114 REVIEW — TROPICAL MEDICINE, ETC. 



Malaria— read^ at the 1907 meeting of the British Medical Association. Simpson states that, as 



continued regards the flight of Anopholines, a distance of a quarter of a mile is a sufficiently 



protective zone. In Africa, the brothers Sergent-* found that the maximum flight of 



Anopholines is less than a mile. Simpson mentions the use of contour catchwater ditches 



for dealing with low-lying, water-logged land, such as marshes at the foot of hills. 



Ziemann summarises the methods which can be adopted for extirpating the malaria 

 parasites in man as follows : — 



(1) f. By systematic prophylaxis with quinine of those infected with malaria; b. by killing those malaria 

 parasites which invade the human body at the beginning of their development and before a fever attack has 

 set in — that is real quinine prophylaxis — (2) by extirpating those mosquitoes which convey malaria ; (3) by 

 protecting man against the bites of malaria mosquitoes ; (4) by endeavouring to raise the resisting power of 

 malaria-infected people by social prophylaxis — by care for the better feeding, housing, clothing and instruction in 

 the nature of malaria, etc. 



These headings are considered in detail. Here we need only note that "it is obvious 

 that for an effective quinine prophylaxis only serviceable, easily soluble quinine (for 

 example, hydrochloride of quinine) is to be used, and that the intestines absorb the quinine. 

 In this case it is indifferent whether the quinine be taken in wafers, tabloids or gelatin 

 capsules." The Sergents^* point out that the taste of quinine can be entirely masked by 

 suspending it in olive oil. 



As regards the various methods of administration, Ziemann states with reference to 

 them all that an absolute protection against malaria, that is, against the first infection, is 

 not to be effected by quinine alone, i.e. without at the same time, injuring the body. As a 

 result of large experience, he recommends the so-called four-day universal prophylaxis 

 which permits of the necessary quinine individualisation. 



He prescribes : — 



(rt) 1 gramme quinine every four days, best given in the evening before going to bed, with 5 drops of acid 

 hydrochlor. in a glass of water, and on the appearance of ringing in the ears and nervous troubles, with one 

 gramme of potassium bromide ; (i) 1 gramme euchinin every four d.iys, if one gramme quinine cannot be endured; 

 (c) 4 gramme quinine if 1 gramme euchinin cannot bo endured; (d) ^ gramme euchinin if h gramme quinine 

 cannot be endured, Those who cannot endure i gramme euchinin had better not go to the Tropics at all. In order 

 that the quinine days may not be forgotten, he recommends that the drug be taken on the 1st, 4th, 8th, 12th, etc., 

 in short, on all dates divisible by 4 up to the 28th, and then begun .again on the first of the following month. 

 This method is applicable to all countries, whether they be the seat of milder or severe malaria and to aU persons. 



If, despite the quinine, malaria be acquired, he still gives, for three days after the 

 successful recovery from fever, 1 gramme quinine daily, then every second day for the next 

 fourteen days and again every fourth day. 



In cases of unsuppressible vomiting and diarrhoea, he recommends most strongly the 

 intramuscular injection of quinine bi-hydrochloride (1 gramme in sterilised solution in 

 the proportion of 1 to 2 of water) into the glutei. A sure absorption of quinine thereby 

 takes place. Excellent results from these procedures are recorded. 



Rogers believes in a prophylactic dose of from 10 to 15 grains in an adult and at least 

 5 grains in a child over five years of age. It should be given twice a week, either on two 

 successive days, or every third and fourth day alternately, in acid solution, and never in 

 pill form. 



For information regarding the methods of Morgenroth, Celli, Koch and Plehn, the 

 reader is referred to notes in the Medical Annual, 1907, pp. 366-367. 



Ziemann has not seen the smallest permanent success from the application of ointments 

 and oils supposed to prevent mosquitoes from biting. Some help at the most for a few hours. 



In the Sudan I have tried a mixture of citronella oil and alcohol and the preparation 

 known as Anti-kito cream, which contains eucalyptus. Both do some good, but neither can 

 protect for any length of time. One of the latest of these remedies is a composite oil, the 

 use of which is strongly advocated in Ceylon,'' especially for coolies. It consists of 

 citronella, kerosine and cocoanut oils, with a certain proportion of carbolic acid. Vaseline 

 can be substituted for the cocoanut oil. The mixture is a limpid liquid, smelling only of 

 citronella and has a far more lasting effect than either kerosine or cocoanut oil by itself. 

 There is no harmful or unpleasant action on the skin. 



' Simpson, W. J. R. (October 19th, 1907), "Anti-malarial Sanitation." 

 ^ Sergcnts, Ed. and Et. (November, 1905), Compt. Rend, dc la Soc. de Biol. 

 ' Scrgents, Ed. and Et. {loc. cit.) 



* " A Simple Preventative against Malaria." Sept. 15th, 1906. .Imirnnl of Tropical Medicine, p. 283. 



• Article not consulted in the original. 



