THE PROPHYLAXIS OF MALARIAL FEVER. In his
of the most
one
volume
new
"
interesting chapters
Traite dib
Laveran discusses this such vital importance to tion of the
Paludisme,"
question
which is
of
in India.
The ques-
of malaria
naturally
us
prophylaxis
of
Mons.
divides itself into two sures
which have for
parts?firstly, the meatheir aim the combating and of making localities
of endemic malaria healthy in which malaria is prevalent; and secondly, individual prophylaxis, that is, how to preserve from paludal fevers those persons
who
are
permanentl}7",
compelled, to reside
Mons. Laveran
in
either temporarily or a malarial country.
is it possible healthy in which paludism has reigned with intensity ? The answer is of course not doubtful; he quotes the examples of many places in England, Ireland, United States, &c., where districts, formerly noted for malarial fever, are now healthy. This of course is due to drainage of the soil, cultivation, &c. He also
begins by asking:
to make localities
points to many instances where the drainage of marshes has resulted in rendering large areas of land fertile and healthy. We do not intend this part of the subject, but in passthat Mons. Laveran gives mention ing may numerous cases in which the planting of euto linger
on
trees has had a most beneficial effect of the district. Of late years, the health on the has been specially recommended for eucalyptus this purpose, and it is certain that notably in Corsica and Algeria the planting of this tree has
calyptus
had excellent results.
As an example may be of the Trois-Fointaines convent quoted This convent had near the .Roman port, Ostia. the
case
been for many years abandoned, and had acquired the significant local name of the Tomb. In 1868, the Pope Pius IX gave over this convent and its
grounds
to the
Trappists.
Even that
band of monks would not live in it at
hardy night, but eucalyptus trees were planted on a large scale, and in a few years the improvement in health was so great that the monks no longer the
course
calyptus
in
the convent at night. In of the next 10 years, over 25,000 eutrees were planted, and now the con-
dreaded to
sleep
Frb.
THE PROPHYLAXIS OF MALARIAL FEVER,
1898.J
65
lost its old reputation as a a low death-rate and two very healthy years fever-stricken house. There was a time when (1895 and 1896). The past year 1897 has generbeen a malarious year, and should prove to it was believed that this rapidly-growing tree ally be a test year for deciding in one way or another was destined to do wonders in malarious parts the value of this prophylactic in our jails. Mons. of India, but we are acquainted with no instances Laveran of its success in India. We gives a complete history of the use of may note, however, that the more common tree, the Eucalyptus quinine as a preventative, illustrated by numerglobulus, is far from being a hardy tree, it needs ous examples taken from the history of the Ro}'al a good soil and is for growing in damp soil Navy and English Army and mors recently from French experiences in Algeria and other parts of inferior to the E. rostrata, which is now greatly Africa. Quinine was first used as a prophylactic used in its in has
vent
entirely
place, especially
We must
now
Algeria.
pass on to the of individual
more
practical points against malarial fevers. In the first Laveran points out that, where possible, expeditions or exploring parties should choose the
non-malarial
country,
season
for
and he of
following expedition
entering
a
malarial
cites, as an example of the wise this advice, the British Ashanti
in 1895.
Count of Bouneral at the seige of is impossible for us to follow
in 1747
by the It prophylaxis Belgrade. Mons. Laveran place, Mons. still
He shows that the
expedi-
tion took
place in the non-feverish month of March, and that steps were taken so that the troops did not stop even an hour on the sea-coast but proceeded up-country at once, all the heavy baggage being carried by natives of the port.
we
in
interesting account, but the vast majority of cases,
his
may note that in
opinions quoted are entirely in favour of this use of quinine. The examples quoted are numerIt is impossible to doubt ous and well selected. the
the conclusions drawn mous
salts
the
by
large
number of
practically unaniThey great prophylactic value of the of quinine, and the}7 point out (and with this
writers
all
are
quoted.
about the
recent
jail experience
in
Bengal agrees),
that
where there has not been a marked prevention in the number of cases admitted, yet
even
there has been a very real benefit derived from fever were all of a great healthiness the fact that the cases of of this well-managed expedition with the disas- mild type and attended with but little mortality. This is exactlj7 what we learn has occurred in trous of the French in He admits
that it is not
to French
flattering
amour-propre to contrast the
bungling
troops
Madagascar
year. He next points out the value of hill stations for European troops, and laments the absence of them in the French tropical in the
same
colonies.
