In Malaya fortunately simpler and less complete measures are required 
than in Africa or in Europe, on account of the different species which are 
dangerous in the three continents. The prevention and diminution of 
Malaria is therefore comparatively easy. 
Fatal Malaria. 
In a considerable number of cases at the autopsy there was evidence of 
old or recent Malaria in the shape of pigmentation of the spleen or liver. 
In those in which only a few parasites were present Malaria, though 
possibly a contributory cause of death, could not be considered as the main 
cause. In some of these, as in one case of Quartan Malaria, Beri-Beri was 
detected during convalescence from the attack of fever. There was no 
recurrence of the fever and no parasites, but abundant malarial pigment 
was found at the autopsy and the patient died of Beri-Beri. 
In two of the cases in which death was attributed directly to Malaria 
there was some tubercular disease of the lungs. In the one case as an old 
wrinkled sclerotic mass surrounding some cretaceous nodules at one apex, 
and in the other recent tubercular infiltration affecting only a small part of 
the apex of one lung. 
In three cases Dysentery and Malaria co-existed, and as clinically the 
dysenteric symptoms masked those of Malaria these cases in which death 
was probably the result of the combination are excluded from the table as 
well as one case of advanced anaemia with sloughing cellulitis of the leg. 
Of the remaining 15 cases in all parasites were found in large numbers in 
cerebral and other capillaries, and they are considered as fatal cases of Acute 
Malaria. 
The parasites found in all were the so-called Autumnoaestival or 
Malignant Tertian parasites. 
The ages of the patients when ascertained were as follows:—Two, 25 
and under ; four, 30 and under ; two, 35 and under ; two, 40 ; and two over 40 ; 
a difference from the proportions dying at various ages in this hospital in 
that twice as many were in the most active life periods under 35 as over it, 
whilst the ordinary proportion amongst the fatal cases of disease was equal 
under and over. 
Fatal cases occurred amongst patients from Kwala Lumpur from the 
mining districts and particularly from Gombak, where extensive engineering 
works are being undertaken. 
Four died within a few hours of admission, and five more within three 
days. Four lived a week and over a week. Of those not dying within the 
first day Quinine in 10 gr. doses was given two or three times a day in 
several cases, and in some of these the temperature became normal, and 
remained so in one case for three days before death. Though the 
symptoms were thus reduced the large number of active and sporulating 
parasites found in the capillaries showed that the treatment had not 
been effective in the sense of destroying or preventing the develop¬ 
ment or reproduction of the parasites in these cases. In other cases the 
rapid and complete recovery and the prolonged disappearance of parasites of 
the same type from the blood under the same treatment shows that such 
treatment may be and often is effective. 
This variation in the effect of small or medium doses of Quinine though 
well known is not easily explained in the ordinary theory of mere poisonous 
