THE TROPICAL 
AGRICtJLTURiST. [Oct, 1, 1901. 
combating malaria, it will be very advantageous 
to find cub what places they prefer, and to pay 
special attention to such. From this focal be- 
haviour of malaria I drew the practical conclusion 
that it is not necessary ac the outset to free 
whole places or extensive regions of the malaria- 
parasites. It will be perfectly practicable to 
advance step by step, in exact accordance with 
the number of assistants at disposal, without 
■ having to fear that the ground jnst freed of malaria 
will be at once reinundated by infected mosquitoes 
from the still malarial neighbouring districts. 
THE EFFECTIVE QUININE DOSE. 
"I now come tp the question as to the best 
method of removing the parasites permanently 
from the blood of malaria-patients by treatment 
with quinine. With a view to deciding this 
question I have made very many experiments, 
and have arrived at the following results, which, 
for the rest, every observing physician who has 
frequent opportunities of treating malariapatients 
will find confirmed by liis own experience. Doses 
of quinine of less than one gram (15"4.32 grains) 
are insufficient for adults. The effect of the 
quinine is very greatly strengthened by giving 
full doses several days running. Considering 
these two facts, and in order to minimise the use 
of quinine, I order one gram of quinine to be 
given two mornings running, which is repeated 
after an interval of nine days. This treatment 
must be continued for at least two months, or 
better three, because one is not safe till then against 
relapses. In obstinate cases one gives one gram of 
quinine three days running, and reduces the in- 
terval, if necessary, to seven days. In quartan-fever, 
which is well known to be the roost obstinate form 
of malaria, quinine must be given three days run- 
ning from the first. There are people with whom 
quinine does not agree if taken through the mouth; 
in such cases it must be given under the skin. 
The patient must be observed for a length of time 
after the treatment, and his blood must be ex- 
amined from time to time, in order that one may 
be quite sure that he is permanently cured and 
free of malaria parasites. In malarial districts 
proper the combating of malaria will restrict 
itself in the main to the treatment of the chil- 
dren and of the persons who have immigrated in 
the immediately preceding years. To children 
under six months one generally gives one-tenth 
of a gram, to older ones more, according to their 
age. They generally stand quinine very well even 
in comparatively larger doses than adults, so that 
one need not hesitate to give children of five to 
six half a gram. They do not dislike it either, if 
£;iven as a powder mixed with raspberry syrup, or 
if sweet tea or the like is given after it. If neces- 
sary, one can give euquinine, which, however, un- 
fortunately cannot be used much, owing to its high 
price. For the rest, the treatment of children suf- 
fering from malaria is one of the most grateful tasks 
for a physician. When I arrived at Stephensort in 
New Guinea there were no children there. They had 
always died of malaria. 1 took special pains to pro- 
tect the children that were born during my stay 
there, and those tliat came to the place with their 
parents against the pernicious influence of malaria. 
They were all examined from time to time for 
malaria parasites, antl treated with quinine, if any 
were found. Under such treatment those children, 
whose number amounted at last to about a dozen, 
Jhruve Splendidly ; not one of them died, 
"The practicability of my method was proved by 
an experiment I made at Stephansort in New 
Guinea. It is a settlement of the New Guinea 
Company with 734 inhabitants. Of these 157, i c, 
21 4 per cent, were suffering from malaria. This 
figure was soon reduced to a small remainder, con- 
sisting exclusively of quartan cases, and this 
favourable result was not a merely temporary one, 
but lasted till the date of the last news I received' 
PRACTICAL TESTS OF DR. KOCH'S METHOD. 
"Further experiments, testing the practical 
efficiency of my method, are going on at this 
moment in German South-Wcst Africa and in the 
Brioni Islands, and experiments are to be begun 
soon in East Africa, and the former ones continued 
in New Guinea. At bottom, however, no further 
proofs of the value of my method are at ail 
necessary, for the results of the extensive and 
successful attempts to stamp out malaria are 
already at our disposal. You are well aware that 
malaria was very prevalent in most European 
countries only thirty to forty years ago. Sirice 
then It has very rapidly diminished, and now it 
has nearly everywhere wholly or almost Wholly 
disappeared What I have just said is especiallyv 
true of Engand, France, Belgium, Holland, ^nd 
Germany. Attempts have been made to explain 
this very striking decrease of malaria by the 
dryingup of;the swamps, but this explanation is by 
no means admissible. There .'•till are swamps enotigh 
everywhere, and the transmitters of malaria, tne 
anopheles gnats, are_ still to be foun in large 
numbers wherever malaria used to be. So there 
must be other reason, and the only other reas^be 
discoverable is the much more general use of 
quinine, which is the only deadly weapon we h'aVe 
against the malaria parasites. Quinine used to 
be so dear that only well-to-do people could get 
it. Moreover, since its use became more frec^ueit, 
the doctors have learned to use it more 
rationally. So the number of malaria cases that 
were properly treated and permanently cured 
became greater and greater, whereas formerly 
every case was followed by endless relafises. 
Consequently the infectious matter has became 
rarer and rarer, and the anopheles gnats, which are 
probably just as numerous as they used to be, no 
j'b,, u^' Einy malaria parasites to transmit. 
T one prevalence of malaria in Germany only 
thirty years ago, and the extent to which it 
has diminished since then, is best shown by tiie 
statistics of the German army. In 1869 the rifani- 
ber of cases still amounted to 54'5 per thoasahd ; 
now it is 0'45 per thousand ; tnat is, it is more 
that a hundred times rarer now than thfen. In 
1874 the garrison of Spaudau, a fortress near 
Berlin, surrounded by swampy meadow.s, had 664 
cases of malaria per thousand men ; now, though 
the swamps are just as they were, the figure 
is one half to one per thousand. In Bafcavia and 
other towns in Dutch India, which used to 
be notorious for their malaria death rate, and 
were called "the European's Grave," a consider- 
able improvement has taken place since the 
gratuitous dispensing of quinine was intioduced. 
THE CASE OF POLA. 
" A very interesting illustration of what I am 
now saying came to my knowledge lately at f*ola, 
the principal seaport of Istria. Being also a w^- 
port, it has a large garrison, and it has from of bid 
had the reputation of being severely infected \^th 
lualaria. In 1864 the naval garrison there had 887 
