cases. In one London clinic alone nearly 30,000 pensioners have been treated in this way. The results have been admirable, and probably very few men who have taken the treatment properly have returned. But the 10 grains of quinine must be taken religiously every day. The explanation of this success is that each dose of quinine makes a small reduction in the number of the parasites present; and that this reduction occurs every day until finally none of the Plasmodia are left. An easy calculation shows that the curve of the fall in the number of Plasmodia must be a logarithmic curve so that the treatment must be continued for a long time in order to reduce to' none the vast numbers of the parasites found during the attack. Empirically, three months appear to be enough, but in obstinate cases or in very early ones four months might be better.
Many experiments were made during the war with a view to ascertaining whether larger doses of quinine administered less fre- quently would not be as satisfactory as the 10 grains administered daily. Thirty grains given two days a week and 20 grains given three days a week yielded good results, but any dosage under a total of 60 grains a week proved insufficient ; and, in fact, the daily small dose is more easily and therefore more certainly taken by patients (out of hospital) than the larger occasional dose, which causes more dyspepsia and headache and is therefore frequently postponed.
Other salts of quinine besides the sulphate were tried. The hydro- chloride and bihydrochloride affect the digestion less and seem to be as satisfactory; the tannate has been much used in Italy, especially for prophylaxis among children ; and various other salts have been commended from time to time. Cinchona bark contains many alkaloids besides quinine and many of these were on trial for a long time, especially at the malaria depot, Dagshai, India, where Maj. H. W. Acton obtained the best results for the benign tertian parasite with cinchonidine and quinidine and with the mixture called " cin- chona febrifuge." But further investigations are still required.
The fact that relapses are banished or largely reduced while quinine is actually being taken in sufficient amount is now seen to account, at least partially, for the supposed good effect of " quinine prophylaxis " clearly, if relapses are rendered less frequent, the total number of attacks registered in the malaria returns will be smaller. But this does not prove that persons cannot become infected while they a/e taking, say, 10 grains of quinine daily which is the true meaning of the term " quinine prophylaxis." In Salonika it was frequently found that bodies of men who were given as much as 30 grains daily as a prophylactic remained free from attacks while they were taking the drug but " went down " with malaria as soon as they stopped it showing that they had been in- fected in spite of it. Much dissatisfaction was felt at these results; but probably they would have been more successful if the medication had been continued longer long enough to eradicate the infection if acquired. Sir Ronald Ross has therefore always felt that, to be effective, quinine prophylaxis should be continued in lo-grain doses daily for three months after a subject has left the malarious locality. There is also much to be said for the view that quinine prophylaxis breaks the initial force of an infection when it does occur. But, from the results obtained at the malaria centres and camps during the war, any dosage under 10 grains daily for an adult is scarcely likely to be useful (children can be given a larger proportion by body-weight say twice as much). These conclusions have been strongly con- firmed by the work of Ed. and Et. Sergent on the malaria of birds.
Many researches have been made regarding the absorption and elimination of quinine. Before the war the chemists laid down that it is absorbed less readily and not more readily as clinicians seemed to think from intramuscular injections than when given by the mouth; but this view was not supported by investigations carried out during the war. Many clinicians, especially in Mesopotamia, strongly advocated intravenous injections in serious cases, but analysis of their arguments does not beget complete confidence in their views. According to classical Italian work quinine destroys only the young Plasmodia so that 48 hours or more may elapse before its good effects become manifest. The impatient clinician is therefore often tempted to think that the orally-administered quinine has been a failure and to resort to an intravenous injection just at the moment when the former begins to act and so, of course, attributes the benefit to the injection. Injections must be given in certain cases; but the very large experience obtained in the home hospitals suggested that there is really very little difference in the values of the various kinds of quinine-administration in ordinary cases. There is also now reason for thinking that very large doses of quinine are resisted by the blood and eliminated more quickly than more moderate doses, and may therefore actually have less effect.
The prevention of malaria on the battle-front was always difficult and sometimes impossible. Mosquito-reduction in the face of enemy fire is impracticable; quinine prophylaxis was, as stated, disappoint- ing; and the armies were obliged to fall back upon mosquito-nets and mosquito-proof tents and bivouac shelters which were carefully designed by the British War Office. Better results were obtained at the bases of operations, especially in Palestine; and a very successful campaign of mosquito-reduction was carried out by Col. J. C. Robertson at Taranto in southern Italy. Apart from the war, the American Rockefeller Foundation, various authorities in Italy, South America, and elsewhere, and the planters in the Malay States have done similar useful work.
