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THE "WEEKLY RETURN."
148 is the less material as conditions in Russia in regard to famine and pestilence are much the same as they were eight months ago.
CINCHONA
FEBRIFUGE.
effect
of the febrifuge was thus found to be equal to that of quinine. Sixteen patients were willing to remain in hospital for three weeks after the conclusion of their treatment ; although from the statements of Acton and Stephens at least 10 of the 16 patients might have been expected to develop fever during these three weeks of observation, only four did in fact do so, and of these four two were probably fresh infecIt was therefore concluded that the pertions. manent therapeutic effects of the Javan cinchona febrifuge are at least as good as those of quinine ; and its toxicity was found to be no greater than quinine toxicity. Dr. Fletcher closes this section of his report with a warning to the effect that cinchona febrifuge is not an official drug, and that until its composition has been legally defined, powders deficient in alkaloids, or containing harmful alkaloids, may be sold under that name.
IN his annual report for 1921 of the Institute for Medical Research, Kuala Lumpur, Federated Malay States, a section is devoted by Dr. William Fletcher to a discussion of the merits of cinchona febrifuge in the treatment of malaria. Cinchona bark was brought to Europe in 1638, and a decoction was used empirically for the treatment of ague for nearly 200 years before its active principle was isolated, and only of comparatively recent times has the exclusive employment of one of its alkaloids-quinine-become customary. The report recalls Major H. W. Acton’s experiments carried out at the British Malaria Convalescent Depot at Dagshai, in the Himalayas, suggesting strongly that the mixed alkaloids are less THE "WEEKLY RETURN." toxic than quinine, and superior to it in the treatment of tertian ague. At Dagshai there was no chance of WE remind our readers of the Weekly Return of reinfection with malaria : Major Acton’s patients Births and Deaths issued by the Registrar-General, were all soldiers, who were kept under observation which has just entered on its second year of publicafor eight weeks after they had finished their course tion in a new and attractive form. Table I. shows the of treatment. The preparation used was cinchona births and deaths each week in the 105 great towns, febrifuge, containing the total alkaloids of cinchona with the numbers of fatal cases of fevers and the made at the Government at factories bark, quinine deaths of infants under 1 year of age. Table II. gives Mungpoo, in India. The average composition of the same information for certain cities in the British cinchona febrifuge is as follows : Crystallisable commonwealth of nations and in foreign countries. alkaloids (54-65 per cent.), quinine 7-40, quinidine Table III. classifies in greater detail the causes of 22’83, cinchonine 18-58, cinchonidine 5-84 per cent. ;; deaths occurring in London. Table IV. sets out the uncrystallisable alkaloids, ash, &c., 45-35 per cent. notified cases of infectious diseases throughout the It is estimated that nearly 20,000 lb. of quinine are Table V. gives a areas of the country. imported annually into British Malaya ; quinine sanitary of notified cases and deaths from certain conspectus costs at least$28 a pound, whereas cinchona febriinfectious diseases for each week in the fuge costs less than$7 a pound, so that an enormous important Tables VI. and VII. are meteoropreceding quarter. be would effected the of substitution the saving by the week ended Jan. 6th there were logical. During unseparated mixture for general use. In the light notified, in the whole of England and Wales, 12 cases of Major Acton’s findings, Dr. Fletcher undertook of 2269 of scarlet fever, 1063 of diphtheria, experiments at Kuala Lumpur, where, however, the 43 small-pox, of enteric fever, 968 of pneumonia, 124 of ophquestion of permanent cure was difficult to inve3ti- thalmia neonatorum, 46 of puerperal fever, and 13 of gate—first, because patients might there become encephalitis lethargica. Of the less frequent infections reinfected- whilst under observation after the con- there were notified 9 cases of dysentery, 7 of cerebroclusion of treatment, and, secondly, because it was 3 of acute poliomyelitis, and one each fever, spinal impossible to persuade patients to remain in hospital of acute polio-encephalitis and " continued fever." for two months after they had completed a four weeks’ Table IV. makes it possible for anyone to course of treatment. Only a small amount of the ascertain at a glance readily the distribution of these infecIndian cinchona febrifuge was available ; its imme- tious diseases throughout the various urban and rural diate effects upon malaria were found to be as powerful districts of and Wales. Table II., with its England as those of quinine. information regarding the cities of the British Empire Another preparation containing the total alkaloids ’, and countries, gives a graphic picture from derived from Javan cinchona bark, also sold