장음표시 사용
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CONSIDERATION ORTHE MALARIA REAT MENT 85
and found that the became negative earlier,ith orat administration. The conditions under hich intramusculari injecte quinine illproduce idesprea necrOSiS, Wit iis terribie sequelae and without rapid absorption a distinguished rom hos under hicli the reserveseemingi holds are not determinabiem existinidata Mathieu l922ὶ potnis ut that theSe grave potentialities for harm inherent in intramuscular injectio preclude in lairnes the delegation of these injectionsto subordinates, hile the uncertainties resardins absorption exclude this route here rapid effect is essentiat. There is no eviden e that disinfestation is more readii obtained it intravenous than illi ora quinine, ut here rapi accessis quinine to the blood stream is imperative, as in commor the antecedent hyperparasitism, intra venous medication is ver strongi advocated
to void the fali in blood pressure hic has accompanie Some of his injections. dilutes ten grains os quinine, presumablyhthydrochloride, withiot more than 200 cc. of normal saline, administration occupyins 20 minutes Other meret advocate low injection, hic seem to attain the fame object so lanas dilution in the circulation foes, althoughany leahase beside the vein illae of concentraled solution with iis attendant ris of necrosis. I intravenous injectio canis accomptished with tartar emetic fortata agar by Indian subassistant SurgeonSat the rate of cases a minute McCombie ouno. 92qὶ, a medicat man wit Europea trainins has litti justificatio formis disresard wit quinin in malaria at his teisure, o the fround that itis a skille operation.
6, nother variabie constanti overtooke lies in the species of PHrctSite concerned For quartan malaria quinin has been reported
quarta malariai. 24m. The cases ere e . No evidenc Seem toexis that the minimum therapeuti dos and the disinfestant valuerun parallel As atready notes se Tropicalilaeases Bullatin Vol.
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86 CONSIDERATIO ORTHE MALARIA REATMENT
against the schizonis of P. falciparum than si vivax. Whereas forthe sametocytes the condition is reversed mehiensi irschbaum. to l92 l . have infecte A. maculipennis illi loo containing crescents the dono belns quininized Eviden e then accumulates that no meret biologicalty and symptomaticali but therapeuticatly there
the discovery that in ali likelthood eason affect the therapeuticessicac o quinine. o lac o knowledge of the factor mahiniforready absorptionis quinine rom alimentar canal o muscle, and of fallure to ake into consideratio that the actionis quinine differs in early an late cases in the different stases of development, an in the different species of plasmodium ou knowledse form no scientificbasis for determinin the est line of reaiment illi his valvabledrus, And, indeed, sives no indication a to hether sue specialmodifications of administrations as have been strongi advocated
l. The Standard reaiment of the United States Nationat Malaria Commission speciali advocated by Bass 492li ThirtyGrains 20m in
The common eatur of at these reaiment is the prolongation fili Course Acton and collaborator. 192l have shown that in relapses of henis tertia malaria a sive quinine reaiment thos teStedrange fro 300 tora 980 grains-wil cur a definite percentas of Cases, and iis repetition mill cur the fame percentas of the relapsins,
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CONSIDERATIO ORTHE MALARIA REATMENT 87
8 weekstein taken a the est for cure Rosi l92l potnt out thata simila fractional curative effect folio Meach dose the inule Dose Reduction Rate. No eviden e has been trace in favour of the widely expressed
inferenc that provocatives hicli cause reappearance of plasmodia in the culaneous circulation id in an way the actioni quinine.
