A comparison is made between atebrin-musonate and quinine bihydrochloride in the treatment of acute malaria. 286 cases of acute malaria due to Malayan strains of P. falciparum, P. vivax, and P. malariae, were treated in alternating sequence with one or other of these drugs. The rates at which the atebrin-musonate and the quinine case groups became trophozoite-free and fever-free are contrasted in a series of graphs. It is shown that there was a tendency for trophozoites to disappear from the peripheral blood and for temperatures to fall to normal somewhat earlier among cases treated with atebrin-musonate. No toxic effects of any importance were observed (but see footnote p. 657). Evidence is recorded which suggests that the minimal effective daily dose for an adult is 0·375 gramme (= atebrin 0·3 gramme). This dose when given either intramuscularly or intravenously on two successive days effected a rapid disappearance of parasites and fever. Intramuscular administration is regarded as the method of choice. It is noted that absorption of the drug from the muscles is very rapid, and that atebrin may be demonstrated in the urine within 10 minutes of an intramuscular injection of 0·3 gramme. A method of testing for the presence of atebrin in the urine which is sensitive to over one in a million is described. It was not possible to obtain precise data regarding the permanency of cure but an analysis of cases returning to hospital within 10 weeks of discharge suggests that relapses after atebrin-musonate treatment are probably fairly common.
Brief clinical and parasitological details of a case which recovered from a malarial infection of unusual severity are described. It is noted that little information seems to be available regarding the highest degree of infestation with the parasites of human malaria which is consistent with life.
1. The Proteus strain XL, isolated by Dr. LIMA in the endemic area at Sao Paulo, represents the serological type of Proteus which corresponds to the local variety of typhus virus. 2. The Proteus strain "Muar", isolated in the Federated Malay States and described by MARTIN, antigenically corresponds to the virus of the local variety of tropical typhus (type XK). 3. The agglutinins for the two types OX19 and OX2, present in the serum from cases of "fie`vre boutonneuse" of the Mediterranean, are of the order of group agglutinins and are due to group antigens present in the virus. 4. It is suggested that the type of the main antigen of the virus of "fie`vre boutonneuse" will remain unknown until the corresponding type of Proteus has been isolated. 5. The relationship between the agglutinogenic and the immunogenic properties of different varieties of typhus virus is discussed. The established facts indicate that cross-immunity between typhus viruses is accompanied by identity of the serum reactions to Proteus X whereas failure to obtain cross-immunity coincides with dissimilarity in agglutination reactions. 6. The present knowledge of serological varieties of typhus, based on the occurrence in the patients' serum of main and group agglutinins for various types of Proteus X is presented in tabular form. It is suggested that serological methods, using various types of Proteus, are indispensable in the experimental study of the typhus group of viruses. 7. The technique of the agglutination reaction with Proteus X strains is discussed. The use of O variants and of the new Oxford standard suspension are recommended. 8. The isolation of Proteus X strains and the hypothesis of the transformation of Rickettsia into Proteus X are discussed and some technical details of the methods of cultivation are described. c 1933.
1. (1) The injection of serum prepared especially against strains of typhoid bacilli strong in "O" and "Vi" antigens appeared during the epidemic at Singapore to be of value in the treatment of serious cases of typhoid fever, even at a comparatively late stage of the disease. The time for the routine use of such serum in treatment has perhaps not yet come, but strong indications for its use are severe toxaemia, or failure to improve with general treatment. 2. (2) The absence of eosinophil cells in a differential white blood count is of value in the diagnosis though it is not an absolute sign in either a negative or positive direction. 3. (3) Congenital immunity against typhoid fever appears to be powerful for several years of childhood, in Malaya and presumably elsewhere also. 4. (4) Compulsory inoculation is advocated as a public health measure of protection against typhoid fever in countries where the disease is endemic, but not earlier than the 5th year of age. c 1941
An analysis is made of parasite counts made on the first day of treatment in a series of 750 cases of acute subtertian malaria. The analysis affords data of the parasitological intensity of the subtertian infections prevalent in the Kuala Lumpur district of the Malay States during 2 years of normal malarial incidence and severity, and suggests:- 1. (a) That parasite counts made on the first day of treatment are of considerable prognostic reliability. 2. (b) That the counts made during the course of treatment are a useful guide to progress but are open to occasional fallacy. 3. (c) That the extreme limit of tolerance of Asiatic adults for the local strains of P. falciparum is probably in the region of three quarters of a million parasites per c.mm. of peripheral blood.
1. 1. The results of various studies by other workers on the spleen and parasite rates in Indians, Malays and Bantu are summarized. 2. 2. The results of our own observations on Khonds in India, and on Masai and Bantu in East Africa are also summarized and compared with the foregoing and with one another. 3. 3. It is pointed out that wide differences may be found in the malarial status of communities in the same country and, in the case of the Bantu, of the same race; while close similarities occur in different countries. 4. 4. The results of experimental infections in birds and monkeys are cited and interpreted in terms of the two states of allergy and immunity. The probable significance of these is illustrated by reference to the role of the two states in tuberculosis. 5. 5. It is suggested that the observed contrasts in the spleen and parasite rates in diverse communities may also be explained in terms of immunity and hypersensitivity. 6. 6. It is concluded that the immune status is dependent not on race but on the frequency of infection; and that the most accurate index of endemicity is the frequency of infections in the non-immune, that is the rate in early infancy. 7. 7. While a consideration of the Spleen Rate and Endemic Index may be of value in forming an estimate of endemicity and immunity when similar communities are being compared, these indices may be misleading when the epidemiological surroundings are dissimilar. 8. 8. A consideration of the variation with age in the spleen and parasite rates throws more light on endemicity and immunity and on such variation a rough classification may be made into immune and sub-immune communities. 9. 9. But it is suggested that by far the most sensitive index at present available for field studies is the average parasite count, and its variation with age. c 1937.