[page 1]

gue fever, which I consider a type of malarial infection.
In accordance with my experience, clinically and microscopically,
the much affection due to malaria can be conveniently and scien-
tifically classified as follows:
Infection by Tertian Parasites. (1) Intermittent fever, paroxysm
every third day counting < day of 1st fever (handwritten)> (2) Malignant intermittent, due
to double infection, giving a quotidian fever or to severe[?]
infection giving rise to < haematuria (handwritten)> and other alarming
symptoms.
Infection by Quartan Parasites, (1) Intermittent fever, paroxysm
every fourth day (2) Irregularly intermittent, due to double in-
fection, it may be additional infection by Tertian Parasite.
Infection by both Tertian and Quartan Parasites. (1) Bilious
remittent fever, mild, severe and grave. This includes all grades
of intensity which are variously designated as Bilious Fever, , Bil-
ious Remittent Fever, and Hemorrhagic Bilious Fever.
Aestivo-Autumnal Parasites. (1) Continued Malarial fever, Typho-
Malrial. (2) Severe continued fever, malignant or pernicious ma-
larial fever, due to super-addition of infections by the Tertian
and Quartan parasites.
Under the foregoing classification after thorough and efficient
Microscopical research, may be arranged all Acute Malarial Diseases.
And in every instance the character of the disease depends on the species of micro-organism,
Plus the intensity and duplicity of the
Infection. Truly the microscope is an invaluable aid in prog-
nosis as well as diagnosis of malarial diseases. Thus it is possi-
ble to predict very accurately the course and duration of a given
case.
In the early years of my career as a physician I was led to be-
Iieve that the question of Malaria was easy and what we had in qui-
nine a specific, With this impression, I now realize how many and

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serious have been my mistakes and errors in former years. To under-
stand malarial infection is a difficult problem, and quinine is not
a specific, in the [strikeout] ordinary [ insert]strict acceptation of the term. Only in recent
years, since I have been doing my own microscopical work in connec-
tion with observation of clinical symptoms, have I been apprised of
how blindly and ignorantly I have treated cases in the past, con-
gratulating myself, at the time, that nothing else could have been
done; and informing the family of the deceased that the patient was
beyond the reach of medical aid, it being his time to die.
Don't be deceived; it is not my purpose to underrate the old doc-
tor and extol the new; I am both old and new myself, having passed
through an age of wonderful strides in the practice of Medicine and
Surgery; I simply want to be honest and truthful. Then let me say
what is even more disparaging to the new: as a profession, we are em-
phasizing what is commercial and thus becoming too lazy or indiffer-
ent to see that the whole light is turned on so that we may arrive
at accurate and correct conclusions. You hear the doctor say,
"Nothing but a touch of malaria, give him a purgative and some qui-
nine," then later on if the man sickens and dies the death certific-
cate never shows that malarial infection was a factor at all; for
the doctor is ashamed to admit that his patient died of malaria.
hence there are hundreds of instances where erroneous death certifi-
cates are signed up by physicians and sent in to state authorities
for compilation of statistics.
I have long since determined that in my county and state, statis-
tics relative to malarial diseases are practically worthless. To the
honor of our noble profession and the good of the public, let us
make the barriers a little higher and stronger and if possible keep
out such as are not painstaking and considerate, efficient and hon-
est, honorable and conscientious. My purpose in all this con-

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troversy is to emphasize a fact that is not full established in the
Science of Medicine by all of the most competent authorities: That
an infection of malaria, however trivial in appearance, cannot be pro-
nounced cured or eradicated until after about six weeks when the mic-
roscipe shows the blood to be free of malarial parasites.
Such knowledge is impossible with the present status of
Microscopical woek in our/laboratories. To prove that it is entirely
unreliable I submit the following comparative reports as to 15 cases
of Malarial Infection in which I have Stained Blood Smears with indi-
vidual records: <Handwritten [illegible] - this means malaria not found + this means malaria found >
No. Slide Report State Report Hospital Emory Univ -
Laboratories New Orleans, L a. versity, At-
lanta, Ga.

