xiii, b, 6 Haughwout: Endemic Malaria 305 



was no fever over a period of several months. All of these 17 

 cases had been unsuccessfully treated with quinine and salvarsan. 



Just a word in conclusion regarding quinine and the question 

 of quinine-fast parasites. The facts regarding arsenic-fast try- 

 panosomes are fairly familiar, but there is much doubt as to 

 whether or not strains of quinine-fast Plasmodia develop follow- 

 ing the prolonged use of quinine. 



James (15) in 1913 stated his belief that the malarial parasite 

 develops some resistance to quinine, and since then several other 

 workers have expressed the same belief. 



Teichmann(30) has made an interesting series of clinical and 

 experimental studies on quinine habituation and the apparent 

 quinine-fastness of Plasmodium. Working in a German mil- 

 itary hospital in Turkey, he noted the apparent failure of quinine 

 as a prophylactic for malaria in certain cases of both benign 

 and subtertian fever. He found that patients who had not taken 

 quinine previously responded readily to the regular treatment. 

 On the other hand in those who had taken quinine regularly 

 the parasites appeared as soon as the quinine was withdrawn 

 or even persisted during its administration. He has reviewed 

 the usual explanations for this condition, but notes that many 

 patients were suffering from dysentery and enteritis, so that 

 the quinine was incompletely absorbed. He ascribes much of 

 the trouble to quinine habituation of the body leading to a 

 reduction in, or even disappearance of, the specific action of the 

 drug, and he gives some interesting experimental data in con- 

 nection with that contention. 



He concludes that a certain concentration of quinine in the 

 blood is necessary before the drug will exert its specific action. 

 In quinine habitues smaller and smaller quantities of quinine 

 are there ; the quinine-fastness of the parasites is therefore only 

 apparent. The Plasmodia are still sensitive to it, but the qui- 

 nine is not present in sufficient amount to kill them. He there- 

 fore gives the quinine intermittently. Teichmann states that 

 he is not opposed to the employment of quinine as a prophy- 

 lactic ; he urges its systematic but careful use. If malaria does 

 develop in spite of the prophylaxis, he advises treatment by the 

 administration of quinine in intermittent and rising doses. 



On the other hand, Giemsa and Halberkam,(ll) reviewing the 

 work along this line, state that they have not been able to 

 confirm the contention of Teichmann, and also that of Neu- 

 schlosz, that elimination of the drug is different in those accus- 

 tomed to quinine than in those who have not been used to 

 taking it. 