Even long courses of treatment will not necessarily cure people who are subject to re-infection while taking the courses; and it is even possible that they are not so effective during the first six months or the first year of infection as they are later. It must be remembered that the results advocated above were obtained among returned cases in Britain. In old cases the parasites are not easily found in the blood except while a relapse is occurring; but it must not be inferred that they are entirely absent in such cases simply because they cannot be detected in the minute quantity of blood usually examined by the pathologist; and the statement sometimes made that cases which do not show the parasites in the blood are no longer infected, may be for this reason quite untrue. Many detailed investigations of the parasites themselves, of their presence in various organs, and of the pathology of the disease have been made during the last ten years, but have not given new results of any great importance. The definite objective diagnosis of chronic malaria among out-patients still remains difficult in spite of various methods which have been advocated, especially by foreign observers. Lastly it may be mentioned that the mathematical theory of the distribu- tion both of mosquitoes in localities and of the occurrence of cases of malaria from time to time has been worked out by Sir R. Ross and by Prof. Karl Pearson. (R. Ro.)
MALAY STATES, FEDERATED (see 17.478). This territory enjoyed a notable immunity from sufferings entailed by the World War, and was able to make substantial contributions in money and armaments toward the needs of the British Empire. The pop. in 1919 was estimated at 1,315,700; the birth-rate was 24-57 a "d the death-rate 29-37 P er thousand. In 1918 the influenza epidemic caused 5,643 deaths. Malaria is by far the most deadly disease normally; the death-rate from this was 12-9 per thousand in 1919, but a slight reduction is apparent, and the work of the special malaria bureau is extending.
The estimated pop. of the several states was: Perak, 622,403; Selangor, 391,103; Negri Sembilan, 156,679; Pahang, 145,515. The chief towns had populations as follows according to the census of 1911: Kuala Lumpor (Selangor), 46,718; Ipoh, 23,978; Taiping, 19,556; Kampar, 11,604 (all in Perak); Seremban (Negri Sembilan), 8,667; Kuala Kuantan (Pahang), 2,102. The pop. in 1911 included the following nationalities: Europeans and Americans, 3,284; Eurasians, 2,649; Chinese, 433,244; Malays, 420,840; Indians, 172,465; Japanese, 2,029. Out of the total number of labourers on estates, 237,128 in 1919, 160,657 were Indians. Of these, 59,154 came from India on free passage during the year, out of a total of 71,000 Indian immigrants in all. Chinese immigrants numbered 25,816, and emigrants 26,033. The activities of a Chinese Bolshevist society working from headquarters at Canton were revealed among the trade guilds, and many labourers were induced to limit their output. The Chinese Triad societies continued to cause trouble in various directions of organized crime such as robbery and blackmail. Serious crimes numbered 1,002 in 1919 and 821 in 1918; gang robberies were especially numerous in Kinta (Perak) until two powerful robber bands were broken up in 1919. In that year 469 persons were banished, 400 being Chinese. The police numbered 87 British and 3,479 Asiatics.
In 1919 important movements for the extension of education were set on foot, despite difficulties encountered in increasing the number of teachers and the improvement of the teaching standard. A new training college for teachers was established at Tanjong Malim. A temporary scholarship scheme for sending teachers to Hong-Kong University was set on foot, to serve until more training colleges were established and pending the opening of Raffles College, founded in Singapore. In 1919 there were 533 schools, with an average attend- ance of 27,325.
Revenue amounted in 1919 to $72,135,075 ($ = 2s. 4d.), the principal sources being customs ($18,024,762), licences, etc. ($17,921,- 677) and railways ($14,957,460). Expenditure amounted to $70,676,- 961, the largest item being upon railways ($26,421,822). The ex- penditure of the agricultural department was $558,156 and the revenue $266,360. Important researches were made on the deteriora- tion of rubber in storage, which was found to be due mainly to surface oxidation, from which it is indicated that the slab form is preferable to the crfiped form for storage. The mouldy rot disease (in Negri Sembilan) and the brown bast disease were further investi- gated. A Government experimental coco-nut plantation has been started. The forest department had in 1919 a surplus of revenue amounting to $490,877, and over 10 per cent of the total area of the states is in reserved forest. The commercial timbers of the country are in process of being scientifically investigated, and the distillation of native woods has also been made a subject of research.
The mines of the territory employed 113,107 hands in 1919. Revenues from mining, exclusive of special war taxes, amounted to $10,489,185. Tin was exported to the amount of 620,518 piculs (of I33i lb.), and the average price per picul was $120.68, as against $150.62 in the preceding year. In the early part of 1919 tin was unsalable locally, and the Government bought from the local mines pending the reestablishment of the market, the subsequent sales realizing nearly $1,000,000 profit. Other minerals were produced as
