REPRINTED FROM 
University Medical Magazine, 
September, 1890. 
MALARIAL AFFECTIONS.' 
By William B. Dewees, A.M., M.D., 
OF SALINA, KANSAS. REPRINTED FROM 
University Medicae Magazine, 
September, 1890. 
MALARIAL AFFECTIONS.1 
By William B. Dewees, A.M., M.D., 
OF SALINA, KANSAS. 
The title malarial affections is here employed to denote conditions pro- 
duced by the poisonous effects of bad air, in preference to the word malaria, the 
use of which is calculated to substitute a cause for an effect. 
There is a widespread belief among the public that malaria-paludal 
miasm-is decidedly on the increase in many parts of the United States. A 
half century ago Staten Island was a healthful place to spend the Summer ; but 
within the last fifteen years portions of it have become notorious for the severe 
agues prevalent. Chills were next to unheard of along the Sound in Connec- 
ticut as late as thirty years ago; but of late years they prevail with increasing 
frequency every Autumn. Many valleys in New York, New Jersey, Delaware, 
Maryland, Pennsylvania, Virginia, Ohio, and throughout the States of the 
great West and South have for the first time witnessed cases of malarial pois- 
oning, of local origin, within a decade or two. These facts add much to the 
interest with which the questions relating to malarial affections will continue to 
be studied. 
Malarial poisoning presents itself under protean forms, and often is the 
active cause of disease where it is not suspected. There are various lesions of 
the stomach, duodenum, liver, spleen, etc., which arise from this cause, not 
1 Read before the South Kansas Medical Society, at the Thirtieth Semi-Annual Meeting, held in 
Wichita, Kansas, May 6th, 1890. 2 
DEWEES, MALARIAL AFFECTIONS. 
amenable to treatment unless their true origin is recognized. The influence oi 
this poison may unfavorably modify the progress of surgical diseases, by arrest- 
ing or delaying the healing of wounds, and giving rise to various complications 
which render the prognosis more than usually unfavorable. Traumatism may 
react upon malaria and bring it out in individuals in whom it would otherwise 
have been dormant. Malaria, when it does exist in a latent or masked form in 
the human body, will excite and complicate any disease to which the body, 
from any peculiar temperament, may be disposed. 
As for the investigations into the efficient cause of malarial poison, we find 
the history of this study to be recent. Theoretical hints are found to have 
been scattered for many years, but no practical work was done until Klebs and 
Tommasi-Crudelli discovered in the mud of the Italian swamps, in 1879, a 
certain bacterium which they named the bacillus malaria?. The investigations 
of Sternberg, in our own country, have not only failed to confirm, but have 
rather denied, the deductions of the Roman pathologists. The question natu- 
rally arises : Is this bacillus malaria to be found in some of the arid soils in the 
tropics, and elsewhere, notoriously fertile in malarial fever ? 
This much seems certain : Up to the present time it has been searched for 
in vain in the malaria-producing soil of lower Bengal. We know that the 
fever-producing rotten granite of Hong Kong and other places is permeated by 
a fungus, but that it is the bacillus malaria has not been determined. 
The well-known theory of Dr. Salisbury, of Ohio, who maintained that 
agues are not produced by any poison of telluric origin, but by the introduction 
into the system of cells and spores, emanating from certain plants called Pal- 
mella, has long since been exploded. 
The doctrine of to-day is that of Daveran, who, in 1881, described a pig- 
ment in the blood corpuscles which he claimed was due to the action of an 
organism which he termed Plasmodium malaria. These observations of 
Daveran passed practically unnoticed until Marchiafava and Celli, in 1886, 
acknowledged their accuracy. 
Camillo Golgi, in the same year, wrote an excellent monograph describing 
a similar appearance, and giving a detailed history of its action that is in entire 
accord with the present teachings on this subject. This doctrine, briefly stated, 
is as follows : It is taught that the Plasmodium malaria is the cause of mala- 
rial poisoning, that it enters the blood, taking up its abode in the red corpuscles, 
and gradually growing therein. At first it is very small, one-fifth the size of 
the corpuscle, but as it grows it takes up pigment, which is deposited in small 
granules in its periphery. It grows until it completely fills the corpuscle, and 
then it divides into a number of daughter cells that repeat the same process, 
and at the division the pigment granules are set free in the blood, causing the 
well known melanosis malaria. They are also more numerous just before the 
chill, and immediately afterward are hard to find, for the division has taken 
place, and the small cells escape observation far more easily. The use of qui- 
nine diminishes the number of the organisms very markedly, and in case of 
cure they can no longer be found. This organism, differing from the bacteria, DEWEES, MALARIAL AFFECTIONS. 
