1124 PATHOGENIC PROTOZOA 



4. The proper treatment and cure of all cases will not only 

 prevent relapses and the carrier state (malarial cachexia), but is 

 one of the most important means of exterminating the disease, since 

 every neglected case becomes a focus for new mosquito and in conse- 

 quence new human infections. It is just as important a part of the 

 prevention of the disease as any other single measure, and in general 

 has been given too little consideration. Between 50 and 90 per cent 

 of all malarial attacks are relapses and not new infections, and 

 these cases can be cured and the sick rates be reduced accordingly 

 by giving proper and adequate treatment during the acute attack 

 and during convalescence. This means, in effect, that the education 

 of the physicians and of the community in general must be under- 

 taken by the health authorities. It is not sufficient merely to obtain 

 the support of the physicians in any given locality, for perhaps not 

 more than 25 per cent of all cases of malaria ever consult a physician. 

 Many now buy various advertised remedies most of which are of 

 little value, but so far as they are curative, the good effect is without 

 doubt due to the quinine which they contain. The general public 

 can be influenced to buy and take quinine in adequate doses over a 

 considerable period by the educational division of the Health Depart- 

 ment. Bass in Mississippi has obtained excellent results by using 

 and advocating the use of a standard treatment of ten grains a day, 

 after the acute attack is past, for a period of eight weeks. While 

 this will not cure all cases, it is a great improvement upon the 

 system of treatment commonly used. To provide as far as possible 

 for the continuation of the treatment for the regular period of 

 eight weeks, the standard package sold and recommended by the 

 local health authorities contains enough quinine for the complete 

 treatment, and it is impossible to buy a part of it at the official 

 price. The immediate effect upon the morbidity and mortality rates 

 of adequate treatment of malarial attacks is immediate and very 

 satisfactory. It is not so much a question of educating the public 

 to take medicine for their illness, they already do that in some 

 form or other, as it is to educate them to take quinine in proper 

 doses. The influence upon the amount of malaria in a community 

 of proper treatment of all cases is difficult to estimate, because of 

 the shifting of population in malarious regions, but it promises to 

 diminish the number of carriers and correspondingly the number 

 of foci of infection. 



