I7I 
VIII.  REMARKS  ON  THE  PROPHYLAXIS  AND  TREATMENT 
OF  BLACKWATER  FEVER. 
It  is  not  here  proposed  to  do  more  than  refer  briefly  to  the 
importance  of  avoiding  malaria  in  countries  in  which  black  water  fever 
is  prevalent,  for  the  need  of  adopting  the  various  measures  available 
for  preventing  the  risk  of  the  bites  of  infected  mosquitos  and  of  using 
quinine  as  a  prophylactic  are  now  well  recognised.  But  a  few 
remarl-is  upon  the  attitude  often  taken  up  towards  prophylactic 
measures  will  serve  to  indicate  the  nature  of  some  of  the  difficulties, 
often  more  or  less  trivial  in  aspect,  which  arise  when  it  is  attempted 
to  secure  avoidance  of  malaria.  It  was,  we  found,  commonly  regarded 
as  unnecessary  to  use  mosquito  nets  until  mosquitos  had  already  made 
their  appearance.  The  presence  of  mosquitos  was,  moreover,  not 
unfrequently  overlooked.  In  many  cases  this  appeared  to  be  in  part 
due  to  the  circumstance  that  those  bitten  by  mosquitos  have  after  the 
lapse  of  months  or  years  ceased  to  suffer  from  irritative  skin  lesions 
as  a  result  of  these  bites.  Mosquito  nets,  when  available,  were 
sometimes  not  used.  Some  of  the  nets  in  use  were  in  a  torn  condition 
and  of  limited  utility.  When  travelling  or  shooting  mosquito  nets 
were  not  unfrequently  left  behind,  though  the  night  would  be  spent 
in  the  neighbourhood  of  a  river  where  mosquitos  abounded,  and  this 
in  spite  of  warnings  afforded  by  the  consequences  of  such  neglect. 
The  importance  of  taking  a  course  of  quinine  as  a  prophylactic  after 
being  bitten  by  mosquitos  is  not  recognised,  and  this  drug  is  not 
taken  until  an  attack  of  malaria  has  supervened,  or  until  several 
malarial  attacks  of  increasing  severity  have  occurred.  The  necessity 
of  avoiding  the  formation  of  collections  of  water  in  the  neighbourhood 
of  houses,  or  of  filling  up  or  draining  places  in  which,  during  the 
rainy  season,  mosquitos  may  breed  is  generally  unknown  to  the  white 
population,  but  the  Government  medical  officers  have  taken  steps  to 
secure  better  sanitary  conditions  in  such  cases.  Many  of  the 
situations  in  which  habitations  were  placed  invmlved  unnecessary  risk 
of  exposure  to  malaria. 
1  he  administration  of  quinine  to  a  patient  suffering  from  malaria 
who  has  previously  suffered  from  blackwater  fever  presents  a  difficulty 
for  which  no  general  rule  can  be  laid  down.  In  some  cases  where  the 
malarial  condition  is  not  showing  signs  of  improvement,  or  is 
becoming  steadily  worse,  the  possible  risk  of  inducing  blackwater  by 
