I204 



THE MALARIAL FEVERS 



In such instruction no pamphlet or book'^should be used, other- 

 wise there is a danger of the knowledge being acquired by rote. 

 The only way, however, to bring about any result by this method 

 is to award a special grant to the school, based upon the knowledge 

 of the scholars. 



All these methods have actually been and are being carried out, 

 but in any case they are only preliminaries, and any good which 

 may result therefrom will not be immediate. 



Another preliminary matter is to use the knowledge acquired 

 concerning the life-history of the anophelines, and not to build 

 houses, coolie-lines, etc., in ravines and valleys, or on the margin 

 of water likely to be a breeding-ground for these insects. Place the 

 buildings on high ground, and, bearing in mind the fact that native 

 children harbour gametocytes, build the houses for Europeans 

 away from the native town or village. 



Quinine. — ^Leaving now these preliminaries, we come to the actual 

 question of prophylaxis by reducing the malaria in man by quinine 

 administration, as recommended by Koch, Celli, Plelm, Lustig, 

 Negri, and others. 



Koch's method consists in taking a large dose (15 grains) of 

 quinine on two consecutive days every eight or ten days for three 

 months, while Celli's method consists in taking about 6 grains (0-40 

 gramme) of quinine daily; Plehn's, in taking 8 grains of quinine 

 every fourth day. Our own method is to give 5 grains daily, and, 

 in addition, a double dose (10 grains) once a week ; and in order to 

 enable the patient to remember the routine, we advise him to take 

 the double dose on a Sunday. For children i grain of quinine may 

 be given for every three years of age, or euquinine may be used with 

 advantage in doses of 2 to 5 grains daily. It is not very bitter, and 

 may be given with a little sweetened condensed milk, as advised 

 by Watson, or chocolates of tannate of quinine (2 to 5 grains), as 

 advised by Celli, may be administered. 



In very malarious zones such as certain tropical countries and the 

 Balkans, the doses mentioned are not sufficient and should be 

 increased. 



All these methods, if properly carried out, give fairly good results, 

 but it must be remembered that unpleasant symptoms may arise 

 after a long use of quinine, of which the most frequent in our 

 experience is a tremor of the hands; but various other nervous 

 symptoms may appear — e.g., irritability. 



The advantages of quinine prophylaxis are, however, in excess of 

 its disadvantages, and we strongly recommend its use. In Italy 

 special laws have been passed, due to the efforts of Celli, which 

 render quinine prophylaxis practicable among the poorer classes. 

 The quinine is manufactured by the State and distributed gratis 

 to the poor, while employers of labour are compelled to supply 

 it to their work-people. Governments, municipalities, etc., can 

 also help in this way by giving free quinine to the populace. 



The systematic free distribution of quinine powders, tinted if 



