Reference

Fletcher, W. (1928). Notes on the treatment of malaria with the alkaloids of cinchona. London, J. Bale.

 

Summary

Notes on the Treatment of Malaria with the Alkaloids of Cinchona, a 1928 publication, was written by the late Dr William Fletcher, who was a bacteriologist in the Institute for Medical Research in Kuala Lumpur. In this book, Dr Fletcher provided an overview of cinchona, a flowering plant with a bark that can be used to extract a variety of alkaloids such as quinine, quinidine, cinchonine, cinchonidine and quinoidine, before he examined the research and observations in using these alkaloids, especially quinine, to treat patients with malaria. He then arrived at conclusions on which of these alkaloids and their treatment options were effective, safe and feasible.

Below are some of the findings mentioned in the book.

1. When administered to patients with malaria in doses of 10 grains twice a day, the alkaloids quinine, quinidine, cinchonine and cinchonidine seemed to be equally effective in getting rid of malaria parasites that were inside patients who weighed approximately 100 pounds.
2. The alkaloid quinoidine, on the other hand, was too toxic to be administered to patients with malaria in doses of 10 grains twice a day. In comparison, a reduced dosage of 5 grains twice a day was observed to be ineffective in getting rid of the malaria parasites in patients.
3. Quinine alkaloid and quinine-ethyl-carbonate, also known as equinine, were found to be effective in treating patients with malaria. The former has a bitter taste while the latter is tasteless.
4. In most cases, it was more effective and safer for quinine to be administered to patients orally.  
5. While there were alternative ways to administer quinine to patients with malaria, such as through intramuscular injections, intravenous injections and rectal injections, it was recommended for these alternatives to only be employed in serious cases where oral administration of quinine was not possible. This was because there were disadvantages in using the alternative measures as they only worked in certain circumstances (e.g. intravenous injection of quinine), could lead to health complications (e.g. intramuscular injection of quinine) or were simply both ineffective in treating patients and painful for patients to receive (e.g. rectal injection of quinine).
   
6. Urine tests could be done to look for traces of quinine in patients’ urine so as to check if these patients had complied with taking the medication orally.
7. Quinine did not appear to work at times which may have been due to factors such as the patient not swallowing the medication or the medication being adulterated.
8. Due to quinine not being the most affordable medication, cinchona febrifuge was used in place of quinine at times. Cinchona febrifuge was found to be just as effective as quinine in treating patients with malaria if it was administered in doses of 10 grains twice daily to patients.