September 15, 1900.]
it is an established fact that the soldiers who slept even a few feet above the ground escaped malaria whilst those lying on the ground suffered terribly. This would seem to bear out the author's remark that mosquitoes rise only a few feet above ground, but on the other hand we know as a fact that many persons sleeping in the second or third floors of houses are frequently attacked. The danger of disturbing soil (p.120, particularly during the warm season, the fact that chills bring out the latent plasmodia, as evidenced by the occurrence of fever on return to a cold climate, and the prevalence of fevers in draughty houses and exposed sites, seem to show that the mosquitos theory hardly accounts for everything. The author's statement that malarial attacks are more common, more severe, and more dangerous in young children than in adults is hardly borne out by facts. Children are certainly more susceptible, but fow practitioners here will recall many deaths from malarial fever in children.
Another statement that a malarial patient is dangerous to his neighbours, since he may spread disease (p. 121) if bitten by the proper mosquitoeshould be true in theory, but is not con- firmed by experience. The writer, for instance, has never known malaria spread through the wards of a hospital in this manner, nor have inquiries amongst other eastern practitioners elicited such facts. The assertion made in the old edition on the authority of Grassi and Faletti that the crescent body is a dis- tinct and independent species of parasite is now disproved by Ross's observations, which show that the destiny of these bodies are the formation of the flagellated body and certain spheres belonging to the special type of plasmodial in which the crescent occurs." It may be remarked that crescents occur only in the more severe forms of malarial fever.
There are numerous other interesting facts noted in connection with what may be termed the theory of disease, but we pass on to the prac- tical and probably more generally interesting portion of the book.
Our author notes that in India many cases returned as" Ardent Fever" are really malarial, a fact which can be readily demonstrated by the microscope; hence the necessity of every practitioner in the east being able to examine blood and intelligently deduce his diagnosis therefrom-most important too for the patient, as the treatment of the two forms of fever differ materially. He also points out that aphasia, an affection of the brain, occuring in malarial attacks, is due to parasites in the vessels of the brain, a fact already noted by Thin, who showed some beautiful specimens in the brain of a patient from South Africa.
A statement is made that Hæmo-globinuric fever, so common in Africa, occurs in South China. The writer in a long experience has never met such a case, except in those returned
from Africa and infected there.
An interesting fact is noted that, contrary to what might be expected, rapid anemia is out of proportion to the number of plasmodia found in the blood and an explanation is given that it is probably owing to the lowered haemo- globinuric value of the blood corpuscles. The writer can support this view, having lost a young patient living in a not markedly malurions district, whose death was due to extremely rapid blood deterioration, though the blood did not contain by any means numerous plasmodia.
On p. 97, an ingenious explanation of the pro- duction of haemo-globinaemia, is given, viz.. that on the breaking up of the plasmodia, in the ord- inary cycle of the fever a digestive agent, which it had previously used in absorbing individual blood- corpuscles, is set free and then runs riot amongst and attacks healthy corpuscles, setting free haemo-globin, thus producing one of the most dangerous sequele of malaria.
On p. 102, the author shows that our bodies contain a defensive agent which kills malaria, i.e.. phagocytes, which being let loose eat up the plasmodia. Our object should be to cultivate these beasties just as we would beas. That which promotes their well-being is warmth, rest, good food, the comforts of a hospital and the removal of the patient from the dis- trict or place where the opposing battalions are recruited; tonic influences, ie, good air and cheerful society help the phagocyte, depres sing influences, as a wetting, a surfeit, over- fatigue, anxiety, grief, favour the develop
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CHINÁ OVERLAND TRADE REPÓRT.
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ment of plasmodia. Our author in giving re- viz. that quinine acts best in solution, whilst commendations to the new arrival states that a warning is conveyed against antipyrin and one of the greatest causes of breaks-down in the phenacetin, "which are much abused in many East is that he (the new arrival) "will persist in malarial countries," which in these days of dietetic habits appropriate to his native land," tabloids and "every man his own doctor" which seems to be a thrust at overeating, but a should be noted. Quinine still holds its little further on he consoles us by stating: place as the most efficient remedy, but the well-fed stand the climate best; evon mo- its actual mode of action is as obscure as derate excess is better than underfeeding;" | ever." A small dose may start a malarial attack which may be the reason that a British work- a course of mineral waters or hydropathic treat- man will do twice as much work as a native.ment have the same effect, and the writer would Many persons think that because they have not add, though it is not mentioned by the author, fever they cannot suffer from malaria. The a good drinking bout will be a more efficient author (p. 107) shows up this fallacy and points factor in producing a good burst of malaria out how the plasmodia may go through its regular than all the other causes mentioned combined. course of rhythmical development without fever. On p. 139 the necessity of giving quinine The writer had under his observation for at once in any stage of grave fever is. months a patient who showed all the symptoms insisted on, a point which should be well digested, of malarial poisoning, but in whom most care- as so many wise women and "old hands ful thermometrical observation taken thrice daily that know everything" will shake their heads. never showed the least rise of temperature, yet at the doctor who orders quinine "when the whose blood, even on arrival in England, was fever is on.' swarming with plasmodia.