1. …………………………… - ..…………………………… Poor Stain ……………….. -
2. …………………………… - ……………………………….... +………………………….. -
3. …………………………… - ……………………………….... +…………………………..-
4. …………………………… - ……………………………….... +………………………….. -
5. …………………………… - ………………………………. Poor Stain ………...….. -
6. …………………………… - ……………………………….... +………………………….. -
7. …..……………………… - ………………………………... -………………………….. -
8. …………………………… - ……………………………….... +………………………….. -
9. …………………………… - ……………………………….... Too Poor Stain……….. -
10. …………………………… - ……………………… <not reviewed (Handwritten)> -
11. …………………………… - ……………………………….not "……………………….. -
12. …………………………… - ……………………………… not "……………………….. -
13. …………………………… - ………………………………. not"……………………….. -
14. …………………………… - ………………………………. not"……………………….. -
15. …………………………… - ………………………………. not"……………………….. -

< Illegible (handwritten)>

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< (I56 to 75 Illegible 6-91) >
Treatment.

The prevention of malaria completely and finally in a semi-
tropical region like that if the Southern States and along the
river valleys and swamps, is an accomplishment for which we could
hardly hope; yet it behooves every community and every family to
Intelligently plan and devise every means possible to prevent as
far as possible its baneful influence in the physical manhood of
our country. Much can be done in the light of modern science and
research. But surely there must be concerted efforts, well di-
rected and organized, on the part of the State; and thorough in-
struction furnished communities and individuals . With al the
available means in this progressive age, very much could be done,
provided our forces could be properly marshaled and enlisted.
At once it becomes the duty of the general practitioner to ad-
vise and urge every precaution against disease.
Not many years ago the medical profession advised people living
in regions where malaria prevailed to use mosquito netting; now
we should tell them to thoroughly screen their houses - all open-
ings and porches as well - and during sickly season get the family
behind screens for the night time. Then if anyone of the family
became infected, immediately put that individual under the mosquito
net. Thereby they would guard against typhoid conveyed by flies as
well as malaria infected mosquitoes. The State should make screen-
ing of homes, where there are children, compulsory. If the Govern-
XXXXXXXXX ment can compel parents to send to school, why not compel
them to protect children from diseases that dwarf their intellects,
impair their usefulness and increase our mortality rate? The rural
population should secure houses so situated that thorough drainage
is possible and then see that, for at least a quarter of a mile in
circumference around their home, no vegetable matter is allowed to
decay while exposed to the summer sun, but as soon as vegetation

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ceases to flourish and grow, have it removed or burned. It would
be well to cut down and burn all undergrowth and cultivate the soil,
planting either grain or grass. The function (Strike through) <Prevention (Handwritten)> of decaying
vegetable matter should be kept in view in selection of shade trees-the oak
should be burned and instead plant the sycamore-and there should be
few shade trees. The orchard and fruit trees should be some dis-
tance from the home. A residence may, with impunity, be located
near a lake or pond, if it has a sand beach and drainage is such
that the water level is kept uniform, and there is no adjacent low-
land subject to periodical overflows. Again, the farmer should not
be content until he secures a deep-bored well and has filled in the
old surface well. The time has passed for "the old oaken bucket,
that hangs in the well."

Of <prodromes (handwritten)> : In a very beneficent manner can the doctor
serve humanity if he is painstaking and conscientious. Never is a
malarial infection insidious; there is always ample and timely no-
tice. These so-called <prodromes (handwritten)> are most sure to come, es-
pecially is this the case with young people and children. Instead
of dismissing the case with instructions to take a cathartic, a dose
of castor oil, or some worm medicine, the doctor should first make a
microscopical examination of the blood, to eliminate malaria in his
diagnosis. IT is too common for doctors to guess at what is the mat
ter . It is a professional injustice to himself, even if he does not
charge for his prescription, whenever a child quits play long and
begins to complain of headache etc. and refuses to eat heartily and
some article of food disagrees, be assured there is something ser-
iously the matter; and the doctor should, if possible , be positive
as to what is wrong physically. Isn't it a pity we no longer have
the "family physician" ? - people are wild about specialists. Only

