533 
District  Aledical  Officer  to  whom  they  would  report  as  to  work  done, 
itinerary,  cases  seen,  etc. 
An  alternative  method,  but  less  satisfactory,  because  it  would  not 
include  house-to-house  visitation,  would  be  to  place  the  distribution 
in  the  hands  of  the  clergymen  and  the  police.  I  am  sure  that  the 
former  would  be  only  to  anxious  to  assist  in  every  possible  way, 
though  their  time  is  taken  up  by  many  other  important  duties. 
Space  will  not  allow  me  to  go  into  details  as  to  rules  and 
regulations  for  such  a  service,  but  there  are  one  or  two  points  which 
1  may  mention. 
In  the  first  place.  Government  quinine  should  be  in  such  a  form 
as  to  render  it  easily  distinguishable  from  other  quinine.  If  in  the 
form  of  pills  or  tablets  it  may  be  tinted,  but  probably  the  form  used 
in  Italy,  namely,  the  tablets  of  quinine  made  up  with  chocolate, 
would  be  the  most  serviceable. 
Of  course  there  must  be  certain  restrictions  and  penalties,  and 
the  sale  by  dispensers  or  others  should  be  entirely  forbidden.  But 
the  regulations  must  be  as  simple  as  possible,  otherwise  too  many 
restrictions  will  defeat  the  object  of  the  service,  and  a  certain 
unavoidable  leakage  must  be  allowed  for. 
As  to  the  well-to-do  there  is  no  reason  why  they  should  not  obtain 
their  quinine  from  the  same  sources  as  they  now  do. 
Quinine  during  acute  attacks. 
And  now  a  word  in  passing  as  to  the  quinine  treatment  of  fever. 
I  have  passed  a  considerable  period  of  my  life  in  the  midst  of 
malaria,  often  of  the  most  malignant  types,  and  if  I  may  venture  a 
humble  word  of  criticism,  I  may  say  that  I  was  much  struck  with  the 
comparatively  small  doses  of  quinine  administered  during  fever  in  the 
Island.  I  am  certainly  inclined  to  advocate  the  administration  of  con¬ 
siderable  doses,  lo  to  15  grains,  two  or  even  three  times  a  day, 
according  to  severity,  as  being  more  likely  to  thoroughly  kill  off  the 
parasites,  and  thus  limit  the  period  of  infection,  and  as  some  stages  of 
the  parasite  are  more  resistant  than  others,  it  is  important  that  quinine 
in  considerable  doses  should  be  continued  for  a  considerable  time 
after  the  febrile  manifestations  have  ceased.  Consequently  in  the 
cases  of  police  and  coolies,  they  should  be  kept  in  hospital  for  rather 
longer  periods,  or  some  superior  officer  should  see  that  their  doses 
LI- 
