MALARIA AND THE PROGRESS OF MEDICINE. 241 



first paroxysm and in the subsequent intervals, and to continue its 

 use as a precaution against the recurrence of the fever. Little re- 

 mained to be added to these practical indications ; they were empiri- 

 cal, indeed and they are empirical still. The profession is not even 

 sure whether quinine acts by breaking the recurrent habit of ague (as 

 an anti-periodic), or otherwise. There are also the most conflicting 

 statements as to whether the taking of quinine will ward off the at- 

 tack of ague in passing through a malarious locality ; there are a good 

 many reasons for believing that quinine has no preventive or anticipa- 

 tory action against the first onset of a remittent or intermittent fever, 

 but the professional advice will probably be that quinine taken as a 

 preventive can at least do no harm. 



But it is when we leave the sphere of empirical experience, and 

 enter the physiological and pathological workshops of the profession, 

 that we realize most acutely how great is the disproportion, in this 

 matter of malaria, between the opportunities of medicine and its 

 achievements. Take, for example, the following sufficiently eclectic 

 statement on the physiological actions of quinine : 



Quinia, CaoH^NaOa, one of the alkaloids of cinchona, in small doses ac- 

 celerates the heart's action in the warm-blooded animal ; in moderate doses it 

 slows it ; and in large doses it may arrest it, and cause convulsions and death. 

 Eesearch shows that its action is essentially upon the central nervous system. 

 It destroys all microscopic animal organisms, apparently killing vibrios, bacteria, 

 and amoebee ; but it seems to be without action on humble organisms belonging 

 to the vegetable kingdom. It arrests the movements of all kinds of protoplasm, 

 including those of the colorless corpuscles of the blood. It arrests fermentive 

 processes which depend on the presence of animal or vegetable organisms, but 

 it does not interfere with the action of digestive fluids. (Quain's " Dictionary 

 of Medicine," p. 35.) 



There is here something far everybody ; and, if we now go to the 

 pathological workshop, we shall discover the beautiful adaptation of 

 these varied actions of quinine to the various opinions that are enter- 

 tained of the malarious fevers over which the drug has so powerful an 

 influence. Is malarial fever a fermentive process, depending on the 

 presence of animal or vegetable organisms ? then quinine arrests such 

 processes. Is malarial fever caused by a profound disturbance of the 

 nervous mechanism which regulates the animal heat ? then the action 

 of quinine is " essentially upon the central nervous system." Nothing 

 could be more accommodating, and nothing more unsatisfactory. 



The theoretical notions about malaria form an instructive page of 

 medical history. Until about 1823 it was always thought to be as- 

 sociated with marshes and swamps, but in that year Dr. William 

 Fergusson brought to England numerous proofs that it occurred 

 abundantly in elevated and rocky regions. Such evidences have gone 

 on accumulating, and it is now well known that malaria has no neces- 

 sary connection with the marsh. But the profession is still profoundly 



VOL. XXIV. \\ 