He shows also the
danger
of being out-
of the
one
the
large
central
jails
past
many observers, quoted attention to this point.
in
Bengal during
It is remarkable how
malarious year.
by
Mons.
draw
Laveran,
As Laveran says, it is not difficult to account climes, and also for this action of quinine. The microbes of the absurdity of putting European troops on such in the blood of a person taking work as digging and clearing land, which could be paludism find, a milieu little favourable to their quinine, natives the done with much greater impunity by
of-doors after sunset in malarial
of boiled water, coffee and tea, and the ill-effectsof alcohol in tropical climates are next touched upon, as well as the importance of a suitable head-dress for marching in the sun. of the place.
The
use
the question of the use of quinine There are few of our readeis as a prophylactic. of who have not had some experience of the use We
now
come to
resume
drug as a prophylactic. For a good the question, we may refer to Surgn.-Mnjoi
this of
of Andrew Duncan's article in the transactions the first Indian Medical Congress. Our readers of the gigantic experiments are also aware in which have, for three years past, been going on The India. of the jails of most of the provinces has ceruse of cinchonidine as a
prophylactic
tainly coincided
in
Bengal jails
at least
with
development. are two
Our author
points
out that there
methods of giving
quinine prophylactically, viz., in daily small doses (3 to 5 grs.), or in larger doses twice or once a week. He prefers the small daily dose as likely to be the more effective.
As to the method, of giving the druo\ are an excellent way, but where this is not possible, he advocates giving it in solution in wine, not in coffee, with
pills,
if
o
O
o'
freshly made,
along
food.
Cu riously its exhibition with sulphuric acid or lime juice he does not mention at all.
Laveran also alludes
arsenic, formerly
to the
prophylactic
use
of
strongly advocated by Tommasi-Crudeli; he considers arsenic, both from a curative and prophylactic point of view, to be inferior to quinine. He alludes to the compaso
INDIAN MEDICAL GAZETTE.
66
immunity against malaria enjoyed by eaters, but naturally is not inclined advocate the use of opium for this purpose.
rative
Indian to
opium
He has also use are
some
amusing remarks upon the if theoretically useful,
respirators, which, practically impossible of
and absurd.
We may now conclude by pointing out the very decided support given to the practice of
using quinine
or
great
of Laveran.
the very We authorit}" may express a that the on this information valuable hope very to collect from which it be must point, possible
our
Indian
jails,
are
such
prophylactic by
will not be lost to the
The terms of this
jails
a
that,
gigantic experiment from them
decision should be able to be of the
salts
of cinchona
against malaria.
an
a
in the
authoritative
given as
public.
on
the
use
prophylactic
[Feb.
1898.
of the most
one
volume
new
"
interesting chapters
Traite dib
Laveran discusses this such vital importance to tion of the
Paludisme,"
question
which is
of
in India.
The ques-
of malaria
naturally
us
prophylaxis
of
Mons.
divides itself into two sures
which have for
parts?firstly, the meatheir aim the combating and of making localities
of endemic malaria healthy in which malaria is prevalent; and secondly, individual prophylaxis, that is, how to preserve from paludal fevers those persons
who
are
permanentl}7",
compelled, to reside
Mons. Laveran
in
either temporarily or a malarial country.
is it possible healthy in which paludism has reigned with intensity ? The answer is of course not doubtful; he quotes the examples of many places in England, Ireland, United States, &c., where districts, formerly noted for malarial fever, are now healthy. This of course is due to drainage of the soil, cultivation, &c. He also
begins by asking:
to make localities
points to many instances where the drainage of marshes has resulted in rendering large areas of land fertile and healthy. We do not intend this part of the subject, but in passthat Mons. Laveran gives mention ing may numerous cases in which the planting of euto linger
on
trees has had a most beneficial effect of the district. Of late years, the health on the has been specially recommended for eucalyptus this purpose, and it is certain that notably in Corsica and Algeria the planting of this tree has
calyptus
had excellent results.
As an example may be of the Trois-Fointaines convent quoted This convent had near the .Roman port, Ostia. the
case
been for many years abandoned, and had acquired the significant local name of the Tomb. In 1868, the Pope Pius IX gave over this convent and its
grounds
to the
Trappists.
Even that
band of monks would not live in it at
hardy night, but eucalyptus trees were planted on a large scale, and in a few years the improvement in health was so great that the monks no longer the
course
calyptus
in
the convent at night. In of the next 10 years, over 25,000 eutrees were planted, and now the con-
dreaded to
sleep
Frb.