under weekforeign to week of the public health and social conthe name of cinchona febrifuge, is made by the ditions prevailing throughout the world. The price of Bandoengsche Kininefabriek Company. The average the Weekly Return is Is. a copy. It is published by the makers to be follows : is stated as composition by the Stationery Office and may be obtained through Crystallisable alkaloids (62-8 per cent.), quinine 11-5, any bookseller. Its perusal will well repay the cost. quinidine 5.0, cinchonine 26-3, cinchonidine 20-0; uncrystallisable alkaloids, ash, &c., 37-2 per cent. A quantity of this Javan preparation was obtained and tested upon a small number of patients suffering PROPOSED TESTIMONIAL TO DR. BYROM from quartan malaria, which form of the disease is BRAMWELL. more rare, and probably more liable to relapses, THE news that Dr. Byrom Bramwell of Edinburgh than the tertian fevers ; the number of patients, 23, has attained his seventy-fifth birthday and that it is was kept small in order to facilitate strict personal supervision of the treatment. These 23 patients proposed to mark the occasion by the presentation to him of an appropriate testimonial will be welcomed were given 10 gr. cinchona febrifuge twice a day for four weeks in cylindrical gelatin capsules (number 0) ; by all old Edinburgh students, as well as by many an average of 21 ordinary and 13 thick blood films others of the profession who know him personally, or were examined during the four weeks of treatment through his contributions to scientific medicine. in’each case. Fifteen of the patients were suffering For many years Dr. Bramwell, together with several frorm quartan malaria, and the remainder from other physicians now, unfortunately, no longer malignant or benign tertian, or mixed quartan and surviving, carried the reputation of the Edinburgh tertian malaria. In every case administration of school, on the medical side, to a level which, if we are cinchona febrifuge stopped the fever before the fifth to take wo rid-wide appreciation as a criterion, has day of treatment, and caused the disappearance of not been equalled before or since. When these men the parasites, although in three quartan cases the were in their prime no school could boast a finer latter were found in ordinary films up to the fifth, galaxy of scientific stars. Only Dr. Bramwell remains sixth, and seventh days respectively, whilst in one to-day, and if his working days are over no one who case they were found in thick films as late as the ever laboured with him, or was taught by him, is eleventh day, but not subsequently. The immediate likely to forget the association with one in whom has
CINCHONA
FEBRIFUGE.
effect
of the febrifuge was thus found to be equal to that of quinine. Sixteen patients were willing to remain in hospital for three weeks after the conclusion of their treatment ; although from the statements of Acton and Stephens at least 10 of the 16 patients might have been expected to develop fever during these three weeks of observation, only four did in fact do so, and of these four two were probably fresh infecIt was therefore concluded that the pertions. manent therapeutic effects of the Javan cinchona febrifuge are at least as good as those of quinine ; and its toxicity was found to be no greater than quinine toxicity. Dr. Fletcher closes this section of his report with a warning to the effect that cinchona febrifuge is not an official drug, and that until its composition has been legally defined, powders deficient in alkaloids, or containing harmful alkaloids, may be sold under that name.
IN his annual report for 1921 of the Institute for Medical Research, Kuala Lumpur, Federated Malay States, a section is devoted by Dr. William Fletcher to a discussion of the merits of cinchona febrifuge in the treatment of malaria. Cinchona bark was brought to Europe in 1638, and a decoction was used empirically for the treatment of ague for nearly 200 years before its active principle was isolated, and only of comparatively recent times has the exclusive employment of one of its alkaloids-quinine-become customary. The report recalls Major H. W. Acton’s experiments carried out at the British Malaria Convalescent Depot at Dagshai, in the Himalayas, suggesting strongly that the mixed alkaloids are less THE "WEEKLY RETURN." toxic than quinine, and superior to it in the treatment of tertian ague. At Dagshai there was no chance of WE remind our readers of the Weekly Return of reinfection with malaria : Major Acton’s patients Births and Deaths issued by the Registrar-General, were all soldiers, who were kept under observation which has just entered on its second year of publicafor eight weeks after they had finished their course tion in a new and attractive form. Table I. shows the of treatment. The preparation used was cinchona births and deaths each week in the 105 great towns, febrifuge, containing the total alkaloids of cinchona with the numbers of fatal cases of fevers and the made at the Government at factories bark, quinine deaths of infants under 1 year of age. Table II. gives Mungpoo, in India. The average