Some, reasoning from the toxic influence this drug exerts on many kinds of free amoebæ, say that it acts in malaria in the same way that is, as a direct poison to the parasite. They support this view by pointing to the degenerative changes, as evidenced by imperfect staining reaction, exhibited by such parasites as persist in the blood after administration of quinine has been commenced. Others maintain that it acts in stimulating the phagocytes, the natural enemies of the parasite. Some experimentalists allege, on the other hand, that it paralyses the white corpuscles. That quinine does not kill all blood protozoa is certain, for it has no effect on the hæmoprotozoa of birds and reptiles, or on the trypanosomes. Certain it is that in man, with the exception of the crescent body, it usually quickly causes the parasite to disappear from the general circulation. It is said by some to be most effective against the free spores and the very young intracorpuscular forms, but inoperative against the more mature parasites; hence they advocate giving it early in the parasitic cycle. Others, on the contrary, maintain that it is operative only on the large intracorpuscular forms, and therefore advocate its use at a late stage of the cycle.
Strange to say, quinine, especially in small doses, seems sometimes to wake up latent malaria and to bring about an ague fit. The same may be said of a course of mineral waters, of hydropathic treatment, and of sea-bathing.
Treatment of bilious remittent.—— In bilious remittent and other severe forms of malarial fever one must not, as in a simple intermittent, wait for the remission before giving quinine. To wait for remission or sweating used to be the practice; it was said that to give quinine at any other time was wrong, and that something terrible would happen if the superstition were ignored. In all grave, fevers a full dose, 10 or 20 gr., should be administered at once. The parasite cannot be attacked too soon. It is desirable to have the bowels freely opened; quinine is said to act better then. It is a mistake, however, to delay the administration of
