The observations of the writer in the different
districts led to the following conclusions with
reference to the etiology, prophylaxis and treatment
of malaria.The most important factors in the etiology of
the disease were the canal irrigation, and the condition
of the houses and forts. No material progress
can be made in lowering the incidence of
malaria in Central and 1orthem India until canal
irrigation is controlled, and, if necessary, prohibited
in the neighbourhood of towns. The condition
of the habitations of all classes of people
calls for great improvement. Old forts and barracks
situated in malarious places should be pulled down
and rebuilt on healtkrsites.As regards the prophylaxis of malaria in India
the only measures which have a general application
are those which aim at the destruction of the mosquito.
General quininisation of the infected
population is impracticable, and screening has only
a limited application. In areas of low endemicity
minor measures will suffice, if efficiently and
thoroughly carried out. The small incidence of
malaria should be no excuse for the relaxation of
antimosquito measures. In regions of moderate
and high endemicity major measures are usually
necessary in addition; and of these drainage and
the control of canal irrigation are the most important.
Until these measures have been carried out
screening has an important place in the prevention
of malaria among Europeans and better class Indians.
The screening of houses, barracks and forts is of
small use unless the buildings themselves are in a
sufficiently good state of repair to render such
screening effective in excluding mosquitoes. On
Frontier campaigns the use of bivouac nets and mos-
quito-proof huts would do much to lessen the incidence
of the disease. Prophylactic quinine has a
definite place in the prevention of malaria in India.
It is indicated particularly for administration to
troops and Europeanson Frontier campaigns and in
hyperendermic areas; and, though attacks of
malaria may not be prevented by the use of prophylactic
quinine under such circumstances, they are
rendered less severe and are less liable to become
pernicious.
TheThe treatment of malaria is true prophylaxis
and can be summarised in one word - quinine. The
drug should be given by the mouth in ordinary cases.
The maximum safe dose of quinine for India is 30
grains a._day and rest is essential while large doses
are being taken. Quinine orally administered in
the form of a Standard course does not prevent reinfection
in hyperendermic areas. Intramuscular
injections of cuinine are of use in the treatment
of severe cases, and of those unable to take quinine
orally, and in selected cases give good results.
Intravenous injections are safe and effective in
skilled hands and are indicated in pernicious cases
and where a speedy effect is desired, but the method
is unsuitable for general use in India. The transient
effect of intravenous injections necessitates
a supplementary course of oral quinine. Rectal
injections of quinine are uncertain in their action,
but have given good results under the supervision
of the writer. Subcutaneous injections cannot be
recommended. No drug treatment of malaria is
successful unless the resistance of the patient is
maintained or increased by rest, nourishing food, and
general tonic treatment.The pernicious forms of the disease are most
common in times of hardship and strain, as on active
service. Cerebral cases are most likely to occur
during the hot weather, and in subjects of latent
malaria who are not taking quinine and are performing
strenuous exertion in the heat of the day.Abdominal and pulmonary types of malaria are
more prevalent during the autumn months. Benign
tertian malaria is more resistant to quinine treatment
than malignant tertian, and early diagnosis
and early treatment of all cases is essential.The eradication of malaria in India can only be
attained by constant and scientifically applied
warfare against the mosquito. The malaria carrying
anopheles of every district must be identified, their
breeding places mapped out, and measures taken to
destroy them. By general improvement of the housing
conditions the possibility of the hibernation of
adult mosquitoes will be lessened. As in other
countries, education should hold a prominent place
in the prevention of the disease. Coincident with
general education a practical knowledge of malaria
should be imparted to every scholar. The progress
of education among the indigenous masses of India
is necessarily slow, but it is proceeding gradually.
The prophylactic measures adopted by the Europeans
and educated Indians should form an object lesson
to the uneducated classes. Agriculture should be
encouraged and the conditions of the peasant improved;
for agriculture scientifically carried
out prevents malaria and the consequent prosperity
of the agriculturalist renders him less liable to fall
a victim to the disease. It is true that the wholesale
eradication of malaria will take many years,
out the time can be shortened and the incidence
lessened by vhole- hearted efforts to prevent the
disease. Antimalarial measures may seem costly,
but the disease is still more costly, and antimalarial
measures alone will render India, with
its unlimited vealth and resources, a healthy and
prosperous country