composition of the same information for certain cities in the British cinchona febrifuge is as follows : Crystallisable commonwealth of nations and in foreign countries. alkaloids (54-65 per cent.), quinine 7-40, quinidine Table III. classifies in greater detail the causes of 22’83, cinchonine 18-58, cinchonidine 5-84 per cent. ;; deaths occurring in London. Table IV. sets out the uncrystallisable alkaloids, ash, &c., 45-35 per cent. notified cases of infectious diseases throughout the It is estimated that nearly 20,000 lb. of quinine are Table V. gives a areas of the country. imported annually into British Malaya ; quinine sanitary of notified cases and deaths from certain conspectus costs at least$28 a pound, whereas cinchona febriinfectious diseases for each week in the fuge costs less than$7 a pound, so that an enormous important Tables VI. and VII. are meteoropreceding quarter. be would effected the of substitution the saving by the week ended Jan. 6th there were logical. During unseparated mixture for general use. In the light notified, in the whole of England and Wales, 12 cases of Major Acton’s findings, Dr. Fletcher undertook of 2269 of scarlet fever, 1063 of diphtheria, experiments at Kuala Lumpur, where, however, the 43 small-pox, of enteric fever, 968 of pneumonia, 124 of ophquestion of permanent cure was difficult to inve3ti- thalmia neonatorum, 46 of puerperal fever, and 13 of gate—first, because patients might there become encephalitis lethargica. Of the less frequent infections reinfected- whilst under observation after the con- there were notified 9 cases of dysentery, 7 of cerebroclusion of treatment, and, secondly, because it was 3 of acute poliomyelitis, and one each fever, spinal impossible to persuade patients to remain in hospital of acute polio-encephalitis and " continued fever." for two months after they had completed a four weeks’ Table IV. makes it possible for anyone to course of treatment. Only a small amount of the ascertain at a glance readily the distribution of these infecIndian cinchona febrifuge was available ; its imme- tious diseases throughout the various urban and rural diate effects upon malaria were found to be as powerful districts of and Wales. Table II., with its England as those of quinine. information regarding the cities of the British Empire Another preparation containing the total alkaloids ’, and countries, gives a graphic picture from derived from Javan cinchona bark, also sold under weekforeign to week of the public health and social conthe name of cinchona febrifuge, is made by the ditions prevailing throughout the world. The price of Bandoengsche Kininefabriek Company. The average the Weekly Return is Is. a copy. It is published by the makers to be follows : is stated as composition by the Stationery Office and may be obtained through Crystallisable alkaloids (62-8 per cent.), quinine 11-5, any bookseller. Its perusal will well repay the cost. quinidine 5.0, cinchonine 26-3, cinchonidine 20-0; uncrystallisable alkaloids, ash, &c., 37-2 per cent. A quantity of this Javan preparation was obtained and tested upon a small number of patients suffering PROPOSED TESTIMONIAL TO DR. BYROM from quartan malaria, which form of the disease is BRAMWELL. more rare, and probably more liable to relapses, THE news that Dr. Byrom Bramwell of Edinburgh than the tertian fevers ; the number of patients, 23, has attained his seventy-fifth birthday and that it is was kept small in order to facilitate strict personal supervision of the treatment. These 23 patients proposed to mark the occasion by the presentation to him of an appropriate testimonial will be welcomed were given 10 gr. cinchona febrifuge twice a day for four weeks in cylindrical gelatin capsules (number 0) ; by all old Edinburgh students, as well as by many an average of 21 ordinary and 13 thick blood films others of the profession who know him personally, or were examined during the four weeks of treatment through his contributions to scientific medicine. in’each case. Fifteen of the patients were suffering For many years Dr. Bramwell, together with several frorm quartan malaria, and the remainder from other physicians now, unfortunately, no longer malignant or benign tertian, or mixed quartan and surviving, carried the reputation of the Edinburgh tertian malaria. In every case administration of school, on the medical side, to a level which, if we are cinchona febrifuge stopped the fever before the fifth to take wo rid-wide appreciation as a criterion, has day of treatment, and caused the disappearance of not been equalled before or since. When these men the parasites, although in three quartan cases the were in their prime no school could boast a finer latter were found in ordinary films up to the fifth, galaxy of scientific stars. Only Dr. Bramwell remains sixth, and seventh days respectively, whilst in one to-day, and if his working days are over no one who case they were found in thick films as late as the ever laboured with him, or was taught by him, is eleventh day, but not subsequently. The immediate likely to forget the association with one in whom has