Tropical Diseases due to Microscopic Organisms. 215 



however, that, firstly, in pernicious cases a high mortality may be 

 present notwithstanding an energetic treatment ; secondly, in a 

 large number of cases, even of the usual benign type, the cure 

 which is brought about by an appropriate treatment is merely 

 clinical — that is, the patient feels well and shows no signs of the 

 malady, but a complete sterilization is not obtained. The affection 

 remains dormant for months and years, and any cause lowering the 

 resisting power of the individual, such as a chill or a traumatism, 

 may cause the acute symptoms to reappear, and I have known the 

 disease to recur in patients in England ten and fifteen years after 

 leaving the Tropics. 



I have mentioned traumatism. An operation — for instance, the 

 simplest surgical act, even a tooth extraction — may re-awaken a 

 very old dormant malarial infection ; the patient shortly after has 

 a rigor, the temperature rapidly rises to lOi" or 105° F., very severe 

 vomiting sets in — symptoms which may cause a very great deal of 

 anxiety to the surgeon, wlio, naturally, may be very far from think- 

 ing of malaria. 



And now a word on the treatment. It seems to me that every 

 person proceeding to a malarious zone should know something about 

 how to deal with acute malarial cases when medical help is not at 

 hand : and this is often the case in many tropical districts. On the 

 treatment of malaria one could speak for hours, but it may be 

 condensed into one word, and that word is — quinine. 



Every tropical practitioner is, of course, familiar with the 

 colonial patient who will earnestly assure him that quinine not 

 only does not cure malaria, but is the true cause of it. Notwith- 

 standing this " dictum," however, quinine is the only drug that 

 cures the disease, only it must be given — and taken — in large doses. 

 I have said " taken " purposely : the patient must be convinced 

 that it is not sufficient to look at the bottle— one must drink the 

 bitter dose. 



In malarious countries quinine may be given in 10-gr. doses 

 three or four times daily to adults, without any danger. It should 

 be given by the mouth in ordinary cases ; by intramuscular injec- 

 tion in severe cases ; intravenously in the pernicious forms. The 

 injections should, of course, be given only by a doctor. 



There are two methods of prophylaxis — the one based on anti- 

 mosquito measures ; the other based on the preventive administra- 

 tion of quinine. There has been a great deal of discussion as to 

 \vhich is best ; in my opinion both measures should always be 

 employed together. If we have several weapons with which to 

 fight an enemy, it seems to me good policy to use all of them 

 instead of one only. As regards anti-mosquito measures, the 

 destruction of all larvte by oiling every pool and pond near the 

 military camps, hospitals, etc., is by far the most useful ; mechani- 

 cal protection by means of mosquito-nets and masks shoidd also 



