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23
It is well recognised at the Ministry of Health, in all centres of Tropical Medicine,
in the Royal Navy and Army, and amongst Port Sanitarians that the disease
is one of the greatest problems of a colonising nation. It is, therefore, a matter
which is constantly before your Worshipful Committee.
A policy with regard to shipping and this disease will eventually emanate from
the Government.
In the meantime your Medical Officer wrote to the Union-Castle Mail S.S. Co.,
Ltd., in the terms added hereunder, as these contain the pith of that knowledge
which should be gradually diffused throughout the whole of the shipping community
in order to the prevention of such states as occurred on the " Hunstanworth "
and now the " Garth Castle " amongst ships recently arriving :—
23rd April, 1923.
The Union-Castle Mail Steamship Co., Ltd.,
3 & 4, Fenchurch Street, E.C. 3.
Dear Sirs,
I would ask you to make the following facts known to all your masters and surgeons
of ships using malarious ports.
(1) Quinine is the only effective drug known in cases of malaria. It is extremely
effective.
(2) Where malaria is suspected, quinine should be immediately resorted to.
If the patient be vomiting excessively or be comatose, the dose of quinine
can be inserted into the rectum or into a vein. In the average case the drug can
be taken by mouth in the early stages and will prevent the appearance of the
more dangerous manifestations noted above.
(3) Quinine prophylaxis is quite useless unless practised in the presence of the
mosquito and at biting time. The dangerous mosquito usually bites from dusk
to dawn ; the time for a preventative dose, therefore, is just before dusk, but
its preventative effect has usually worn off before cease-biting time. Morning
and mid-day dose, or doses, taken while at sea, are useless as a preventative.
(4). A preventative dose is five grains taken at dusk. As the infective mosquito is
most prevalent ashore the man to whom the dose is most useful is the man
spending the evening or the night ashore.
(5) A dose in treatment is ten grains, or more in urgency, repeated every six hours
until effect is produced, the treatment being then continued with lessened doses.
(6) Quinine is rapidly voided from the body; it is necessary for full effects to repeat
the dose at regular intervals so as to have the drug always in circulation in the
blood.
Yours faithfully,
&c., &c.

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