Quinine  Administration 
3.  But  there  is  a  third  method  of  prevention  as  applied  to  the 
individual,  which  is  simple,  inexpensive,  effective  and  of  easy  general 
application.  I  refer  to  the  preventive  administration  of  quinine. 
Although  the  curative  effect  of  quinine,  or  rather  of  the  bark  from 
which  it  is  extracted,  namely  cinchona,  has  been  known  since  the 
17th  century,  attention  has  only  been  drawn  to  its  extreme  value  as 
a  preventive  of  recent  years,  but  it  was  evidently  well  known  to  the 
old  Jamaicans.  ‘  Strangers  newly  arrived  in  such  places  and  those 
who  are  constitutionally  subject  to  agues  should,  during  the  sickly 
season,  take  every  other  night,  two  or  three  teaspoonfuls  of  tincture 
sacra  or  a  few  grains  of  pilula  rufi,  not  sufficient  to  purge  but  only  to 
keep  the  body  pretty  open,  and  for  further  prevention  a  wineglassful 
of  the  infusion  of  bark  and  orange  peel  in  water,  or  a  tablespoonful 
of  a  strong  tincture  of  bark  may  be  taken  diluted  with  water 
occasionally  in  the  morning  before  breakfast  ’  (History  of  Jamaica, 
As  far  back  as  1891  I  advocated  in  the  ‘Lancet’  the  daily  use 
of  quinine  as  a  preventive,  and  with  every  year’s  residence  on  the 
West  Coast  of  Africa  I  was  more  convinced  of  its  efficiency,  and  it 
was  very  striking  to  observe  the  immunity  from  malarial  fever  which 
was  enjoyed  by  those  who  took  it  regularly,  as  compared  with  those 
who  did  not. 
A  reference  to  the  section  dealing  with  Italy  will  show  the 
remarkable  results  which  have  been  obtained  there. 
It  is  sometimes  suggested  that  the  long  continued  use  of  quinine 
has  a  deleterious  effect,  but  as  a  matter  of  actual  experience  this  is 
not  found  to  be  the  case.  On  the  contrary,  the  small  doses  required, 
generally  act  as  a  tonic.  Nor  does  practical  experience  support  the 
objection  that  larger  doses  will  be  required  during  the  attack  of 
fever  if  one  is  habituated  to  the  drug. 
Two  methods  of  quinine  prophylaxis  are  recommended,  first,  the 
administration  of  fifteen  grains  twice  a  week,  and,  second,  the  daily 
use  of  five  grains.  In  my  experience,  the  first  method,  though 
efficacious,  if  regularly  carried  out,  is  unsuccessful  in  practice,  as  it  is 
rarely  adhered  to.  Fifteen  grains  of  quinine  will  produce  in  most 
individuals  unpleasant  symptoms  of  cinchonism,  headache,  buzzing  in 
