Mabch 16, 1906.] 



SCIENCE. 



413 



tongue, odor, etc., but none are at all 

 reliable. 



Treatment.— In the alkaloids of Peruvian 

 bark we have the specific quinine given in 

 the form of the bisulphate or ehlorid. The 

 older form (sulphate) does not seem to 

 kill so effectually or quickly this form of 

 malarial parasite, because, for some reason, 

 it is not absorbed; if so it may not have 

 sufficient solubility to affect the parasite. 

 I have been in consultation with physicians, 

 and they have said that this disease can not 

 be malarial, as I have given large doses of 

 quinine, and the patient did not improve. 

 They were giving the sulphate in capsules, 

 and the patient did not absorb it. I give 

 the bisulphate of quinine in capsules, and 

 perforate each capsule at each end just 

 before administering it. If you perforate 

 the capsule some time before administer- 

 ing, the quinine sifts out and the patient 

 gets the bitter taste. If the stomach is so 

 irritable that the quinine is rejected, then 

 give, per rectum or hypodermically, either 

 the bisulphate or the ehlorid dissolved 

 in sterilized water. Fifteen or twenty 

 grains daily are usually sufficient, except 

 in malarial coma when I give more. I 

 gave as much as one hundred and twenty 

 grains of- the sulphate by rectum, some 

 years ago, when I did not know of the 

 utility of the bisulphate. When giving the 

 hypodermics insert the needle deep into the 

 thigh or arm, and abscesses are not so liable 

 to occur. Fifteen to twenty grains in 

 twenty-four hours is effectual, continued 

 until you can medicate by mouth. I 

 usually give in the ordinary cases a simple 

 purge, such as calomel and soda followed 

 by a saline purge, or simply a seidlitz 

 powder, citrate of magnesia, in fact any 

 purge is efficient. Then push the quinine 

 in doses of fifteen or twenty grains daily 

 until the fever is gone. The patient must 

 be kept in bed and under the influence of 

 an antiperiodic for at least twenty-eight 



days, or the multiple of seven, as there are 

 usually four generations of parasites to get 

 rid of. The diet should be liquid during 

 the febrile stage (soups, milk and broths) ; 

 solids should be given gradually ; plenty of 

 water such as vichy and other alkaline 

 drinks are desirable. Mortality of this 

 fever is practically nothing, if properly 

 treated and cared for. If not, then you 

 have a most fearful condition of affairs, 

 and you can imagine yellow fever or most 

 anything else. What means should be in- 

 stituted by communities to prevent this 

 disease from spreading? Our esteemed 

 friend and collaborator. Dr. J. H. White, 

 makes the assertion that yellow fever can 

 not be introduced into a community except 

 by a sick person. It is the same with this 

 fever. The mosquito in both instances 

 must be infected from a person infected; 

 otherwise, its sting is simply painful for 

 a few minutes and conveys no disease. Con- 

 sequently quarantine against freight is use- 

 less and harmful to all concerned. It is 

 the sick person we must look out for; the 

 infected person. 



Sanitary measures necessary to prevent 

 the spread of this disease are the same as 

 those for yellow fever. Screen the patient, 

 destroy all mosquitoes and their breeding 

 places; have no mosquitoes and we will 

 have no malaria or yellow fever in our 

 midst. When making extensive improve- 

 ments either in a city or country, 'observe 

 this well, as it is very important from a 

 sanitary standpoint. In these improve- 

 ments the previously existing drainage 

 natural in the country, artificial in cities, is 

 usually interfered with and stagnant water 

 accumulates and mosquitoes breed. There- 

 fore, see that no still or stagnant water 

 exists. The greatest friend we have is the 

 little minnow, the top minnow or Gamhusia 

 ajfinis. This little creature abounds in 

 nearly all southern states, and is one of the 

 greatest enemies to the mosquito, so cherish 



