PROPHYLAXIS OF MALARIA. 
81 
malaria, blit in practice this result could only be attained where the 
drug could be administered to every individual in the infected locality 
for a long period of time, for the prophylactic use of the drug would 
have to be continued as long as Anopheles were present, for just so 
long would there be danger of the spread of the disease from the 
mosquitoes becoming infected by imported cases of malaria. There¬ 
fore it follows that while quinine prophylaxis is a method of the 
very greatest value in the prevention of malaria, it can not be de¬ 
pended upon alone, but should be combined with those that have 
already been described. 
The results achieved by this method of prophylaxis have varied 
greatly in different localities, depending upon the methods of admin¬ 
istration and the form of quinine used; the efficiency with which the 
administration of the drug has been conducted; and the class of 
people with whom the method has been tried; so that the literature 
is filled with discordant reports regarding the value of the drug 
as a prophylactic. Most of the unfavorable reports have been the 
result of careless application of the method or of lack of control of 
the people to be benefited. It is obvious that to be successful the 
drug must be regularly administered, and in the military service 
this can be done, whereas it might be impossible in civil commu¬ 
nities. It is true, however, that even when the method has been 
given the most careful trial it has failed, in rare instances, to have 
much effect upon the incidence of malaria; but the experience of 
numberless observers of the great value of the method when properly 
applied leaves no doubt of its worth, and the rare failures recorded 
must have been due to exceptional conditions surrounding the experi¬ 
ments. 
Among the arguments that have been urged against quinine pro¬ 
phylaxis may be mentioned the production of haemoglobinuria, 
harmful physical effect upon the consumer, the difficulty of applica¬ 
tion, and the danger of producing a resistant strain of the plasmodia 
by the exhibition of small doses of quinine over long periods of 
time. As a matter of fact none of these objections are valid, and 
there is practically no proof that any of them possess actual merit 
sufficient to forbid the use of quinine in this manner. Haemoglobi¬ 
nuria is sometimes produced by quinine, but very rarely where the 
drug is taken regularly, and the few instances in which it does occur 
is no argument against the use of the drug. There is absolutely no 
scientific proof that the taking of quinine, even in much larger doses 
than are used in prophylaxis and continued for weeks and months, 
produces any harmful effect, and even the slight dizziness and roar¬ 
ing in the ears disappear after taking the drug in prophylactic doses 
for a few days. The danger of producing quinine-fast strains of the 
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