The infant mortality rate per 1,000 births for all Ceylon was 158, with the following highest rates per 1,000 births in the following nine districts : Vavonij'a, 386 ; Mannar, 313 ; Pnttalam, 305 ;

Anuradhapura, 243; Ratnapura, 215; Mullaitivoe, 213; Trincomalie, 211; Matale, 205; and

Kurunegalle, 190. These abnormally high

are

thus

prevalence

infant

mortality

rates

to be coincident with the

greatest of malaria, and thus strongly support

seen

the view that malaria is the chief cause of infantile convulsions in tropical malarial countries, and indicate that treatment by hypodermic injections of quinine should be resorted to largely and promptly. Unfortunately, the preparations of quinine,vis., the bi-hydrochlorate or the hydrobromate, most suitable for hypodermic use are not usually available, but where they are not the sulphate should be used. The adult maximum l^podermic dose of the sulphate would be about half the internal dose; the maximum hypodermic dose of the Bi-hydrochlorate is grs. 3 ; and of the hydrobromate grs. 2, and the hypodermic doses of these for infants and children would be found by the rule given at page 136 of Burrough's and Wellcome's most welcome 1898 diary, vis., divide the age by the age increased by 12; thus for a child 2 3'ears old 2+To~t> j thus the dose would be i. The following is from page 469 of Laveran's article on "Malarial Fever" in Wilson's "Applied

Therapeutics" (American)

:?

Finally, one can employ, for hypodermic injection, quinine sulphate which has been rendered soluble by the addition of tartaric acid. Vinson gives the following useful formula :? "

MALARIA,

TILE CONVULSIONS IN THE TROPICS. Br Hayman Thornhill, m.b., Senior Medical

Officer, Ceylon. The

Quinine Sulph

THE CHIEF CAUSE OF INFAN-

Ceylon Registrar-General gives

the fol-

lowing statistics for 1896

Tartaric Acid Distilled water

Estimated

Population.

3,292,367

Total Deaths.

81.898

16,374

6,635

Kate per

1,000=24*7

Thus of the total mortality 8'10 per cent, and of the total infant mortality 4052 per cent, may roughly be attributed to infantile convulsions, though, no doubt, many of the deaths from infantile convulsions occurred in children more than 1 year old.

...

..*

grs. xv. grs. viii. Siiss.

"Great care should be taken to plunge the point of the needle well into the subcutaneous tissue. "The solution of quinine employed should be clear and should contain neither crystals nor

spores." Deaths of children Deaths from Inunder 1 year (infantile Confant mortality). vulsions.

...

Malaria the Chief Cause of Infantile Convulsions in the Tropics.

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