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recently a prominent lady in my town took her child to a neighboring
city to be treated for earache. I presume she paid the specialist
ten dollars for a prescription and the assurance that the child had
an abscess(?) in progress in the ear. What them must the ordinary
doctor do? Do his best, and if the patient has money, insist on a
specialist's fee. Learn to be an expert microscopist and make the
clientele pay for it . In this instance it would be money well
spent. By such a procedure, inestimable suffering and lives would
be saved. In nearly every instance these <prodromes (handwritten)> mean
that infection began a week or more previously and the multiplica-
tion of the parasites is not quite sufficient to produce marked
paroxysms. A properly secured smear or two stained and placed under
the microscope will invariably reveal the parasite in some stage of
its developmental cycle. Be assured, no living vegetable or animal
matter is dormant one minute under favorable conditions.
If, by microscopical examination, a positive diagnosis of ma-
laria can be made, active anti-malarial treatment should be instit-
tuted and continued for at least three days. After which, keep up
for three weeks longer what may be termed prophylactic treatment.
Prescribe a laxative or cathartic, as the symptoms may indicate,
preferably calomel followed in 12 hours by a saline. Then give qui-
nine during the second quarter of every 24 hour period, 20 grains
the first period, 15 grs. the second and 10 grs. the third period.
After three days, the patient should take during the period of three
weeks three or five grains of quinine every night and morning. Med-
ication may then be discontinued provided a microscopical examina-
tion of the blood proves negative with regard to malaria.
This plan will invariably suffice in every case of tertian infec-
tion with intermittent fever; provided, of course, it is graduated
according to the severity of the attack and the age and physical

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condition of the patient.
Since I began a routine and systematic examination of the blood
for malaria, in all suspicious cases, I have been surprised at the
frequent instances where minor ailments such as bronchitis, indiges-
tion, catarrh of the stomach and intestines, nose-bleeding and many
other real diseases, are due primarily to infection by malaria. And
too, they cannot be permanently cured until the infection is eradicate-
ed.
Of Intermittent Malarial Fever: As heretofore stated, the plan of
treatment outlined is almost sure to cure when due to infection by the
tertian parasite and we have only to persist in medication, it may
be according to a more vigorous plan. But when there is an intermit-
tent fever due to infection by the quartan parasite, the doctor is
"up against" a harder proposition. I have known of cases of fourth
day chill and fever to persist for six months or longer . Such in-
tractable cases should be given hypodermatic medication at the proper
time, to be cured. yet it is a fact that the quartan parasite is
more refractory and more apt to give rise to conditions known as
chronic malaria and malarial cachexia.
This emphasizes the importance of the practitioner's being more
than a mere automaton; prescribing only the so-called specifics for
disease as soon as he is satisfied in diagnosis and has a name for
the disease. He should endeavor to get the patient well as quickly
as possible, but at the same time it should be a desideratum to make
him as comfortable as possible while he is being cured. This cannot
be done, even in severe remittent fever, without due consideration of
what is appropriately termed the resultant manifestations of malaria,
or, as some call them, complications. These have been shown, by mi-
croscopical pathology, to be directly caused by the malarial para-
site. Grown parasites have been found (domiciled) lodged in mucous
membranes of air passages and the alimentary tract, as well as the

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spleen and liver and bone marrow. It is authentically established
that quinine circulating in the blood current does not destroy the
adult parasites, but only the sprorozoites of those that sproulate at
that particular time-meaning of course the death of the mother germs.
this leaves according to able authority , in the human system
somewhere malarial parasites both male and female. So, if I have any
explanation of why I prefer calomel as an eliminant (cathartic) in
malarial fevers, it is because I believe it destroys the parasites
in the mucous membranes, the lymphatics and the liver. This is evi-
denced by the clinical observation that it requires only about half
the amount of quinine in a given case, if administered in conjunction
with a course of mercuric chloride.
My old preceptor of 1882 commonly almost invariably, prescribed
twelve pills, containing each two grains of quinine, one grain of
calomel, one of pulv. Rhubarb and two of Bicarb. Soda, directing one
every two hours regularly till all were taken. I observed that it
generally "broke the fever" - if it didn't , he simply repeated the
course for another twenty-four hours. Unless a very obstinate case,
the patient got well, but often he had a sore mouth to treat during
convalescence. My honored Prof. Bartholow, who excelled in Thera-
peutics and Materia Medica, advised against this plan of treatment,
recommending one or two small doses of calomel followed by a saline
and then a single large dose of quinine about three hours before time
for the chill. this was my plan for a few years, but for reasons I
will explain further on, I have adopted a procedure that is somewhat
of a XXXXXXXXXXX compromise on the two plans. To be brief, I will
give the prescriptions.
No. 1 <(Perscription symbol "Rx"Partially handwritten)> < Quinine Sulfur gr X 11/y -grX v
Phenacetin grX-grX11/y
Hydro ang chlor mitis grv 1/j -gr X
Soda Bicarb grX-grXv
M. Fit. Caps vj. Seg; (Handwritten) >