PROPHYLAXIS OF MALARIA. 
103 
this dosage continued until the symptoms have disappeared and plas- 
modia can no longer be detected in the peripheral blood. Thereafter 
the drug should be continued for at lease three months, the dosage 
being gradually reduced during the first two weeks of convalescence 
until the patient takes 0.40 gm. (gr. vi) per day at the end of the 
second week, and this dose should be continued for at least two weeks 
longer, and the same dose given twice a week until three months have 
elapsed from the date of attack. In regions where reinfection is 
probable, the prophylactic dose of 0.40 gm. (gr. vi) daily, should be 
adopted at the end of two weeks after the plasmodia have disappeared 
and kept up as long as required. 
/Estiva-autumnal malaria .—In sestivo-autumnal malaria the dosage 
of quinine must be somewhat increased, as these infections are more 
resistant to treatment than tertian and quartan infections. In most 
cases a dose of 0.32 gm. (gr. v) administered every four hours will 
result in the disappearance of the symptoms within three or four 
days, but not infrequently cases will be observed that require larger 
doses. After the symptoms have disappeared 1 gram (gr. xv) should 
be taken daily for two weeks, and for two weeks thereafter 0.65 gm. 
(gr. x) should be the daily dose. At the end of this period 0.32 gm. 
(gr. vi) should be taken daily for at least two months, and as long 
as required if quinine prophylaxis is necessary. 
Patients should only be returned to duty when the peripheral 
blood is free from plasmodia, or, if gametes are present, when they do 
not number more than 1 to every 500 leucocytes. Before leaving hos¬ 
pital a malaria register should be prepared for each patient, giving 
the type of infection, the amount of quinine administered, and other 
data that may be useful or necessary, and upon this register should 
be entered further treatment after return to duty. Patients should 
not be allowed to take quinine away with them for self-administra¬ 
tion, but should be instructed to report to the hospital at the proper 
time and the administration of the drug personally attended to by 
the medical officer in charge of this work. In case of transfer to 
another organization, the “ malaria registershould be sent to the 
surgeon of that organization and the treatment continued at the 
man’s new station. In this w T ay every malarial patient treated in 
the Army can be followed and a really scientific prophylaxis of the 
disease, so far as he is individually concerned, be rendered possible. 
The results of quinine prophylaxis .—In concluding this chapter 
it may be of interest to give a very few illustrations of the efficacy 
of the quinine prophylaxis of malaria where other methods have 
failed or have been only partially successful. Without question the 
most notable instance of quinine prophylaxis is that which has been 
in operation in Italy since 1905 under the auspices of the Society for 
