102 
PROPHYLAXIS OF MALARIA. 
but in camps and posts the microscope should be depended upon in 
the diagnosis of malarial fevers. In this way the exact species 
of plasmodium is ascertained and there can be no doubt of the cor¬ 
rectness of the diagnosis. 
Not onty should the diagnosis of malarial infection be made by 
blood examinations, but the treatment of the disease should always 
be controlled by frequent microscopic examinations of the blood, 
and no patient should be allowed to leave the hospital until his blood 
is free from parasites, except where a military emergency exists 
justifying such action. If this rule be followed the danger from 
“ carriers ” of the infection will be very greatly reduced and the 
surgeon can not be charged with helping along malarial disease by 
discharging “carriers” from the hospital, while gametes are still 
in the peripheral blood. If only the forms concerned in the human 
life cycle of the plasmodia are present in the blood, it will be found 
that they will disappear within a few days after beginning quinine, 
and then the patient may be returned to duty with directions regard- 
in further treatmentbut if gametes are present it will mean from 
two to three weeks of treatment with the dosage of quinine already 
recommended before they will be reduced to a noninfectious mini¬ 
mum, and the patient can be safely returned to duty. 
The treatment of initial and recurrent attacks of malarial fever 
varies with the species of plasmodium present, the tertian and quar¬ 
tan infections requiring less quinine to cure them than the estivo- 
autumnal infections. It is not my intention to discuss the treatment 
of malaria here further than to call attention to the method I have 
found effective in the usual acute and recurrent infections observed 
in hospital, the reader being referred to the many excellent works 
upon this subject for information regarding the treatment of per¬ 
nicious infections. The object of all treatment is to rid the blood 
of plasmodia as quickly as possible and to cure the disease, and I 
am no believer in routine methods in the treatment of infections vary¬ 
ing so much in severity as do the malarial fevers. It should be dis¬ 
tinctly understood that the methods that follow are merely those that 
I have found most useful in the vast majority of infections that I 
have had under personal observation and are inserted merely for the 
purpose of demonstrating the absolute necessity of continued treat¬ 
ment with quinine and of suggesting the way in which the drug may 
be employed to secure the end aimed at. i. e., the cure of the infection 
and the prevention of “ gamete carriers.” 
Tertian and quartan malaria .—In these infections, during the acute 
symptoms, quinine should be given in doses of at least 0.32 gm. (gr. 
v) every four hours until from one to two grams are given in the^d 
hours (gr. xv to xxx), according to the severity of the symptoms, and 