THE PROPHYLAXIS OF MALARIAL FEVER,
1898.J
65
lost its old reputation as a a low death-rate and two very healthy years fever-stricken house. There was a time when (1895 and 1896). The past year 1897 has generbeen a malarious year, and should prove to it was believed that this rapidly-growing tree ally be a test year for deciding in one way or another was destined to do wonders in malarious parts the value of this prophylactic in our jails. Mons. of India, but we are acquainted with no instances Laveran of its success in India. We gives a complete history of the use of may note, however, that the more common tree, the Eucalyptus quinine as a preventative, illustrated by numerglobulus, is far from being a hardy tree, it needs ous examples taken from the history of the Ro}'al a good soil and is for growing in damp soil Navy and English Army and mors recently from French experiences in Algeria and other parts of inferior to the E. rostrata, which is now greatly Africa. Quinine was first used as a prophylactic used in its in has
vent
entirely
place, especially
We must
now
Algeria.
pass on to the of individual
more
practical points against malarial fevers. In the first Laveran points out that, where possible, expeditions or exploring parties should choose the
non-malarial
country,
season
for
and he of
following expedition
entering
a
malarial
cites, as an example of the wise this advice, the British Ashanti
in 1895.
Count of Bouneral at the seige of is impossible for us to follow
in 1747
by the It prophylaxis Belgrade. Mons. Laveran place, Mons. still
He shows that the
expedi-
tion took
place in the non-feverish month of March, and that steps were taken so that the troops did not stop even an hour on the sea-coast but proceeded up-country at once, all the heavy baggage being carried by natives of the port.
we
in
interesting account, but the vast majority of cases,
his
may note that in
opinions quoted are entirely in favour of this use of quinine. The examples quoted are numerIt is impossible to doubt ous and well selected. the
the conclusions drawn mous
salts
the
by
large
number of
practically unaniThey great prophylactic value of the of quinine, and the}7 point out (and with this
writers
all
are
quoted.
about the
recent
jail experience
in
Bengal agrees),
that
where there has not been a marked prevention in the number of cases admitted, yet
even
there has been a very real benefit derived from fever were all of a great healthiness the fact that the cases of of this well-managed expedition with the disas- mild type and attended with but little mortality. This is exactlj7 what we learn has occurred in trous of the French in He admits
that it is not
to French
flattering
amour-propre to contrast the
bungling
troops
Madagascar
year. He next points out the value of hill stations for European troops, and laments the absence of them in the French tropical in the
same
colonies.
He shows also the
danger
of being out-
of the
one
the
large
central
jails
past
many observers, quoted attention to this point.
in
Bengal during
It is remarkable how
malarious year.
by
Mons.
draw
Laveran,
As Laveran says, it is not difficult to account climes, and also for this action of quinine. The microbes of the absurdity of putting European troops on such in the blood of a person taking work as digging and clearing land, which could be paludism find, a milieu little favourable to their quinine, natives the done with much greater impunity by
of-doors after sunset in malarial
of boiled water, coffee and tea, and the ill-effectsof alcohol in tropical climates are next touched upon, as well as the importance of a suitable head-dress for marching in the sun. of the place.
The
use
the question of the use of quinine There are few of our readeis as a prophylactic. of who have not had some experience of the use We
now
come to
resume
drug as a prophylactic. For a good the question, we may refer to Surgn.-Mnjoi
this of
of Andrew Duncan's article in the transactions the first Indian Medical Congress. Our readers of the gigantic experiments are also aware in which have, for three years past, been going on The India. of the jails of most of the provinces has ceruse of cinchonidine as a
prophylactic
tainly coincided
in
Bengal jails
at least
with
development. are two
Our author
points
out that there
methods of giving
quinine prophylactically, viz., in daily small doses (3 to 5 grs.), or in larger doses twice or once a week. He prefers the small daily dose as likely to be the more effective.
As to the method, of giving the druo\ are an excellent way, but where this is not possible, he advocates giving it in solution in wine, not in coffee, with
pills,
if
o
O
o'
freshly made,
along
food.
Cu riously its exhibition with sulphuric acid or lime juice he does not mention at all.
Laveran also alludes
arsenic, formerly
to the
prophylactic
use
of
strongly advocated by Tommasi-Crudeli; he considers arsenic, both from a curative and prophylactic point of view, to be inferior to quinine. He alludes to the compaso
INDIAN MEDICAL GAZETTE.
66
immunity against malaria enjoyed by eaters, but naturally is not inclined advocate the use of opium for this purpose.
rative
Indian to
opium
He has also use are
some
amusing remarks upon the if theoretically useful,
respirators, which, practically impossible of
and absurd.
We may now conclude by pointing out the very decided support given to the practice of
using quinine
or
great
of Laveran.
the very We authorit}" may express a that the on this information valuable hope very to collect from which it be must point, possible
our
Indian
jails,
are
such
prophylactic by
will not be lost to the
The terms of this
jails
a
that,
gigantic experiment from them
decision should be able to be of the
salts
of cinchona
against malaria.
an
a
in the
authoritative
given as
public.
on
the
use
prophylactic
[Feb.
1898.
