164 MALARIA 



the stomach. Many a patient has died from malaria with 

 enough quinine in his stomach to have saved his life had it been 

 properly given. In such cases injections into the muscles, or 

 stUl better, directly into the veins, is necessary. In malignant 

 malaria quinine does not reach the parasites plugged in the 

 capillaries and therefore can destroy them only as they sporulate 

 and get back into the circulation. Since the parasites of this 

 type often sporulate at irregular intervals a constant supply of 

 quinine at a killing concentration must be kept in the blood. 

 However, overdosing with quinine is not an uncommon fault 

 with physicians. Quinine poisoning in some respects resembles 

 malarial symptoms and the physician, thinking the latter are 

 not abating, gives still more quinine until the patient succumbs 

 to it. Not a few malarial deaths are really due to excessive 

 quinine. Malarial specialists, such as Professor Bass of New 

 Orleans, say that it is never necessary to give more than ten or 

 possibly fifteen grains of quinine at a time, if given as the case 

 requires it. Twenty grains of quinine sulphate a day taken by 

 mouth in several doses for a period of two weeks is said by Bass to 

 disinfect anyone. Quinine must be avoided during or immedi- 

 ately following an attack of blackwater fever, since the symptoms 

 of this malady are intensified by its use. 



In case of severe malarial cachexia, the only safe course is for 

 the patient to leave the malaria-infected country in which he 

 has been living, and stay away for an_ extended period of time. 

 He should take regularly small doses of quinine to kill any lurk- 

 ing parasites which may remain in his body, and do everything 

 possible to build up his general health and to regain his lost 

 vitality. 



Prevention. — The prevention of malaria is a problem that 

 should be solved not by individuals but by civic effort. Ross 

 says: " It (malaria) is essentially a political disease — one which 

 affects the welfare of whole countries; and the prevention of it 

 should therefore be an important branch of public administration. 

 For the state as for the individual health is the first postulate' 

 of prosperity. And prosperity should be the first object of 

 scientific government." 



Since the malarial parasites have two hosts, man and mosquito, 

 the possibility of exterminating them in either host presents itself. 

 Stephensport, in New Guinea, was practically cleared of malaria 



