PROPHYLAXIS OF MALARIA. 
85 
ger of the production of hemoglobinuria by the constant administra¬ 
tion of the acid salts of quinine they should not be used; but, as a 
matter of fact, there is no evidence that the prophylactic use of any 
of the acid salts has resulted in the production of any appreciable 
amount of hemoglobinuria, so that it may be stated that they may 
be used in prophylaxis without danger. It should also be remem¬ 
bered that the proper treatment of initial malarial infections and 
of “ carriers ” of the disease are most important prophylactic meth¬ 
ods, so that the consideration of the form of quinine to be used in 
prophylaxis must not only take into consideration what form can be 
used most successfully in preventing the disease, but also what form 
is most efficient in curing those already infected. 
Of the many salts and compounds of quinine that have been used 
in the prophylaxis and treatment of malaria I believe that, from a 
military standpoint, the only ones deserving of consideration are the 
sulphate, the dihydrochloride, tannate of quinine, and the quinine 
alkaloid. Of these the sulphate and the dihydrochloride (hydro- 
chlorsulphas) are on the supply table, and, in my opinion, are all that 
are needed in the prophylaxis and treatment of malaria in the Army, 
although for prophylactic use the tannate might be adopted with 
benefit. 
This is the salt that has been so successfully used in Italy in the 
prophylaxis of the disease and which Cell! regards as the ideal one 
for this purpose, owing to the fact that it is almost tasteless, is well 
tolerated by the stomach, is absorbed more slowly, and is more com¬ 
pletely oxidized than other salts of the drug. For the treatment of 
those already infected it is inferior to the sulphate or dihydrochlo¬ 
ride. MacGilchrist 44 has recently urged the adoption, both for pro¬ 
phylaxis and treatment, of the amorphous precipitated quinine base 
or alkaloid for the following reasons: 1. It is sparingly soluble in 
water and almost tasteless. 2. Absorption is as quick and complete 
as after the administration of quinine salts. 3. Being pure quinine 
it represents quinine in the smallest bulk and weight. I. Being non¬ 
hemolytic it is safer. 5. Low cost. If further experience shows that 
these contentions are correct it would appear as though quinine alka¬ 
loid possesses advantages over salts of the drug, but experience has 
shown that the sulphate of quinine can be relied upon in prophylaxis 
and treatment in the military service, and there would seem to be no 
great advantage to be gained by carrying on the supply table sev¬ 
eral preparations of the drug. So far as the danger of the sulphate 
producing hemoglobinuria is concerned, the statistics of the Army 
demonstrate that it is infinitesimal, for despite the immense amount 
of this salt that has been used in the prophylaxis and treatment of 
malaria among our soldiers since 1898, hemoglobinuria has been so 
rare as to be a medical curiosity. 
