xiH. b,6 Haughwout: Endemic Malaria 307 



continue to repose faith in active treatment directed against 

 the trophozoites. 



SUMMARY 



1. The recruiting of large bodies of men destined to form 

 •army units, from areas in tropical countries where malaria is 



known to be endemic or epidemic, is certain to bring together 

 many men who, apparently healthy, are yet earners of the 

 malarial parasite and are capable of conveying it to healthy 

 persons. It likewise imposes a heavy responsibility upon the 

 medical staff of any military organization so obtaining its 

 recruits. 



2. These carriers, in the presence of anopheline mosquitoes, 

 are a source of peril to any community that is comparatively 

 free from the malarial fevers. They are likewise a peril in 

 their own garrison, and great care should be exercised in the 

 selection of a site on which to establish a training camp. 



3. Such men, on undergoing the heavy work of military train- 

 ing, with its attendant fatigue and exposure, are extremely 

 likely to develop the disease in its active form with the con- 

 sequence that the effective strength of their unit will be reduced. 



4. At the front, in a foreign country where antimosquito mea- 

 sures may be impracticable and quinine prophylaxis fraught 

 with difficulties, these carriers are a source of peril to all neigh- 

 boring troops, especially as they may be the bearers to the troops 

 of other nations of new and virulent strains of the parasites. 



5. Carriers should be sought out with care. No reliance 

 should be placed on the simple examination of blood films ; some 

 will be detected by this method, but many will escape detection. 

 Use should be made of concentration or cultural methods, supple- 

 mented in the negative cases by provocative methods that will 

 tend to awaken the latent infections and bring the parasites into 

 the peripheral circulation, where they can be destroyed by the 

 usual specific treatment. 



6. In the event of quinine failing to act, investigation should 

 be made to see if the drug is being absorbed and turned into 

 the blood stream in sufficient volume to bring about the des- 

 truction of the organism. If the drug is not being utilized by 

 the patient, either the condition should be corrected by the use 

 of adjuvants or some other form of treatment should be 

 instituted. 



7. If all of these measures fail, the recruit should be honorably 

 discharged from the service. 



