95 
Quinine has })een used by the physicians of the Bitter Boot Valley in small doses 
by mouth for a number of years in the treatment of this disease. During the spring 
of 1902 the writers urged, on purely theoretical grounds, the use of large doses of the 
drug intravenously, hypodermically, or per rectum. Cases 94 and 95 were given 
quinine per mouth and rectum to the point of cinchonism, with some apparent bene- 
ficial results. Both cases died, though No. 95 was convalescent from spotted fever 
and died of a complicating pneumonia. During 1903 cases Nos. 115, 118, 119, 122, 
124, 125, and 126 were treated with doses ranging from 5 grains by mouth (case 
No. 119) to 60 grains subcutaneously (case No. 118). All of these cases except No. 
125 recovered, though case No. 119 died later of a complication (acute gastritis). 
Case 125 was an old debilitated man, and had the most abundant infection of all the 
I cases examined by the writers. The remaining 5 cases occurring in 1903 and 
untreated with quinine were all fatal. These cases are too few on which to base 
I conclusions, but are sufficiently suggestive to warrant a further trial of the treat- 
I iiient. In this connection it is worthy of note that Theiler (1903) has recently made 
the observation that in South African equine malaria, a disease caused by Piroplasina 
I equi, the pyroplasmata rapidly disappear from the blood of infected horses on the 
administration of quinine and ammonium chloride.” — Wilson and Chowning, 1904a, 
j p. 57. 
In connection with the cases which occurred in 1903, it may be 
; noted that Gates’s case (No. 10, 1903) was not reported as having been 
treated with quinine, but recovered. As this case was known to 
I Anderson and to Wilson and Chowning, it must be concluded that they 
I did not include it in the statements that the 5 cases which did not have 
I quinine treatment died. 
So far as I was able to learn, the quinine treatment in large or com- 
I paratively large doses is not new in the Bitter Root Valley. Doctor 
Mills, for instance, gave quinine in large doses per mouth some years 
; ago, but his results were so unsatisfactory that he discarded its further 
use. Doctor Howard has been giving quinine for 6 years in large 
I doses twice a day, and claimed to have had veiy good success with it 
' up to 1904:. He states that under quinine treatment 6 out of 7 cases 
recovered. Doctor McGrath has been using quinine for about 5 years; 
I ' of 6 quinine cases 5 recovered. One physician has lost 2 or 3 cases 
under quinine treatment — 3 grains every 2 or 3 hours. Doctor Brook 
informed me that one of his quinine cases died after 12 days of treat- 
;ment; he also lost another quinine case. Doctor Gwinn used quinine 
‘ from 1887 to 1890; some patients recovered, others died. He then 
, rejected it. He tried it again about 1897, giving about 1 dram per 
' day, but as all of these cases died he again rejected it. He used it in 
2 cases in 1903, and one case recovered; the other died under the same 
^ treatment. 
I ‘ I Quite a number of local physicians with whom I spoke maintained 
that except in imported malaria cases quinine could not be given in 
^ that locality so freely as in lower eastern and southern localities, with- 
i out more serious effect, but this view was not shared by two other 
physicians. 
Early in 1901 Doctor Mills stoutly combated the quinine treatment 
