REMARKS ON THE VALUE OF QUININE AS A PROPHYLACTIC. By J. Butler Hamilton, M. D., \Qth Brigade, It.A. This subject, one of great interest and importance, has been much before the medical profession of late years, especially in India, and strange to say, the opinions held by men equally qualified to judge are much at variance. During a service of some eight years abroad, both in the West Indies, including Central America and the East Indies, I have paid much attention to this subject, and have endeavoured to form a fair unbiassed judgment on the merit, or otherwise, of quinine and its allied drugs as prophylactics where malaria is present. In the "West Indies, I had little opportunity of trying the
system on any extended scale, as most of the troops are black and less liable to the influences of climate, but even there, from observations on the effects of the prophylactic system white non-commissioned officers, and the European on the
favorably of its effects. battery of Royal Artillery then Indies, a station which up to that date bore a rather favorable reputation for health. During the rainy season of 1868, I gave quinine as a prophylactic to the men of the battery under my charge at the rate of grs. ii every day, during the months of September and October, and, as far I could judge, with marked benefit. The surgeon of the European regiment quartered at the station disagreed with me, and held to the theory of the quinine iosing its effect on the system when administered for any length officers, I
was
led to
judge
most
In the year 1865, I joined a quartered at Jufcbulpore, East
of time, and that when the attack of malarious fever did come, quinine failed to cure the disease with the same rapidity
that
it would have done had the system not been saturated with it. This opinion I could not concur in, and found no such results follow. On the contrary, I had fewer men attacked in proportion, and the cases in my battery were all of a mild type, seeming to yield as easily to large doses of quinine, as they would have done if it had not been given in the small daily doses. Next year, 1866, the 23rd R. W. Fusiliers arrived, and were quartered in the same barrack with the Royal Artillery, my " hospital being part of theirs. The surgeon of the Royal Welsh" held different opinions to his predecessor as to the advisability of giving quinine as a prophylactic, and we both applied for permission to do so. In those da}-s, the issue of stores and medicines to European troops rested with the administrative officers of the Indian Medical Service, and on application being made for a supply of quinine for the purpose, it was refused, as not being considered necessary. Having but a small number of men, some 135, and being in possession of a rather large stock of quinine, so fully impressed was I by the advantages of the system, that I took it upon myself It was to issue it at the rate of grs. iii every second day. given before breakfast, just after the men came off parade, and was issued in the form of a solution with a little sulphuric acid. The wet season of 1866 happened to be a most malarious one, as the 23rd Regiment soon knew to its cost. Malarious fever of a severe remittent type attacked the regiment, and shortly, out of a force of some 500 men, there were at one time 150 in hospital. In addition to this about 150 men who were convalescent from the fever were encamped on a hill close by. The regiment was so reduced in numbers that all parades were stopped, except those absolutly necessary, and really few men The number of deaths I cannot were fit for duty. remember, but I think they were about 20. The surgeon of the regiment and both of his assistants were ill, (one of the latter died,)
THE INDIAN MEDICAL GAZETTE.
