In October, 1931, A.L.J., an Anglo-Indian engineer, aged 59 years presented himself for examination on account of sore eyes and photophobia. The visual actuity was R.V. 6/12 with+0.75 sph.=6/6. L.V. 6/18 with+1 sph.=6/6. The pupils at that time were active to light and accommodation, the anterior chamber was slightly shallow and the tension not raised. The filtration atngle was " crowded."
Kuala Lumpur, Federated Malay States
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.
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.