of Allihosphorescence Onieins removed homuli platein whichit has been eated the sulphat o quinine onoe more hecomes hosphorescent ori molinse, an hein afferinarcis place o fh dish of the electros perit sive off forthree o Mur minutes an abundant discliars of essiuvia, hic causes the leaves of the instrument to approachiach other 12 durius the firs minute andri 'durins thesecondi. The dose sed in ou experiments was bout 2 gram os sulphate os quinine. The dis-charpe stops Ionibefore the insappectrance of the phosphoresceri . The fio phenomena re Consequently in pendent. Accordin to the mensurementa hich M. Du-hoire, professor of hemistr of the Facuit of Science of Grenoble carrie out very carefulty the absorptioni les than i millifram os ater vapou is sufficient to alie fram os dried sulphat os quinine phosphorescent an radio-active. The foresolns operation cani repeate indefinitely when the sulphate os quinineis hydrale it is ni necessar to hea it anew. It hecomes hosphorescent by the heat foes ut the lis his p alaesti by coolin wit hydration and becomes radio- active. A the hydratio an dehydration are the cause of the phosphorescen eis sulphate os quintae this phosphorescence cani obtaine o hydratins and dehydratius by an means differing rom eat Letos inseri sulphate os quinin in a idenecked botile it a litile phosphori acies hydride, and clos the botile. The phosphori acid mill Atinc possessestself of the water of the sulphate os quinine. It illthen e sufficient to ope the botile an blow into it to se the sulphate os quininebecome brighil phosphorescent. Is the botile is then losed the quinin salici oncemore dehydrate and the fame operations canis repeated a freat number of times: sulphate os cinchonine sive the fame resulis a sulphate os quinine, but the are tess
These ver interestins experiments were confirmed by M. Duboireandi M. Manc. and were finali repeate an confirme by me. Nevertheles I have o been able to findisnythin in realises ontherapeutic resardininthis curious properinos quinin os siving orthlisti and becomin radio-active in consequence of a stistit hydration. and I know of no author,ho ventures to sive a Serious Xplanationo the mode os operatio of the Sald drus. Letis see whether bearin in min this most important propertyos quinine of hecomin radio-active by reasonis stight hydration itis possibi to explain the mode of iis actio in the organism an to disclose halcis the weapo whicli destroy the producin agent of