3 
belongs to the lowest order of animals, the protozoa, and might be termed pro- 
tozoon or haematozoon malariae. 
Whatever be the etiological factor of malaria, the discovery of microor- 
ganisms, and the establishment of the relation which they sustain to pathologi- 
cal states, led the way to the successful study of specific influences, and the 
results tend to show that it is a specific factor, a materies viorbi of regular 
aspect, of given demeanor, and of ascertainable character; in fact, that the 
malarial poison is due to an organism which multiplies in the soil. Anyone 
who has studied this difficult subject knows the great variety of conditions and 
soils where this poison manifests itself. 
In reference to the increasing distribution of malaria, it is worth noting 
that water is often the vehicle by which the malarial poison reaches the system, 
and that it is often charged with malaria at points distant from the places 
where it comes to the surface and is used. Thus, it happens that soils are often 
reputed malarious when, in reality, the unhealthfulness is due to the fact just 
stated. There is no less doubt that the poison may also be carried by the 
wind, various observations having shown this ; persons living on the lee side 
of a marsh (with reference to the prevailing winds), suffering more than those 
to windward of it. Again, it is erroneous to suppose that all soils containing 
this organism poison the superjacent atmosphere, for it is known that outbreaks 
of fever occur when soil, malarious in ancient times, is stirred up by cultiva- 
tion or excavation. From this it has been argued that the poison can remain 
in a latent state, or a state of inertia, for centuries, similar to the long time 
during which the seeds of plants may lie dormant. The conditions necessary 
for the development of the poison, as given by Tommasi-Crudelli, areas follows : 
I. A temperature not less than 20° C. 
II. A moderate amount of permanent moisture in the soil. 
III. Ready access of oxygen to the strata which contain the poison-ferment. 
Natural causes tend to diminish or suspend the activity of the poison-ferment. 
In Winter Condition No. 1 is wanting, though a few very hot days have often been 
known to be followed by outbreaks of fever even in Winter. 
In Summer Condition No. 2 fails if the heat be sufficiently prolonged. This, he says, 
occurred in the Agro Romano in 1881-82, though a single heavy shower of rain caused the 
reappearance of the disease with even greater force. 
Condition No. 3 is affected favorably for man when 
1. The malarious soil is covered by natural top-dressing (colinate) formed by alluvial 
deposits ; or, 
2. By the felting together of the roots of the grass on strong pasture. Both these cir- 
cumstances prevent the access of oxygen to the soil which contains the poison-ferment. 
Regardless of all theories, it must be admitted that some soils-be they 
marshy or not-seem to possess the properties necessary for the propagation 
and development of the malarial poison, while others do not, even though 
apparently under very similar conditions. 
In reference to prophylaxis, science has given us but very limited scope. 
Up to the present time we scarce can recommend anything aside from : 
1. Change of climate to a higher elevation and dryer locality. 
2. The internal use of arsenic, as the best means whereby the system can 
be rendered insusceptible to the influence of the malarial poison. 4 
DEWEES, MALARIAL AFFECTIONS. 
3. The use of top dressings (colinate) combined with subsoil drainage as 
being probably of service in reclaiming the malarious regions. 
The proposed cultivation of the soil has failed in this, that the time for 
cultivation is also the period of the greatest activity of the malarial poison, 
and the laborers are rendered unfit for work by its influence. In reference to 
the prophylactic power of eucalyptus plantations, we can only say that they 
have brought disappointment, both in draining the soil and in proving destruc- 
tive to microorganisms by their exhalations. 
Treatment.-Whatever theory be accepted as to the cause and nature of 
the malarial poison, we know that quinine and arsenic destroy its influence in 
the system. Whether the effect of these remedies is due to their action as 
protoplasm poisons remains to be answered. It is, however, worthy of note, 
that the same saturation necessary to produce a fatal effect in these low organ- 
isms in fluids without the body, is necessary also in the blood, to be most 
effectual in the treatment of malarial poisoning. It has been observed, more 
especially as to the use of quinine, that the saturation of the blood to this 
degree very greatly interferes also with the development and migration of the 
white corpuscles. This probably explains the increase of anaemia that is so 
frequently (if not always) present in malarial affections, when the quinine treat- 
ment is used, while the body weight of those treated with arsenic usually 
increases, and the anaemia, when it exists, diminishes. 