Cinchona Athalaicis ther than Ouinine. There is considerable eviden e that the senera disresar o cin-chon aikaloid other than quinin is therapeuticatly unjustifled and economicatly unfortunate MacGilchrist l9l5 bi, workins in Calcutta Dom September to December determinedinest,prisoner the weight
in grammes of the various aikaloid requirexto produce a negative blood examination presumabinima thin film Dosas was a the rate
film hein taken a the time os every dose For quinine, inchonine, quinidine and inchonidine the respective veras figures ere forbenis tertia malaria 4 7. 5 5.5 andri 6 grammes, and for sub-tertian malaria 6 1 5 6 4 85 and grammes. In his series quinine acted most rapidlympo Plasmodium vivax, cinctionidine upons falciparum. It would no necessarii folio that thei capacit for complete dis- infestation Ouid te in the fame order Iudsin by the minimum therapeuti dose se p. 85ὶ the relative curative values for the cin Chona derivatives ere, ithout distinctionis the two parasites firSthydroquinine hydrochloride nexi and of practicali equa value, thesulphates of Cinchonine quinin and quinidine then, in order, opto hin
quinidine Acts more powerfuit oni vivax He put the cure rate of the cinctiona aikaloid fori. Dioax as quinine 20 per cent. , in honine q0 per centi cinctiona febrifus 50 per centi, inchonidine and quin-idine 60 per centi an quinoidine . Moers 19l8 find that in
rabbiis inchonine is absorbe after intramusciar injectio more completet than is quinine and that in an iis se is tesssainful and Cctuse more rapid disappearance of plasmodi than does quinine fini l92li advocates cinctionine. Siluestrii l 923 reporis a se experimentS in hicli inchonine thydrochloride injecte intramuscalarly AVeles loca precipitation andireate viscera accumulationis the drus than dio the correspondin quinin sali, whil in ora administration more of the forme was excrete by the urine than of the lalter. Cordes l92q find cinctionine es satisfactory for subtertian Alctrict
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88 CONSIDERATIO ORTHE MALARIA REATMENT
than quinine. Quinoidine, in opposition to the conclusion of Acton
in the parasite o preventins relapses The contradictor evidence SusseSt that quinoidine varies in composition and that some of the amorphous aikaloid are valvabie, ther morthlesS.It is o no litile economi importance that further investigation, takins cognizance of the fources of error above mentioned should putthe relative value of the cinchon aikaloid on a satisfactor footing. Other lines of trea erit. NeoSalvarsan, o a Domaeins curative in subtertia malaria, hasbeen in a number os cases the cause of death lislitin uina malaria latent and recogniae to late Onienis tertia malaria ita immediate effect in suppressin parasite is senerali marked, et relapse has constanti been reported Mercurnand tartar emetic have falled.
Splenectom does no disin fest ma indee induce immediate and fata relapse Deporce. 9l33. X rays, sed unde certain precise conditions Pala. 923ὶ are stili advocate a curative. The good resulis reporte wit infusion os ilex peduncularis by auohan
In spite of their imperfections perhaps the resultis our ignorance of thei proper se quinine an iis allies remat invaluabie andvnsurpasse in the reaiment of the malarias. REFERENCES.
Trea ent of Benisn Tertian and Malignant Tertiantevers. IndianR Med. Res viii. 750-871. Anderson A. G.). l922 . Malaria in Macedonia. 1915-19l9. Par II. Clinical Observations o the reaimentis Malaria in Macedonia. II. Roy Amy Med.
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CONSIDERATIO ORTHE MALARIA REAT MENT 89
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90 CONSIDERATIO ORTHE MALARIA REAI MENT
Heis T. S.). 1922ὶ Malaria in Macedonia. 915-1919. Pari. IV. Chemicat Investi
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CONSIDERATIO ORTHE MALARIA REAT MENT 1
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92 HE RESISTANCE OF MALARIA TO QUININTHE RESISTANCE OF MALARIA TO QUININ
Editorial of hedourna of the America Medicat Association Chicaso. Ill.
