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Title: The incidence, prevention and treatment of malaria in India
Author: Smith, Norman H.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1928
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The observations of the writer in the different districts led to the following conclusions with reference to the etiology, prophylaxis and treatment of malaria. The most important factors in the etiology of the disease were the canal irrigation, and the condition of the houses and forts. No material progress can be made in lowering the incidence of malaria in Central and 1orthem India until canal irrigation is controlled, and, if necessary, prohibited in the neighbourhood of towns. The condition of the habitations of all classes of people calls for great improvement. Old forts and barracks situated in malarious places should be pulled down and rebuilt on healtkrsites. As regards the prophylaxis of malaria in India the only measures which have a general application are those which aim at the destruction of the mosquito. General quininisation of the infected population is impracticable, and screening has only a limited application. In areas of low endemicity minor measures will suffice, if efficiently and thoroughly carried out. The small incidence of malaria should be no excuse for the relaxation of antimosquito measures. In regions of moderate and high endemicity major measures are usually necessary in addition; and of these drainage and the control of canal irrigation are the most important. Until these measures have been carried out screening has an important place in the prevention of malaria among Europeans and better class Indians. The screening of houses, barracks and forts is of small use unless the buildings themselves are in a sufficiently good state of repair to render such screening effective in excluding mosquitoes. On Frontier campaigns the use of bivouac nets and mos- quito-proof huts would do much to lessen the incidence of the disease. Prophylactic quinine has a definite place in the prevention of malaria in India. It is indicated particularly for administration to troops and Europeanson Frontier campaigns and in hyperendermic areas; and, though attacks of malaria may not be prevented by the use of prophylactic quinine under such circumstances, they are rendered less severe and are less liable to become pernicious. The The treatment of malaria is true prophylaxis and can be summarised in one word - quinine. The drug should be given by the mouth in ordinary cases. The maximum safe dose of quinine for India is 30 grains a._day and rest is essential while large doses are being taken. Quinine orally administered in the form of a Standard course does not prevent reinfection in hyperendermic areas. Intramuscular injections of cuinine are of use in the treatment of severe cases, and of those unable to take quinine orally, and in selected cases give good results. Intravenous injections are safe and effective in skilled hands and are indicated in pernicious cases and where a speedy effect is desired, but the method is unsuitable for general use in India. The transient effect of intravenous injections necessitates a supplementary course of oral quinine. Rectal injections of quinine are uncertain in their action, but have given good results under the supervision of the writer. Subcutaneous injections cannot be recommended. No drug treatment of malaria is successful unless the resistance of the patient is maintained or increased by rest, nourishing food, and general tonic treatment. The pernicious forms of the disease are most common in times of hardship and strain, as on active service. Cerebral cases are most likely to occur during the hot weather, and in subjects of latent malaria who are not taking quinine and are performing strenuous exertion in the heat of the day. Abdominal and pulmonary types of malaria are more prevalent during the autumn months. Benign tertian malaria is more resistant to quinine treatment than malignant tertian, and early diagnosis and early treatment of all cases is essential. The eradication of malaria in India can only be attained by constant and scientifically applied warfare against the mosquito. The malaria carrying anopheles of every district must be identified, their breeding places mapped out, and measures taken to destroy them. By general improvement of the housing conditions the possibility of the hibernation of adult mosquitoes will be lessened. As in other countries, education should hold a prominent place in the prevention of the disease. Coincident with general education a practical knowledge of malaria should be imparted to every scholar. The progress of education among the indigenous masses of India is necessarily slow, but it is proceeding gradually. The prophylactic measures adopted by the Europeans and educated Indians should form an object lesson to the uneducated classes. Agriculture should be encouraged and the conditions of the peasant improved; for agriculture scientifically carried out prevents malaria and the consequent prosperity of the agriculturalist renders him less liable to fall a victim to the disease. It is true that the wholesale eradication of malaria will take many years, out the time can be shortened and the incidence lessened by vhole- hearted efforts to prevent the disease. Antimalarial measures may seem costly, but the disease is still more costly, and antimalarial measures alone will render India, with its unlimited vealth and resources, a healthy and prosperous country.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available