This is a clinical fact, often and repeatedly observed by me, and for which 
I can offer no rational scientific explanation, but from which I have deduced 
the following treatment, modified according to the nature of each case. The 
patient is placed in a bed, covered with woolen blankets, in a well-ventilated 
and lighted room, the temperature of which is 70° to 76° F., in charge of a 
competent nurse. I then order a purge of calomel (10 to 20 grains) followed in 
one to two hours by half an ounce of Rochelle salts, a Seidlitz powder, or liquor 
magnesii citratis (% bottle), given at such an hour that the bowels will be 
moved before night-fall of the same day. At bed-time, 15 to 20 grains of qui- 
nine are given, and the following morning 10 to 15 grains of the same drug are 
administered ; during the day the following is mainly relied upon : 
R Quininae bisulphatis, 3ss 
Euonymin, 
Extracti colocynthidis compositi, aa gr. x 
Extracti belladonnae, gr. ij 
Fiant capsulae No. XX. M. 
Sig.-One capsule every two hours during the day. 
This usually suffices to bring the patient safely to a stage of convalescence 
in from one to three days. Thereafter' the capsules are ordered three to four 
times daily, together with : 
R Liquoris potassii arsenitis, fl§ss 
Elixir ferri quininae et strychninae 
phosphatis, M. 
Sig.-Teaspoonful before meals, three times daily. DR. A. E. FOOTE 
MINERALS and BOOKS 
MEDICAU, AGRICULTURAL, HORTICULTURAL, EDUCATIONAL, ETC. 
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CASE I.-Chart showing the variation of temperature every two hours. 
CASE II.-Chart showing the variation of temperature every two hours, DEWEES, MALARIAL AFFECTIONS. 
5 
or if, as has often been the case, the patient objects to the bitter taste, I order 
with good effect: 
R Liquoris potassii arsenitis, fl § ss 
Syrupi hypophosphit. compositi, fl§vijss. M. 
Sig.-Teaspoonful before meals, three times daily. 
To counteract the evil effects of quinine on the head, ears, etc., I have found 
nothing to act so happily as hydrate of chloral given in like doses half an hour 
after the large dose of quinine in the evening. My preferable mode is to give 
the quinine and chloral in five-grain capsules. 
While this treatment has proved very successful in the major portion of 
cases under my care, it has not been so effectual in a certain line of cases which 
came under my notice here in Kansas during the past five years. These cases 
presented the same typical train of symptoms, history, etc., and occurred at the 
same time with the regular typical cases, differing only in this one particular- 
of having unnaturally clean tongues from the very onset, and continuing so 
through the entire course of the disease, even in protracted cases. In those 
cases the best results were obtained by beginning with the same treatment given 
above, and combining Fowler's solution, io to 20 drops given an hour before 
the first dose of quinine in the evening, and 10 to 15 drops an hour before the 
second dose of quinine in the following morning, fasting. Thereafter the qui- 
nine and arsenic were given in one-half to one-fourth these quantities, until the 
stage of convalescence was reached-which seldom required more than three 
days-when the above-described convalescent treatment was resorted to with 
equally good results as in the cases with furred tongues. This, together with hot 
water sponging and friction of the entire surface of the body, and good clean, 
cheerful surroundings, gave the best results in the treatment of malarial affec- 
tions of the intermittent type. 
This treatment in malarial affections of the remittent form is not so favora- 
ble. Here, to express my experience and views, I can do no better than endorse 
the words of Dr. Bemiss ? 
"It must be admitted that in quite a large proportion of cases of remittent fever spe- 
cific treatment fails to cure. I suppose that may be a reasonable proposition which holds 
that in the majority of these cases the presence of secondary blood-impurities annuls the 
ordinary specific effects of cinchona. These must be gotten rid of by depurative medicines. 
The intestinal canal, the skin and kidneys are the emunctories through which elimination 
must be effected. It is, therefore, proper for the physician to endeavor to recognize cases 
where such impurities exist, and to so modify his treatment as to remove them. If the first 
efforts to break the febrile paroxysms fail, it is better to discontinue the quinia and place 
the patient under symptomatic treatment, and await conditions of the system more favora- 
ble for its repetition. Of course the high temperature is generally the symptom requiring 
most care and attention." 
