TREATMENT 163 



the other hand, the average tolerance of the community to the 

 disease suffers an annual relapse, and may constantly decrease 

 for a number of years. When the immunity of the community 

 as a whole becomes quite low, and there is a sudden increase in 

 the probability of infection by a great increase in number of 

 mosquitoes, accompanied possibly by an influx of infected people, 

 an epidemic of the disease may occur of such extraordinary se- 

 verity as to involve almost the entire population, and to cause a 

 mortality of several hundreds per thousand. Such devastating 

 epidemics, probably of the subtertian type of malaria, have been 

 termed " fulminant malaria" and are believed to occur quite 

 extensively in malarial countries lying just outside the region of 

 " tropical " malaria. Fulminant malaria in especially severe 

 form occurs periodically in parts of India and in Italy. 



It was formerly thought that considerable racial immunity 

 protected the negro races, but it has been shown that in many 

 cases, at least, the immunity has been acquired by constant 

 exposure to the disease, and that it disappears upon removal from 

 infected regions. The whites in southern United States are said 

 to suffer markedly more from malaria than do the negroes though 

 the latter are more frequently parasitized, but this may be due, 

 in part at least, to the more permanent residence of the latter 

 in the malarial districts. As said before, individual resistance 

 to the effects of the disease is variable. Occasionally there is 

 found a fortunate individual who is naturally absolutely immune, 

 but this is a very rare occurrence. 



Treatment. It is one of the greatest blessings in the world 

 that we have for malaria a definite and specific cure as near to 

 being a " sure cure " as has been discovered for any disease. 

 Quinine has been found absolutely destructive to malarial para- 

 sites. While a dose of quinine given during a fever attack will 

 not act quickly enought to cut it short, it will, if given immediately 

 after an attack, prevent the next one, or at least alleviate it. 

 Meanwhile the organisms disappear from the circulation. It is 

 usually supposed that they are directly killed by the quinine, 

 which acts as a virulent poison for them, though this is doubted 

 by some workers. The methods of administering quinine must, 

 of course, vary with the age and condition of the patient, and the 

 state of the disease. Sometimes very speedy action is needed, 

 and it is not safe to wait for quinine to be slowly absorbed from 



