The daily morning journal and courier., 1898-08-31

| known, saVant, it would probably be l treated with little or no respect. Now, however that the subject has been | brought forward so prominently, 1t is
 to be hoped that 1t will receive, from those qualified to investigate such mat ters, the consideration 1t deserves, According to Professor Koch the treat | ment of malarial fever by quinine has I been so overdone as to cause in many cases the even more pernicious black | water fever Whether quinine is or Is not the cause of black-water fever,
 there can be no doubt that it is frequent ly given in very large doses, and is ot-
 ten taken far more indiscriminately
 than it should be. The drug first came | into great prominence as the specific | for malarial fever. A few years ago, in
 many cases, it had to take a second | place to arsenic-not that 1t was interi- or, but because it's cost put it out of the 1 reach of many. Now 1t can be obtained at such a reasonable price that 1t has
 to some extent displaced arsenic, and
 nobody going to the tropics has any
 reason now to consider the relative eX- l pensiveness of the two drugs. It is in 1 many instances not only taken in large doses but also as regularly as food, with the object of impregnating the system, and thereby rendering it proof against the ravages of malaria. Whether such course succeeds or not, the person who takes quinine in this wholesale manner feels at ease, since he is under the impression that he has done all he can in what is generally &C., cepted as the right direction. For it must be remembered that at present there is no check on the promiscuous | use of quinine by those who know very little about all it's properties. The wri- ter, who has had many years expert
 ence in malarious countries, and en- | joyed numerous opportunities of ob- | serving the treatment of malaria, is, however, emphatically of opinion that | the object desired by the habitual con- | sumer of quinine is not attained. Those l who saturate their systems with the | drug die in the same way as those who | do not, and, as a matter of fact, close | observation goes to prove that the reg ular use of quinine is almost entirely | confined to persons comparatively new | to malarial regions, and that, if the | consumer survives, the tendency is to leave 1t off as experience is gained.
 Taken in excess, quinine can be poi
 son, like everything else, and often pro- l duces cinchonism. A subject getting a
 bad attack of fever, who is already de- | bilitated by the use of quinine, and in
 many cases also by anti-pyrine and l anti-febrin, is weakened stfll more by
 the effects of the fever and increasing | ly heavy doses of the remedies are re-
 sorted to. Is it any wonder, therefore,
 that in the great majority of cases
 where death occurs the actual cause is l assigned to failure of the hearts ac-
 tion?" In partial support of this argu-
 ment it may be pointed out that the
 mortality in certain portions of West l Africa, for instance, is greater now
 than formerly, although the conditions
 of life have been vastly improved. If l Professor Koch's theory be correct, the fact that quinineis so much more within
 reach of every one, and as result is
 far more used, may be some explana-
 tion. Besides being cheaper, the drug
 may now be obtained in forms that
 render it less distasteful. Thus, tab-
 loids are not so unpleasant as the so-
 luble forms of quinine, and, if sugar. i coated, have no taste at all, while they
 are more easily carried about. Again,
 1t has been found that women are una
 ble, for various reasons, to take quinine l in the same wholesale way as men.
 And yet the mortality among women on the west coast of Africa is infinitely
 less, in proportion, than that of the 1 other sex
 Ma1arial fever in pernicious climates, 1 In subjects not accustomed to the ha | btual use of quinine, has, where no
 complications have existed, been coped with by doses not exceeding thirty
 grains in the twenty-four hours, and
 that in cases where the temperature | has risen to one hundred and four and
 one hundred and five degrees; while in
 cases of remittent fever, where quinine
 has proved intellectual. arsenic given
 regularly in moderate doses has often proved successful. Apart from the
 quantity of quinine which may be in a
 persons system, perhaps unknown to
 the medical attendant, in ordinary | cases of fever on the west coast, fifty,
 sixty, or seventy grains, or even more, | in twenty-four hours is no uncommon
 quantity to be administered, even to a
 new subject. But on this point one 1 fact must be conceded, viz. that the | progress of malarial fever on the west
 coast of Africa is more rapid than in
 many other nlalarial regions, and dras- | tic measures are necessary. But, as | the mortality has increased notwth
 standing, the problem suggested for so
 lution is, why do some live and some
 die when all climatic and other condi-
 tions are apparently equal? For ex
 ample, putting aside the question of | quinine, why is it that as before stated,
 women stand the West African climate
 better than men? During the appalling mortality on the Gold coast within the l past four years, there was hardly death among the women living out
 there, while every kind of man was l dying-men new to the tropics, men al-
 most born in them, men who had been
 accustomed to them for years men | who had battled with the ravages of l West Africa itself for upward of ten years. How is it that, with all the ad
 vantages given to government officials l in the way of unlimited free medicinal | attention and exceptional leave privi- leges, the death and invaliding rates | among that class have been far in ex- | cess of those of the mercantile corpnu-
 nity, who invariably have, owing to
 their vocation, to live in the more un-