It is to this class of cases that the so-called typho-malarial fever properly 
belongs. This is my opinion based upon an extensive experience in treating 
malarial fever both in Pennsylvania and in Kansas. I have yet to see my first 
case of the hybrid form. 
1 Pepper's System of Medicine, Vol. I, page 604. 6 
DEWEES, MALARIAL AFFECTIONS. 
The following cases have been of special interest to me, as illustrating 
rather rare types of the intermittent and remittent fevers, as well as demonstra- 
ting the fact that malarial poison presents itself under protean forms, and that 
all types may arise from the same local cause, and all occur at the same time 
in places where malaria was never known to have existed, though the ground 
had been occupied and cultivated for upwards of thirty years. 
REPORT OF CASES. 
On Sunday evening, October 13th, 1889, I was summoned to the house of Mr. J. G., 
to see two of his sons who were ill. Upon my arrival I obtained the following history : 
Clarence, aged 9 years, returned home on the afternoon of October 10th complaining of 
weakness, nausea, vomiting and diarrhoea, anorexia, headache, backache, and a great desire 
to lie down and rest. He slept well during the night, and on the following morning arose 
feeling refreshed ; partook of a little breakfast, and several hours later began to feel a 
return of the symptoms of the day before, together with a decided coldness of the entire 
body, which continued till about noon, when it was succeeded by fever, which continued 
without any perspiration until the evening. 
Saturday morning he arose feeling comparatively well, until about 9 o'clock, when he, 
and also his brother Clark, aged 6 years, began to experience a similar train of symptoms 
to those just described. Sunday morning both boys were w'eak and restless. This restless- 
ness began to increase at about 10 o'clock with very decided coldness of body, nausea, 
diarrhoea, headache, backache, and occasional bleeding from the nose. The coldness was 
much more marked in degree than on the preceding mornings, and lasted till 12 o'clock, 
when again fever became the order of events, the coldness leaving with a marked subsi- 
dence of all other symptoms. The fever continued increasing without any perspiration 
until evening, when I was summoned and found the boys in the following condition : 
Temperature, 104%° and 103X0 F- ! pulse, 132 and 124 respectively ; skin hot, dry, tense and 
of a dusky hue ; tongues coated with a greyish-white fur along the edges and of a dark- 
yellowish color along the central portion ; anorexia, slight nausea, headache and backache, 
with a restless disposition in bed. I deemed the cases to be malarial fever. 
The diarrhoea having evacuated the bowels freely, I did not give any calomel. As the 
nausea threatened a non-retention of quinine, I concluded to reduce the fever by the aid of 
antipyrine, and gave eight grains to Clark and ten grains to Clarence, with good effect. 
Next morning (Monday), I reached the home at about 9 o'clock, and found them already 
suffering from the coldness of body, with headache, backache, and less nausea than they 
had experienced the days preceding, and both having bled a little from the nose. Tem- 
perature, 97X0 and 97%° ; pulse, 86 and 84 respectively. There was an unnatural pallor of 
the entire surface of their bodies, which were also colder to the touch than normal. I now 
prescribed 
R Quininae bisulphatis, gj 
Extract! opii, gr. iij 
Capsici (pulveris), gr. xij 
Glycerini q. s. ft. mass. 
Fiant capsulae No. XIJ. M. 
Sig.-Give three capsules to Clarence and two capsules to Clark imme- 
diately, thereafter one capsule to each every four hours. 
Also, 
R Potassii acetatis, 3j 
Liquoris ammonii acetatis, fl 3 j 
Spiritus aetheris nitrosi, fl 5 ss 
Syrupi simplicis, 
Aquae camphorae, ad §iv. M. 
Sig.-Two teaspoonfuls to each every four hours, alternating this with 
the capsules every two hours. DEWEES, MALARIAL AFFECTIONS. 
7 
At i o'clock, P. M., of the same day, I was notified that the boys were very much worse. 
