INDIAN MEDICAL GAZETTE.

98

ON

THE

PROPHYLAXIS

OF

MALARIAL

FEVERS.* By Surgeon-Major A.

I propose, with

Duncan,

regard

ji.d., b.s., f.r.c.s.

to the

prophylaxis

ot

short resumd of the opinions of medical officers of our own and other countries ; and, secondly, to narrate the results of my own experience. I do not intend to enter into the points of prevention, such as are involved in the disposal of men's bodies at night at a distance above the ground, in their dress, etc., but to restrict myself to the question of preventative drugs and other ingesta. The evidence, as we shall see, is somewhat contradictory as regards any efficacy derived therefrom. Amongst the French physicians, M. Corre holds it still unproved that that method of keeping the Organism impregnated with drugs intended to kill the malarial organism directly it gets into the body or to modify the latter so as to render it insensible to its action, is established. He, however, considers that such a course is feasible under the daily exhibition of tea, or small doses of quinine given at the beginning of the malarious season, or whenever troops are operating in a malarious country. At any rate, such means will diminish the chance of infection. They will not, however, be of any avail against the more pernicious forms of fever.

malarial fevers, to offer, first,

a

M. Marvaud recommends tea, coffee and small doses of alcohol, and states that a daily ration of quinine during the Niger Expedition gave good results, except as regards the gravest forms of malarial fever. MM. Kelsch and Kiener state that the officers of the French marine favour the exhibition of quinine. But their experience as regards the severe forms met with in the Niger Expedition Marvaud. They, agree with those narrated by M. the on whole, however, prefer the exhibition of coffee, tea or small doses of alcohol. That the latter gave better results than quinine, and moreover did not habituate the organism to the effects of this remedy and thus render it insensible to its action when required to combat the actual onset of malarial fevers. M. Thorel found successful results in Mekong. M. Bizardel even found it admirable in warding off attacks of pernicious ague.

The Austrian and Russian surgeons, however, found no advantage to arise from the prophylactic use of quinine on the Danube or the Caucasus. In Poland quinine was given with good results to the soldiers posted in bad malarial spots ; 736 soldiers were lodged in the same barrack, 500 of whom took quinine, with attacks of malarial fever in the proportion of 18 per cent., whilst the remainder, who had not taken it, were attacked in the proportion of 28 per cent. Read at the Indian Medical

Congress, December, 1894.

[March

1895.

Coming now to the Italian physicians notable results have been obtained by Tommasi Crudeli. This physician experimented with other drugs than quinine. In 1880 he began to try the effect of arsenic with encouraging results. Dr. Ricchi in 1883 gave it to 78 persons in the district of Borino, where malaria is very rife ; of the 39 who took it 36 escaped entirely, while the three remaining had only slight attacks ; of the 39 who did not take it the great majority had severe attacks of fever. Again, in 1885, 657 persons were experimented upon. Of these 402 gave good results, 119 pretty good, whilst the effect was indifferent in 136. Dr. Crudeli also speaks highly of a decoction of lemon. Such therefore have been the results obtained by our continental brethren. With regard to America we have the experience derived from the War of the Succession. Surgeon Bryan found quinine and cinchona to be sure prophylactics, but in all cases the experience of this war did not show that the indiscriminate use of quinine as a prophylactic was necessary. When men were exposed in a specially dangerous locality it was recommended, provided they were only located here for a short time ; but if the locality were occupied for a lengthy period the results On the whole in this war, were not so good. however, the reports are almost all favourable to this method of treatment.

Coming now to our own countrymen, BrysON reported excellently on the prophylactic effects of quinine. On the West Coast of Africa, on the

Gambia, Harvey found, however, no good results The blue jackets who took quinine to occur. daily had as much fever as the men who did not. The late Surgeon-Major Parke ten days before entering the mouth of the Congo, gave the officers four grains of quinine three times a day. There were only two cases of slight intermittent fever, although 350 miles of the most unhealthy region No other white man had were passed through. travelled the same country with the same previously immunity. My late friend, Dr. Ralph Leslie, whilst acting as Government medical officer in the Congo Free State, gave a protracted administration of arsenic, by interrupting it during fifteen days every six weeks. Every one who had gone regularly through the cure was preserved from Dr. Cross of the Niger severe attacks of fever. Company has again had favourable results from the exhibition of quinine. At Peshawar, 1866, during the autumn the different corps were divided into wings, the men in one wing having five grains every evening, the men in the other having none. From September 1st to November 30th 1,203 men took quinine, with an admission into hospital of 10*22 per cent, for malarial fever ; 1,202 men who took no quinine had an admission rate of 27*28 per cent, of fever. There is, however, evidence of a contrary kind# Sir Anthony Home did not consider quinine Thus I

March

DUtfCAN ON THE PROPHYLAXIS OP MA.LA.IMAL FEVERS.

