80

Report on Kála-ázar.

the malarial organisms before they kill the patient. The only
instance that I know of in which this method of using the
drug has been given any trial in kála-ázar, is by Dr. Dodds
Price, and he did not meet with much success with it;
but when it is mentioned that he only used it in two and a
half-grain doses, it will be evident that there is still scope
for a fuller trial of it in larger doses than this. Unfortunately,
owing partly to my having been on tour nearly the whole
of the cold weather, and to the impossibility I found of getting
early acute cases during this season of the year, when, as has
been before mentioned, fresh cases seldom occur, I have not
been able to test this line of treatment, so can only commend
it for trial as being that which is likely to give the best results.
Either the soluble bi-sulphate of quinine may be used, or
the ordinary drug dissolved in sufficient dilute hydrochloric
acid, and then diluted to a strength of one in four may be
injected into the back or loins.

     (2) When once the fever has been stopped, it must not be
lost sight of that the patient will most likely have had 25 per
cent. or more of his blood destroyed by it, although this may
not appear in the state of his mucous membranes, and can
only be revealed by the hæmoglobinometer. He must then
remain under treatment until this has been repaired, and now
quinine, in small doses to ward off a recurrence of the fever,
combined with arsenic and, if desired, some iron (although
the former is of much greater use in the anæmia due to
malaria than the latter, for reasons which will be pointed out
in the next section), together with some nux vomica and some
bitter tonic to strengthen the heart and digestion (both of which
also will have suffered in the previous fever), will be indicat-
ed, and this tonic should be continued for at least a month
if the fever has been at all severe. By this time the patient
should be quite restored to health; and if he be warned
to come again directly fever recommences, it should be possible
to prevent him from ever reaching that chronic condition
which is so very difficult to rescue him from. If only cases