I found them both very restless, rolling their heads from side to side, moaning and groaning, 
in a semi comatose state, faces pallid and inexpressive, skin cold and moist, pulse small and 
very feeble and irregular, tongues large and moist, with coating less thick, pupils dilated 
and eyes rolling around in their sockets with apparently no possible control by the patients 
to fix them on any object. Upon inquiry, the mother informed me that they both continued 
growing worse since my first visit at 9 o'clock that morning ; that they had had a decided 
chill at about noon ; that the medicine which I had prescribed in the morning was not 
brought till about 11.30 o'clock, when she gave each one the capsules as directed, but that 
they vomited in about a half hour later and probably had thrown off part of the medicine ; 
that none of the medicine in the bottle had yet been given, as no two hours had elapsed since 
giving the capsules. 
I felt satisfied in my mind that here were two cases of pernicious malarial fever, of the 
algid or congestive type, threatening the lives of my patients. Having nothing with me 
to stimulate the heart's action but solution of nitro-glycerine, 1 per cent., I gave one drop 
on sugar to each patient, repeating the dose every ten minutes, till three doses were taken, 
placed hot-water bottles to their feet and alongside of their limbs and bodies, and adminis- 
tered hot milk with lime water. In the meantime a messenger was despatched for ether and 
aromatic spirits of ammonia ; he arrived at 2 o'clock. The patients instead of improving 
had by this time approached a stage of complete collapse. Temperature had fallen to 96° 
in both. I now injected one drachm of purified sulphuric ether hypodermically in each 
patient, and within ten minutes there became manifest a decided improvement in their con- 
dition. In fifteen minutes I again gave a hypodermic injection of one drachm of ether to 
each boy, repeating this same quantity three times in forty-five minutes, with the most 
encouraging result, for the time being. In an hour's time from giving the ether conscious- 
ness was restored, heart's action invigorated, and I had become hopeful of my patients. 
Ten drops of aromatic spirits of ammonia were now ordered to be taken with two tablespoon- 
fuls of hot milk every fifteen minutes. At 7 o'clock I saw my patients again, and found 
that they had continued doing well until about 6 o'clock, when a return of unfavorable 
symptoms was observed. Dr. W. F. Houser was called in consultation. He concurred in 
the diagnosis and treatment. The patients, in spite of all efforts, grew weaker until finally 
large, liquid, very offensive involuntary evacuations occurred. Clark died at 10 o'clock 
that evening, and Clarence at 7.30 o'clock next morning, October 14th. On October 17th, 
the father, two sons and one daughter were all attacked in a similar manner, manifesting an 
analogous but more severe train of symptoms. I gave all four a purge of ten grains of 
calomel and one-half ounce of potassii et sodii tartratis, followed by large doses of quinine. 
Cure was rapid and complete. Two more cases in this family were likewise treated with the 
most gratifying results. Thus there were eight similar cases treated in this one family within 
one week, with two deaths which occurred before any impression with quinine could be 
made, while six were saved by the heroic administration of this drug. (See accompanying 
table of these eight cases.) 8 
DEWEES, MALARIAL AFFECTIONS. 
AGE. 
NAME. 
PULSE 
AND 
Temperature 
Time of 
Day. 
OCTOBER, 1889. 
REMARKS. 
Sun. 
13 
Mon. 
14 
Tues. 
15 
Wed. 
16 
Thurs. 
17 
Fri. 
18 
Sat. 
19 
Sun. 
20' 
6 
CLARK. 
Temperature. 
Morning. 
2 P. M. 
Evening. 
104% 
97% 
96 
97% 
Died 10 P. M., October 13. 
Pulse. 
Morning. 
2 P. M. 
Evening. 
132 
86 
74 
76 
Temperature fell to 950 and pulse to 60 one hour 
before death. 
9 
CLARENCE. 
Temperature. 
Morning. 
2 P. M. 
Evening. 
i°3% 
97% 
9* 
97% 
96 
Died 7.30 A. M., October 14. 
Pulse. 
Morning. 
Evening. 
124 
84 
76 
78 
70 
Temperature fell to 950, and pulse to 54 one hour 
before death. 
52 
JACOB (Father). 
Temperature. 
Morning. 
2 P. M. 
Evening. 
97% 
98 
99 
98 
98% 
98% 
98% 
98% 
98% 
Pulse. 
Morning. 
2 P. M. 
Evening. 
68 
84 
108 
70 
72 
. 72 
72 
72 
72 
27 
JOSEPH. 
Temperature. 
Morning. 
2 P. M. 
Evening. 
97 , 
97% 
99% 
98 
98% 
98% 
98% 
98% 
98% 
JACOB, JOSEPH, JOHN and ESTELLA. 
