The diagnostics and treatment of tropical diseasesStitt, E. R. (Edward Rhodes)
Science
The diagnostics and treatment of tropical diseases
Stitt, E. R. (Edward Rhodes)
Tropical medicine
Of the greatest value have been the observations of Stott. Using
native Indian troops he gave one group (3931) prophylactic quinine
while the other (3906) did not take quinine prophylactically. He
continued this experiment one year giving 15 grains 3 times weekly
for five months, and 10 grains 3 times weekly for the remaining seven
months. Those taking quinine gave 170 primary admissions while those
not taking it gave 179 (43.2 per thousand strength for the former as
against 45.8 per thousand for those not taking quinine prophylaxis).
Further observations were that those taking quinine prophylaxis
showed a greater tendency to relapse, had somewhat longer fever, and
required more quinine for treatment.
Linnell states that he used quinine prophylaxis among 2000 coolies
for a year, giving 5 grains or more daily with most discouraging
results. It seemed to act as a slow poison and did not protect.
_Quinine Immunity._—Bignami thinks that malarial relapses
may be connected with insufficient initial treatment so that
quinine-resisting forms survive and later, when some factor lowers
the patient’s resistance, active multiplication of parasites, which
are not readily destroyed by quinine, follows.
While quinine prophylaxis may not be desirable on board ship, where
one is in a position to readily recognize and treat the onset
of malaria and to more or less efficiently carry out mosquito
protection methods, or in a wealthy seaport, where sufficient
interest in and funds for draining and screening exist, yet on
military expeditions or exploring trips in tropical or subtropical
countries it is the only practical method of keeping a force
efficient.
Of course, one should also utilize mosquito nets as assisting in
protection from malaria, and as effective for yellow fever, dengue
and filariasis.
_Methods of Prophylaxis._—There are innumerable methods of carrying
out quinine prophylaxis among which may be noted.
(_a_) Celli’s method. In this there is given 3 grains of quinine
each morning and 3 grains each night. Taken in this way Celli
thinks that harmful effects from quinine are avoided, that quinine
immunity does not occur and that there is no danger from quinine
haemoglobinuria. For children he recommends the tannate in
chocolate tablets.
(_b_) In 1909 Bertrand and other members of a French Commission
recommended two consecutive doses of 5 to 10 grains every
seventh and eighth day for benign infections and two consecutive
prophylactic doses of 10 to 15 grains every third and fourth days
where malignant tertian was prevalent.
(_c_) Ziemann gives 15 grains every fourth day with the idea that
the quinine is entirely eliminated in four days. Nocht gives about
12 grains on two succeeding days of each week in divided doses of
2 or 3 grains instead of the entire amount in one dose.
Koch gave 15 grains on tenth and eleventh days.
Public-domain text, read in full here on John Shaqi.
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