2C4 and the
regiment devolved on me for a short time, a comparison between the two bodies of men. During this period the health of the battery remained remarkably good, only an average of about 4 per cent, being in hospital. The cases of fever were few, and of a mild type, and not a single death took place. When the above state of affairs became known, quinine was then, so to speak, showered on us; every post for days brought in a parcel of it, and it was issued to the men of the regiment so
charge
that I
was
of the
able to draw
with undoubted benefit: this was not so appai'ent under the circumstances, as the men had now become saturated by the malaria, still it did act beneficially: the cases became fewer
in number, and of a milder type. Ever since that year I have been in the habit of carrying out the same plan, and last year made some comparative experiments between the values of quinine, cinchoniue and quinoin the Indian Medical Gazette. The which I
published
dine,
result of the
experiment was phylactic, then quinine, and at
place cinchonine first as a prolong interval came quinodine. plan somewhat, and instead of a body, only give it to those
to a
This year I have modified my to the men in who are liable to attacks of malarious fever, but rainy season is nearly over, I purpose issuing it
issuing quinine
as soon as as
the
before, viz.,
every day. tells me that the cases of fever are fewer, of a milder type, and more amenable to treatment, while the sequel?, such as enlargement of the spleen, dysentery, &c., are Much discussion has also arisen lately concerning most rare. grs. ii per
man
My experience
hypodermic administration of quinine, and despite all statecontrary, it is, I am satisfied, a mode of treatment that will now become general. The injection of quinine under the skin is of great value in certain cases: such as in great irritability of stomach, and in cases where head symptoms are present, and the patient cannot be got to swallow; also in the treatment of insolation, but as a general mode of treatment it will never be popular. In the first place it requires to be done with care, and requires skilful hands i next, it is more or less painful, and where women or children are concerned, that will always be a great objection, and most important of all, the operation is frequently followed by very ugly sloughing. In several cases I have seen a slough of nearly an inch in diameter, and involving the cellular tissue, separate after the use of the hypodermic syringe. Why is it quinine is so seldom (comparatively) given 'in pills ? People object to the bulk of them very often, but if quinine be first well triturated in a mortar so as to break up its crystal form, and then rubbed up with a saturated solution of citric acid, it will form pills that contain 5 grains of the drug, and not be larger than ordinary; even to young babies I give quinine in pills; well worked up as above, ? a grain of quinine forms a pill about the size of a No. 4 shot, and when feeding the child with a spoon, it is easy to drop one in, and the
ments to the
let it be swallowed with the food.
Another method of adminis-
tering quinine, and one not nearly so often practised as it might be with advantage, is per rectum, and young children, who reject it from the stomach, even when given in the form of a pill, often retain, and apparently absorb a considerable portion of quinine given in an enema. Wherever the tropical sun shines there will be malaria, and where malaria is, there will be disease. Quinine is nature's supplied remedy against malarial disease,
and too much importance cannot be attached to every connected with its administration.
point
Deaths in the Town of Madras.?The returns for the month of September show: ?19 deaths from small-pox, 7 from measles, 182 from fever, 96 from dysentery, 83 from diarrhcraa, 8? from cholera, and 68 from other diseases?in all, 1,120, of which 529 are males and 591 females. As with compared there is an excess of 54 deaths, August, small-pox and cholera an increase of 11 and 42 respectively. showing
[November 1,
1871.
system on any extended scale, as most of the troops are black and less liable to the influences of climate, but even there, from observations on the effects of the prophylactic system white non-commissioned officers, and the European on the
favorably of its effects. battery of Royal Artillery then Indies, a station which up to that date bore a rather favorable reputation for health. During the rainy season of 1868, I gave quinine as a prophylactic to the men of the battery under my charge at the rate of grs. ii every day, during the months of September and October, and, as far I could judge, with marked benefit. The surgeon of the European regiment quartered at the station disagreed with me, and held to the theory of the quinine iosing its effect on the system when administered for any length officers, I
was
led to
judge
most
In the year 1865, I joined a quartered at Jufcbulpore, East
of time, and that when the attack of malarious fever did come, quinine failed to cure the disease with the same rapidity
that
it would have done had the system not been saturated with it. This opinion I could not concur in, and found no such results follow. On the contrary, I had fewer men attacked in proportion, and the cases in my battery were all of a mild type, seeming to yield as easily to large doses of quinine, as they would have done if it had not been given in the small daily doses. Next year, 1866, the 23rd R. W. Fusiliers arrived, and were quartered in the same barrack with the Royal Artillery, my " hospital being part of theirs. The surgeon of the Royal Welsh" held different opinions to his predecessor as to the advisability of giving quinine as a prophylactic, and we both applied for permission to do so. In those da}-s, the issue of stores and medicines to European troops rested with the administrative officers of the Indian Medical Service, and on application being made for a supply of quinine for the purpose, it was refused, as not being considered necessary. Having but a small number of men, some 135, and being in possession of a rather large stock of quinine, so fully impressed was I by the advantages of the system, that I took it upon myself It was to issue it at the rate of grs. iii every second day. given before breakfast, just after the men came off parade, and was issued in the form of a solution with a little sulphuric acid. The wet season of 1866 happened to be a most malarious one, as the 23rd Regiment soon knew to its cost. Malarious fever of a severe remittent type attacked the regiment, and shortly, out of a force of some 500 men, there were at one time 150 in hospital. In addition to this about 150 men who were convalescent from the fever were encamped on a hill close by. The regiment was so reduced in numbers that all parades were stopped, except those absolutly necessary, and really few men The number of deaths I cannot were fit for duty. remember, but I think they were about 20. The surgeon of the regiment and both of his assistants were ill, (one of the latter died,)
THE INDIAN MEDICAL GAZETTE.
