33 « 
administration by that method is of any avail. Thus in one of my 
cases of mixed infection, i.e., benign tertian and malignant tertian. 
I found that no evidence of an alkaloid could be obtained in the 
urine by the picric acid and gold chloride tests, although 
the patient was getting fifteen to thirty grains of quinine 
hydrochloride daily. Together with this I found that the attacks 
of fever continued in spite of the quinine by the mouth. 
Hypodermic injections of quinine had to be resorted to, and the 
urine at once showed the alkaloidal test. The temperature became 
normal, and continued to be normal for a few days. Another 
attack of fever, due probably to a fresh infection, occurred, and 
quinine was injected with equally good result. However, I had to 
persist injecting it about half a dozen times and ultimately this had 
no effect too; the urine at that time was found to be free from 
quinine, thus showing that the injected quinine was not being 
absorbed. 
The toleiance of the malarial parasite to quinine is also possible, 
as in some cases the patient gets an attack showing parasites in his 
blood, although he may be taking ten to fifteen grains of quinine 
daily. At this stage it is found necessary to increase the amount 
of the drug. 
In an interesting paper on malaria by Darling* it is stated that 
the number of gametes diminish under quinine administration. He 
cites only one case, No. 48987 (vide Table ‘ C ’) to show that no 
diminution occurred when quinine was withheld. However, one 
must bear in mind that the patient had non-sexual forms also 
present m his blood at the time when these observations were made; 
and as quinine was withheld there is a likelihood of fresh gametes 
being continually formed. 
If one studies the table carefully, one can see that at first there 
is a diminution in the number of gametes, and only in the last count 
a sudden increase was noticed. This shows that gametes can 
isappear even when no quinine is administered, and, therefore, we 
ave up to now no evidence to show that quinine has any effect in 
diminishing the number of gametes. It is unfortunate that the 
observation was not made in Case No. 53,937, which was free from 
Annals of T rop. Medicine and Parasit., Vnl. 
IV, No. 2, 25th July, 1910. 
