drugs as long as they cure, but don't cling to those that sometimes kill when you have found others to work safely." For the treatment of acute attacks of malaria chloroquine appears to be the most rapidly acting drug4 and for fulminating or cerebral P. falciparum infections is best given intravenously in a saline drip. Intramuscular or intravenous mepacrine is probably the most satisfactory alternative to chloroquine, but the use of quinine in these cases is inadvisable in view of the risk of blackwater fever, and pyrimethamine and proguanil should also not be given unaided for such infections, as Sir Gordon Covell has recently emphasized in a letter to this Journal (July 4, page 41). For malarial suppression proguanil is the drug of choice, for it combines effectiveness with absence of toxicity, while it is the only drug known to be a true causal prophylactic in P. falciparum infections. It may be found that pyrimethamine also has such an effect against this parasite and P. vivax. If this is so, it will mean that a drug has at last been found which when taken prophylactically prevents late relapses of benign tertian malaria. Finally, it cannot be too firmly stressed that quinine should not be used for suppression. In maximally tolerated doses it has been found to be ineffective and to lead to latent or to recrudescing infections in the presence of which blackwater fever is liable to develop.4 An important result of the introduction of the modem antimalarials is that in communities in which they are used in proper dosages blackwater fever is abolished. This in itself has led to great saving of life.
British Medical Journal