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"Drainage and cultivation are our strongest supports against the assaults of malaria." "By their means enormous districts formerly useless and pestilential are rendered healthy and produc- tive, and Drs. Stephens and Christopher in the very latest pamphlet on the malarial diseases of Africa point out the necessity of surface drain- age and the radical cure of pools, puddles and swamps as the most effective means of stamping out malaria. This furnishes a strong argument in the favour of the Jubilee Road, by means of which the D. P. W. proposes to abolish the malarial swamp at Aberdeen.
Other safeguards which the anthor points out are that houses should not be too exposed, that grass should be preserved, or if disturbed re- placed, that exposed soil should be covered with rammed clay or cement, that it is unwise to have flower beds, vegetable gardens, etc., near bedroom windows, or to allow water from bathrooms or cook houses to flow over the ground in the vicinity of the house, or to keep water unchanged in tubs or water-butts for mosquitoes to breed in." The authors have just quoted have proved that the neglect of these things and the filthy condition of the native hats are the cause of the severe form at fever found in Free Town (West Coast of Africa).
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The soil moreover should not be disturbed in the sickly season, nor should workmen employ- ed thereon be allowed to sleep near their works, a hint which might be taken by our military authorities, who lost many soldiers employed in making the new batterios between 1880-90. Bad water should also be avoid ed. Though there is no proof that malaria can be carried by this means, natives believe it can, and impure water is the paradise of anopheles, so the ignorant native may be right. Sunflowers, chrysanthemums and the eucalyptus globulus are supposed to be useful because the mosquitoes object to their smell; in fact, in the prophylax. is of malaria the mosquitoe turns up everywhere like King Charles's head. The author dog matises on p. 113, that if you have no mosquitoes malaria is also absent. At Capsuimoon lately a severe outbreak of malarial fever occurred amongst visitors there and the one good thing the sufferers could say about the place was there were no mosquitoes-we never had to use nets,"
We give the fact for what it is worth. Our author tells us (on p. 147) :-"Mosquito nets must invariably be used. Tea and coffee, very small doses of alcohol are decidedly of service. The writer's patients did not use the latter, hence perhaps the fover.
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Many persons vomit quinine as soon as taken and the author gives numerous remedies to overcome this idiosyncracy, but curiously enough does not mention the simplest mode of 'all, viz the hypodermic injection of quinine. It is clearly an oversight, as a few pages further 'on in connection with another matter it is noticed. Enchinine which is mentioned as being useful for children, is also fregnently well borne by adults, who cannot retain the ordinary quinine preparation. The use of salicylate of soda in the haemoglobinuric fevers of Africa is mentioned and it is a curious fact that many of tho unclassed fevers of Hongkong yield to this drug.
The writer believes that quinine is the most efficient drug, but cannot agree with the author that arsonic is useless in fever and only of bene- fit in the sequelao. In many cases where quinine has failed a combination of 14 Arsenic and Bark" (which contains many Alkaloids besides Quinine) has been found most efficient.
The consideration of the other subjects with which the author deals will be taken up later, but they have not the same local interest as the portion of the book with which this review deals.
W. HARTIGAN, M.D.
China and the Present Crisis. By JOSEPH WALTON, M.P. London: Sampson Low, Marston & Co.
MR. T. Walton's book shows too many proofs of having been rushed into print, in order to catch the public at a time when China occupios a good deal of their attention, to allow it to be of any permanent value. Besides eight months' travel through China, Japan and Corea does not elevate the traveller to the rank of an an- thority on these countries. We must, however, do him the justice to observe that he has in a painstaking manner collected from the best sources of information within his reach what- ever he could get on the subjects which he dis cusses. But why Mr. Walton elected to write the greater part of the book in short paragraphs with cross-headings over them, it is impossible to imagine. The result is that it looks like a scrap-book compiled from newspaper articles. He deprecates, it is true, any pretensions to literary form, but he would have done well to avoid giving his work an absolutely repulsive appearance.
With Mr. Walton's travel-notes and statis- tics we do not propose to deal here. The de- ductions which he made from them appear in his speeches in the House and public statements, to which we have drawn attention earlier in the year. Undoubtedly Mr. Walton did useful work at home by his persistence in calling attention to facts which ought to have been, but were not, well-known, and for this he deserves every credit. We propose to quote a few lines from the chapter on "The Present Crisis" and to give Mr. Walton's idea of what the ultimate settlement should be.
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The author points out that acclimatisation, ex- perience, i.e. not exposing onself and being care- fal to avoid chills, etc., and education, i.e. adopt ing the wisdom of others, together with an in- telligent adaptation of habits to climato are amongst the most powerful safeguards against malarial infection, and to support his argument he mentions the comparative immunity of Chi- nese from fever. This hardly tallies with the
"The Hongkong China Association," he says, Hongkong experience, where almost the first early in last year sent a communication to the warning of a house being unhealthy is that the Foreign Office strongly representing that trou- servants are down with fever and that blo was browing in China, and that an anti- “Missusee no can catchee new boy" "or cook, too foreign outbreak was almost certain to take muchee fear. Of course the less healthy con- place. They expressed their strong conviction dition of servants' quarter may partly account that it was of the highest importance that ade. for their greater susceptibility: In the chapterquate naval military forces should be concentrat on treatment, p. 131, a point of practicaled at Weihaiwei or Hongkong in order that interest long known to the writer is mentioned, they might be promptly availadle for the pro-
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