Pulse. 
Morning. 
2 P. M. 
Evening. 
64 
78 
99 
72 
74 
72 
74 
75 
72 
Each one took 90 grains of quinine the first 24 hours 
in 10-grain doses. 
Each one took 40 grains of quinine the second 24 
25 
JOHN. 
Temperature. 
Morning. 
2 P. M. 
Evening. 
97% 
98 
99 
98% 
98% 
98% 
98% 
98% 
98% 
hours in 5-grain doses. 
Each one took 25 grains of quinine the third 24 
hours in 5-grain doses. 
Each one took 15 grains of quinine the fourth 24 
hours in 5-grain doses. 
Each one took 170 grains of quinine in four days. 
Pulse. 
Morning. 
2 P. M. 
Evening. 
70 
84 
96 
74 
76 
74 
74 
74 
74 
19 
ESTELLA. 
Temperature. 
Morning. 
2 P. M. 
E veiling. 
97 
97% 
99% 
98% 
99 
98% 
98% 
98% 
98% 
Pulse. 
Morning. 
2 P. M. 
Flvening. 
66 
76 
86 
76 
80 
76 
78 
76 
78 
15 
HERBEN. 
Temperature. 
Morning. 
Evening. 
• 
97 
99% 
98% 
98% 
98% 
9S% 
HERBEN took 75 grains of quinine the first 24 
hours in 10-grain doses. 
40 grains second 24 hours, 5-grain doses. 
Pulse. 
Morning. 
Evening. 
64 
88 
76 
76 
76 
76 
20 grains third 24 hours, 5-grain doses. 
>35 grains of quinine in four days. 
11 
LEOLA. 
Temperature. 
Morning. 
Evening. 
97% 
99 
98% 
98% 
LEOLA took 60 gr ins of quinine the first 24 hours 
in 10-grain doses. 
30 grains second 24 hours in 15-grain doses. 
Pulse. 
Morning. 
Evening. 
66 
94 
80 
80 
120 grains of quinine in four days. DEWEES, MALARIAL AFFECTIONS. 
9 
Immediately succeeding these cases, there occurred an outbreak of thirteen cases of 
malarial fever within a fortnight, all in the same building-a four-story brick structure, with 
high ceilings, heated by steam and well ventilated, with all modern improvements from a 
sanitary standpoint. It was erected about one year before on artificially elevated ground, 
and sheltered some seventy occupants. 
The first cases manifested themselves on Sunday, October 20th, 1889. They all pre- 
sented the same symptoms in general in the onset, differing only from those of the eight 
cases just enumerated in this, that they were seized with a decided chill, followed by a hot 
stage and free perspiration on the same day that nausea, vomiting and diarrhoea set in- 
the nausea and diarrhoea being present in all cases, while vomiting was experienced in but 
five, the characteristic headache and backache which marked the other cases being likewise 
present, together with epistaxis in six instances. 
This map illustrates the location of the house and the surroundings of the farm of Mr. J. G , near the 
city of Salina (10,000 inhabitants), Saline County, Kansas, where the preceding tabulated cases occurred. 
Of these thirteen cases all promptly yielded to the same treatment except- 
ing two, which I shall endeavor to note more at length, since, to me, they 
proved of much interest, especially in connection with the series. I would 
have you carefully notice the temperature charts of these two cases and the 
map illustrating the distance and relative location of these two outbreaks of 
malarial fever. 
I subjected the water and milk, together with some blood drawn from the 
patients, to experts for examination. 10 
DEWEES, MALARIAL AFFECTIONS. 
Dr. Tiffany reports: "I have made several examinations of the water, 
blood and milk you sent. I have not arrived at any definite conclusion as to 
the germs being those of typhoid fever. In the blood there were numerous 
spirillae and small bacilli." Dr. Kiefer writes : ''We have made various cul- 
tures of the bacteria found in the different samples of water, etc., but as far as 
microscopical investigation is concerned, have found nothing to indicate the 
origin of the disease in the water of the various wells. I have also made a 
chemical examination of the different waters, and find nothing in them that 
warrants the opinion that they are deleterious to health. ' ' 
There were no other cases of malarial affection in this section of the 
country at this time, save in one other farm- 
house in this same locality, designated at 
point b on this same map, where a number 
of similar cases occurred, which yielded to 
the influence of quinine, excepting one 
case, which assumed a chronic form. 