were bein attacked by malaria that quinin would not cure. Prat Johnson and Gilchris Mund that relapses,ere reported in 23 percent of 18 000 soldier in Africa whil quinin Washeins administered: mea reporte in Macedonia that quinin as ineffective in malaria that was complicated by dysentery ilico cin Mesopotamia encount-ered cases that did not improve unde quinin by mouth for te days: Machi Mund quinin ineffective in malaria in orther Persia, and the accumulationis invalid in Salonihi a constanti incre ins . Such contradictio an disappotniment concernins quinin te to an extensive experimenta an clinica inquir into the reaiment of malaria a the Liverpool School of Tropica Medicine, the resulis of hich. nfortunately, id not entiret restore confidence in quinin. Many soldiers were sentiac to Ensland rom Macedonia in 19l8. and Sir Ronata Ros arransed to treat the malaria patienis in special ard a Southampton. In recenti publishe notes Helcher saystha l. 150 patienis ere admitted to these,ard in t etve monthS. and that o landin parasites mere found in the peripheralilood inq87. Although many had documentar evidence of reaiment,ith quini in various hospitals the were placed on lysrain os quinin
hymouth twicem day. There a strici supervision of these patientS, an specia interest in relapses that might occur. In every instance the outine reaiment rescribe a Southampto caused both severandiarasites to diSAppectr. Retcher emphasietes the Southampto experien eis a repor of his observations in the Federate Malay States since the war. The patient Seen there,ere litile more than Sheletons and dysente Masa complication in f per cent. Forty-four dissiculi cases in hich
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THE RESISTANCE OF MALARIA TO QUIN IN 93
been wallo ed the mout was inspected. Notine of these coolies in uala Lumpur falled to improve There was in ne aramali numbero parasites that persisted in the blood in spite os quinin but in everyother case both laver an parasites disappeared Dysenter did notmahe an difference. hen quinin as actuali swallowe andretained malaria in dysenter patients was as easti controiled a inpatienis horai no have dysentery. The conclusion of this studywas the Same as mons soldier in Southampton that the so-calledresistance to quinin vanished hen the quinin was actuali swallo edand retained. The obvious alternative ould Seem to herio reSoriri injections. Intramuscula injections os quinin ere sed extensivel in the cam-pais in Macedonia, and this practice a subjecte to inquiry It was demonstrate experimentali that haleve concentration Orwhateve sat was injected there a necrosis of the musci a thesile of injection. Lars nerves may be involve&with paralysis, and abscesses may form. Si Patrich Manso opposed intramuscula injections unies made for good reasons Sir Ronata Ros has repeatedlyexpresse his opposition in ordinar cases It i no generali recogniete that intramuscula injections o quinin alwayS BUS necroSiS,
O that quinin is absorbe more quickl by mouth Helcher in uala Lumpur injecte lyurain of the dihydrochlorid in diminim os saltsolutio into each buttock of twenty-two patients. The hortes time in hic quini appeare in the urine of an patient a twentyminutes, and the Verage time a SiXt minutes. The Same amount of the fame sat was sive by mouth to a simila froumos patienis, and the hortes time in hic quini appeare in the urine of any patient a les than fifteen minutes and the averas time thirty-one
There is a profound falluntlood pressure when quinin is introducedintravenously, hicli seriousi affect the respirator center Helcher has seen ne death and one casei serious ilines due to sepsis aster intrRVenous quinin injections. In a clinica investigationi recta injections he conclude that quinin is to irritatin tot administered
In generat Helcher repor is a plea for the restorationis fati inquinin in malaria, and forciis orat administration Hesdoes not say that an absolute resistance to quinin is impossibie but in a wide experience
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9 MALARIA REATMENT BY QUIN INE INIECTIONSON THE REATMEN O MALARIA BYINTRAVENOUS INIECTIONS OF QUIN INE
Assistant in the Medicat Universit Clini in Rostov-on-Don Russia
Trita riter o the strensi of the good resulis obtained by Dr.Dobrotin illi intravenous quinin injections against malaria, himself applied his reaiment in such manne that controi aspossibi forine ea after the reniment.we realed 22 patient receivin 1703 injections:
Aster microscopica determinatio of the diagnosis o the irst day usuali 6 .c. Da lyra solutionis bihydrochloridem quinine, asinjecte into a vein. A da later accordin to the strensili of thereaction, Mi lyc. . . and o the third da lyto 2 c. . even lyc.c. In ne particular case 10 .c. of a 20 solution was injected once. In tertian malaria the injections were maderi to 5 days in succesSion. Asaelapses occurred speedily the first series of injections was followed by a secon series of tori injections Sometimes a wee late theremere ne or Wo rectiment consistin in quinine οὐ days per os . Fili cases thus realedictve: