141
CHAPTER VI.
THE PLACE OF QUININE IN THE PREVENTION OF
MALARIA IN BOMBAY.
401. When considering the problem of malaria prevention in Bombay-
it is unnecessary to discuss the relative merits of quinine prophylaxis and
anopheline reduction because the facts described in detail in the chapters
dealing with " Malaria in Bombay " and " the Mosquitoes of Bombay " lead to
the conclusion that anopheline reduction is not only possible but comparatively
easy of accomplishment as far as the absence of physical obstacles in the city is
concerned. Moreover, as has been pointed out in a previous report, the general
conditions present are so favourable to the success of anopheline prevention
that the complete eradication of autochthonous malaria should be aimed at
rather than the mere mitigation of the disease.
402. This being so, the place of quinine in any scheme of malaria
prevention for Bombay should be a subordinate one. But it must be made
clear that this statement is in no sense a generalization. It relates only to the
Bombay City ; it is a conclusion arrived at as the result of careful investiga-
tion ; it is based upon the assumption that the end to be achieved is not the
mere palliation of malaria but the complete eradication of local sources of
infection; and should any scheme aiming at mitigation of malaria rather than
its complete control be finally adopted in the city, the question of prevention
by quinine treatment would require further consideration.
403. Shortly after the commencement of the investigation Captain
A, G. MeKendrick, I. M. S., who was then in charge of the work, proposed
that a distribution of quinine should be undertaken in certain malarious areas
in order to effect an immediate mitigation of the disease and in the hope of
preventing a recurrence of epidemic malaria in the following autumn. The
Municipal Commissioner supported his proposals, and as a result the Munici-
pality made a special budget grant to cover the cost of the measure. Two
medical men and ten compounders were placed in charge of the work of dis-
tribution which was commenced in April 1909. At first it was confined to the
treatment of children shewing splenic enlargement, but as a result of blood
examinations which shewed that children without enlarged spleen, and adults
also, harboured malarial parasites in almost as great a proportion as children
with spleen, after July 1909, treatment was extended to all who were willing;
and by the end of August between 4,000 and 5,000 people were in receipt
of the remedy.
404. Each compounder was given a certain area to cover and was supposed
to visit each house about three times a week. The use of sugar-coated tablets
was at first decided on, but there was some little delay in obtaining a supply
and for about ten weeks coated pills were used. The pills proved to be unsatis-
factory as it was found that many of the children did not swallow them; in
some houses they were simply put on one side and in other cases they were
thrown away ; but when the sugar-coated tablets arrived they appeared to be
much more acceptable than the pills, and they were taken readily both by the
small children and adults.
405. The following table gives particulars of the amount of quinine
distributed :—
April
May
June
...{
1,000
5,000
2,000
18,000
8,000
32,600
5 grains
2 „
5 „
2 „
Grains of
quinine.
5,000"
10,000
10,000
36,000
40,000
65,200
Total grains of
quinine.
=
15,000
=
40,000
= 105,200
B 136—36