It may likewise be of interest to note 
that a prolonged drouth, followed by a 
heavy rainfall and a number of unusually 
warm days, preceded this local outbreak 
in a locality where the malarial poison 
was heretofore unknown, the soil having 
been cultivated annually for upwards of 
thirty years. 
a. Location of home on farm of Mr. J. G. 
more fully described by preceding map. 
c. Location of college building, wherein occurred 
cases No. i and 2. 
b. Location of home on farm of Mr. R. M , 
where occurred several cases of well-marked 
malarial fever during the same period of 
time as those herein reported at localities a 
and c. 
Case I.-R. W., of Topeka, Kansas, a stu- 
dent attending said school, was taken ill on Sat- 
urday morning, October 20th, with nausea, diar- 
rhoea, headache, backache, anorexia and coldness 
of body, lasting till about noon, when vomiting 
and a chill, with bleeding from the nose, gave relief. This was followed by a fever, and 
later by free perspiration. On Tuesday morning, October 23d, I first saw this case. Being 
satisfied that the causative factor was malaria, I resolved to establish cinchonism by the 
method already described. This produced a good night's rest, with no head symptoms 
from the quinine, and the temperature next morning was 990. This result was so gratifying 
that I felt sure the poison was under control, so I prescribed the convalescing treatment; 
but the temperature became higher, and continued rising till 4 P. M. on the 24th, when it 
had become apparent that the poison was not subdued, and, lest it should get control of my 
patient, I ordered 15 grains of quinine and 15 grains of chloral, to be given as before. This 
dose was not well borne. Next morning the temperature was 100 4-50, the tongue more 
thickly coated, sordes forming on teeth, and there was a tendency to adynamia. 
On October 27th, at 4 P. M., the temperature rose to 104 3-50. I gave 15 grains of anti- 
pyrine. This reduced the temperature very rapidly, but proved much more weakening than 
the quinine. 
I now felt convinced that here was a case of the remittent type, not curable by specific 
medication. The patient was ordered judicious feeding, hot-water sponging of the surface, 
champagne and brandy. Quinine was used only to reduce the temperature, and was given 
in I5_grain doses on November 1st, 6th, Sth and 10th (see chart). His bowels were more 
or less loose during the entire sickness, with slight tympanitis and borborygmus for some 
days during the lowest stage. The first dose of quinine and chloral was followed by a pecu- 
liar eruption, which was similar to quinine eruption, seen before, and which continued DEWEES, MALARIAL AFFECTIONS. 
11 
throughout the course of the disease. Sordes continued on his teeth ; his condition was 
•very decidedly adynamic or typhoid. The temperature did not return to normal till the 
fortieth day of the disease. He was removed to his home in Topeka as soon as possible, 
where, I learn, his temperature again rose to 103°, and continued high for several weeks, 
under wdiat was considered a relapse. He, however, made a good recovery in three months. 
Case II.-H. Z., of Wichita, Kansas, student attending school, was taken ill, with sim. 
ilar symptoms to Case I. On the morning of October 23d I first saw him, and gave 20 
grains of quinine and 15 grains of chloral preceded by a purge. The following morning I 
found the temperature reduced from to 98 3-50, and an eruption from the medicine similar 
to that which marked the preceding case. This, likewise, remained visible during the entire 
illness. I prescribed the same convalescing treatment as in the other cases, but on the 
25th the remittent type was manifest, and I placed him under the same treatment as 
described in Case I. 
On the 29th the temperature rose to 104%°, and 15 grains of quinine wyere again admin- 
istered. The temperature continued falling gradually till 2 o'clock P. M. next day. On 
November 6th, by 12 o'clock M., the temperature had risen to 104°. I now gave 20 grains 
of quinine, and by six o'clock the same evening the temperature had fallen to 970. There- 
after the case progressed satisfactorily under ordinary convalescing treatment, making a 
rapid and good recovery. The temperature in this case reached its normal standard on the 
twenty-sixth day of the disease. The symptoms and physical signs were all analogous in 
these two cases, save that in Case No. II the bowels were constipated after the third day 
of the disease throughout the entire course of the fever, and the typhoid condition was less 
marked. Dr. F. B. Browne, of Salina, Kansas, and Dr. A. H. Fabrique, of Wichita, Kansas, 
saw these two cases with me.