1895.]

99

Here again, therefore, arsenic effected no In the Malay effect; if anything, the Companies not prophylactic a daily issue of three grains was ordered. taking it were rather freer from malarial fever. The Goorkhas did not receive the ration, and yet Thus the malarial fevers in India are either not so they suffered only very slightly more than The amenable to prophylaxis by arsenic as those of Buffs who took it. But among The Buffs, the or else the form in which the preparation malarial fever which did attack the corps appeared Italy, was given was the cause. Tommasi Crudeli does one month at least after they had been regularlv not recommend the liquid preparation of arsenic, but taking it. the drug in the solid form in gelatine tablets. gives I am afraid, gentlemen, I have wearied you with With regard to quinetum, the Companies taking this recapitulation of the result of prophylactic it were unfortunately placed on it from October issues. I will, therefore, conclude my paper with 11 to the end of the month and, not having a brief resume of the data I have myself gathered had any prophylactic previously, the results obviin this direction. The men from whom my results are not sufficient to draw any conclusion from. ously have been obtained are Sikhs and Goorkhas. of quinine and cinchona, Turning"now" to the"effects Therefore no disturbing elements due to race or " A and B Companies from August febrifuge. station are involved. They have all been at the 2nd to October 31st took respectively 3 grains, time of the same race and of the same station. in the last week to 5 grains of quinine The drugs I have given have been quinine, quine- increasing and cinchona febrifuge. Up to the week ending " " " " " " tum, cinchona febrifuge, cinchonidine, sulphur, October G and " H F, 10th, when E, arsenic and atees. Atees, I may mention, I chose, took quinetum, the results were :? as, on enquiry from my Hospital Assistant, I found " 10 cases malarial fever. this was a favourite drug among the native com- A" Coy. taking quinine "B" C. F. ? taking munity for ague. ?E? I With regard to arsenic, I have derived no ? j1? 110 drug " G" f takinS benefit from it. During 1886 and 1887 I placed H" I) the men of the regiment I was serving with on a prophylactic ration of arsenic during the months Here we see, therefore, a decided prophylactic most iiable to malarial fever. effect was exercised. Finally, coming to the results In 1886 four Companies of the 23rd Pioneers obtained this year amongst the l-3rd Goorkha were ordered arsenic, commencing with 5 minims Rifles with quinine, cinchonidine, sulphur, arsenic twice a day, and finally taking 10 minims of the and atees I regret to say that I have none of any liquor three times a day. From August to De- value to offer. Almora seems to be remarkably cember there were total cases of malarial fever 54. free from fever. As a matter of fact, the admisIn the companies taking arsenic 28 cases occurred ; sions from fever have been remarkably small, and in the companies not taking it 26. the Companies not taking prophylactic medicine In 1887 the men of the 14th Sikhs were sub- have shared equally well as regards fever with jected to a similar treatment from September 20th those taking it. The result of my experience is, then, that of all to November 16th. The Right Wing took 6 minims of the liquor twice daily; the Left none. The the drugs named, quinine and cinchona febrifuge Right Wing had eight cases of ague ; the Left nine. are the only ones that have exercised any influIn 1889, whilst in charge of the 14th Sikhs at ence. By this means certainly a certain proporPeshawar, the regiment having suffered to an tion of men have been enabled to perform their unusual extent from malarial fever during the duties, and thus their services not lost to the army. again tried the pro- Under these circumstances I would therefore urge preceding year at Jhelum, Iacid from August 16th that in all campaigns involving a sojourn in a arsenious of effect phylactic 16th From to September malarious district, prophylactic issues of either of August to 'October 30th. " 15th " 0." and D." Companies took 7 minims of these drugs be ordered. Quinine is now manua day ; from September factured at a much cheaper rate than formerly, liquor arsenicalis twice this 20th was increased to 10 and the services of our men could thus, at a slight 15th to September minims ; from September 20th to October 7th the expense to Government, be preserved intact to the dose was 12 minims, and from the latter date to army operating in the field. October 31st the men took 15 minims twice a day. Compared with the Companies not taking any prophylactic, the results are as follows, the number of men in each Company being practically the same:? Malarial fever. " C" Coy. 24 cases. thus

given war, again,

to have had any value.

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