PROPHYLAXIS OF MALARIA. 
101 
to the improper treatment of infections coming under the direct 
care of the practitioner. The practice of regarding a malarial in¬ 
fection as cured because the symptoms have disappeared is respon¬ 
sible for most recurrences and for the development of “ malaria car- 
riers,' ? and it is too often the case that a patient is allowed to resume 
his work without a blood examination having been made or anv 
directions given regarding the continued use of quinine. Despite 
the fact that the malarial infections have occupied the attention 
of the medical profession since the time of Hippocrates, it is not 
even now impressed with the fact that every such infection is re¬ 
sistant to treatment; that the disappearance of symptoms is no proof 
that the plasmodia are destroyed; and that a continued course of 
quinine is absolutely necessary to eradicate even the mildest malarial 
infection. 
The attitude in this respect is very similar to that which obtained 
in regard to the cure of syphilis prior to the use of the Wassermann 
test. In both malaria and syphilis specific drugs were known, and if. 
after the use of these drugs, the symptoms disappeared, the patient 
was regarded as cured. In the case of syphilis, however, it was 
recognized that eAen though symptoms disappeared, from two to 
three years of constant treatment was necessary before this supposed 
cure was really accomplished; but in the case of malaria a large 
proportion of the profession appear to believe that a few doses of 
quinine, if followed by the disappearance of acute symptoms, signi¬ 
fies the cure of the infection. As a matter of fact, quinine in the 
treatment of malaria is like mercury in the treatment of syphilis, in 
that its use must be persisted in for a considerable time after the 
symptoms of infection have been conquered if one desires to really 
cure the infection. When this fact is actually realized and acted 
upon by the medical profession we will witness a great reduction of 
malaria, because the “carriers” of the disease will be prevented. 
The time to begin malarial prophylaxis is with the treatment of every 
aeute infection , and if this is well done one has performed one of 
the most important duties, from a prophylactic standpoint, that falls 
to the lot of the physician. In civil life it may often be impossible 
to thoroughly treat malarial infections, but in the military service, 
owing to the absolute control the authorities have over the personel, 
the proper treatment of malaria is possible and there can hardly be 
any excuse for its neglect. 
The first requisite to the proper treatment of malarial infection is 
a correct diagnosis, and, in the military service, this should always be 
made by the aid of the microscope. This may be impossible in the 
field and the patient may have to be placed at once upon quinine, 