2C4 and the
regiment devolved on me for a short time, a comparison between the two bodies of men. During this period the health of the battery remained remarkably good, only an average of about 4 per cent, being in hospital. The cases of fever were few, and of a mild type, and not a single death took place. When the above state of affairs became known, quinine was then, so to speak, showered on us; every post for days brought in a parcel of it, and it was issued to the men of the regiment so
charge
that I
was
of the
able to draw
with undoubted benefit: this was not so appai'ent under the circumstances, as the men had now become saturated by the malaria, still it did act beneficially: the cases became fewer
in number, and of a milder type. Ever since that year I have been in the habit of carrying out the same plan, and last year made some comparative experiments between the values of quinine, cinchoniue and quinoin the Indian Medical Gazette. The which I
published
dine,
result of the
experiment was phylactic, then quinine, and at
place cinchonine first as a prolong interval came quinodine. plan somewhat, and instead of a body, only give it to those
to a
This year I have modified my to the men in who are liable to attacks of malarious fever, but rainy season is nearly over, I purpose issuing it
issuing quinine
as soon as as
the
before, viz.,
every day. tells me that the cases of fever are fewer, of a milder type, and more amenable to treatment, while the sequel?, such as enlargement of the spleen, dysentery, &c., are Much discussion has also arisen lately concerning most rare. grs. ii per
man
My experience
hypodermic administration of quinine, and despite all statecontrary, it is, I am satisfied, a mode of treatment that will now become general. The injection of quinine under the skin is of great value in certain cases: such as in great irritability of stomach, and in cases where head symptoms are present, and the patient cannot be got to swallow; also in the treatment of insolation, but as a general mode of treatment it will never be popular. In the first place it requires to be done with care, and requires skilful hands i next, it is more or less painful, and where women or children are concerned, that will always be a great objection, and most important of all, the operation is frequently followed by very ugly sloughing. In several cases I have seen a slough of nearly an inch in diameter, and involving the cellular tissue, separate after the use of the hypodermic syringe. Why is it quinine is so seldom (comparatively) given 'in pills ? People object to the bulk of them very often, but if quinine be first well triturated in a mortar so as to break up its crystal form, and then rubbed up with a saturated solution of citric acid, it will form pills that contain 5 grains of the drug, and not be larger than ordinary; even to young babies I give quinine in pills; well worked up as above, ? a grain of quinine forms a pill about the size of a No. 4 shot, and when feeding the child with a spoon, it is easy to drop one in, and the
ments to the
let it be swallowed with the food.
Another method of adminis-
tering quinine, and one not nearly so often practised as it might be with advantage, is per rectum, and young children, who reject it from the stomach, even when given in the form of a pill, often retain, and apparently absorb a considerable portion of quinine given in an enema. Wherever the tropical sun shines there will be malaria, and where malaria is, there will be disease. Quinine is nature's supplied remedy against malarial disease,
and too much importance cannot be attached to every connected with its administration.
point
Deaths in the Town of Madras.?The returns for the month of September show: ?19 deaths from small-pox, 7 from measles, 182 from fever, 96 from dysentery, 83 from diarrhcraa, 8? from cholera, and 68 from other diseases?in all, 1,120, of which 529 are males and 591 females. As with compared there is an excess of 54 deaths, August, small-pox and cholera an increase of 11 and 42 respectively. showing
[November 1,
1871.
