84 
PROPHYLAXIS OF MALARIA. 
let's 42 observations confirmed those of Rieux; and James 43 , in the 
Canal Zone, obtained the same results from his studies of the action 
of quinine upon the plasmodia. 
From these observations it is evident that quinine is capable of 
affecting the plasmodia in practically every stage of their develop¬ 
ment, and it follows that the best results will be obtained in prophy¬ 
laxis and treatment if the drug is present in the blood continually. 
Thus, I am a firm believer in divided doses at regular intervals in 
the treatment of all forms of malarial infections, except, of course, 
the pernicious cases, where a large dose of the drug must be admin¬ 
istered at once; and in the prophylaxis of the disease I believe that 
better results will be obtained if quinine be given in morning and 
evening doses rather than in one dose during the 24 hours. The 
object desired is to have a maximum quantity of the drug continually 
present in the blood, and the nearer we approach this ideal the better 
will be our results with the quinine prophylaxis of malaria. In 
the field, of course, it would probably be necessary to depend upon 
one dose, given either in the morning or evening, but in camps and 
posts a morning and evening administration of quinine could be 
arranged and enforced in the vast majority of instances. 
The form, of quinine to he used in prophylaxis .—Until quite re¬ 
cently we have been very ignorant regarding the exact fate of 
quinine after ingestion and the salts or compounds of the drug best 
fitted for use in the prophylaxis and treatment of malaria. The 
researches of Gaglio, MacGilchrist, Webb, and others have demon¬ 
strated that many of our ideas regarding the pharmacology of this 
drug were erroneous and have resulted in new points of view as to 
its use in malarial infections. Thus, the old idea that the salts most 
soluble in water should be preferred, because they would be more 
readily absorbed has been proven incorrect, for Gaglio has shoAvn 
that the insoluble salts and compounds are as well absorbed as the 
most soluble salts of the alkaloids, and that the drug is absorbed 
mostly in the intestine combined with the biliary acids and carbonic- 
acid gas. It has also been shown that if the drug is taken daily 
it accumulates in the blood up to about double the initial dose, and 
that it is eliminated through the kidneys, elimination never taking 
longer than three days, no matter how administered or what prepa¬ 
ration is administered. The least soluble preparations have been 
found the best tolerated by the stomach and intestines, because of 
their more gradual absorption, and MacGilchrist has shown that 
the acid salts are strong hemolytic agents outside the body and are, 
therefore, less safe than the neutral salts or quinine alkaloid itself. 
In the selection of the form of quinine to be used in prophylaxis 
all of the points enumerated are of importance, owing to the length 
of time that the drug must be administered. If there is serious dan- 
