Chapter 11

We cannot, therefore, in the future, count upon the assistance of external natural forces to increase the power of resistance of human society against the assaults of malaria. Such an object can be obtained only by artificial means. It has been sought to attain this end by the daily administration of the salts of quinine, of the salicylates, and of the tincture of eucalyptus, each and every one tried in turn. But the salts of quinine are dear, exercise a prompt, though very transient anti-malarial action, and, when administered for a long time, disturb rather seriously the functions of the digestive and nervous systems. The salicylates, when well prepared, are rather dear, and there is as yet no proof that they possess prophylactic powers against malaria. The alcoholic tincture of eucalyptus is useful in malarious regions (as are all the alcoholics, beginning with wine) in quickening the circulation of the blood; may it, perhaps, also act as a preservative against light attacks of malaria? Possibly. But it is very certain that it possesses no efficacy in places where malaria is severe. It will suffice to prove this to recall the two epidemics of fever which afflicted the colony of the Tre Fontaine, near Rome, in 1880 and 1882. Everybody was attacked, and there were several cases of pernicious fever, although a good preparation of eucalyptus is manufactured in the place and is distributed largely to the colonists during the dangerous season of the year.

ARSENIC FOR MALARIA.

Having several times had occasion to observe, in malarious regions, that when recourse was had to arsenic in order to subdue fevers over which quinine had exerted almost no effect, relapses occurred but rarely; and having been able to satisfy myself that the arsenical treatment sometimes procured a permanent, immunity in individuals who are subject to frequent attacks of malaria, I began in 1880 to employ arsenic (arsenious acid) as a prophylactic in certain portions of the Roman Campagna. This remedy was indicated in an experiment of this sort, not only by reason of its durable anti-malarialæ effects, but also by its low price, by the beneficial influence it exerts upon all the nutritive functions, and because it has no disagreeable taste and may therefore be given to everybody, even to children. My first trials in 1880 were rather encouraging, and I felt myself justified in engaging some proprietors and the association of our southern railroads to repeat the experiments on a large scale the following year, recommending them, however, to use arsenic in a solid form as offering an easy and certain dosage. This extensive prophylactic experiment began in 1881, and acquired constantly increasing proportions in 1882 and 1883, which have become still larger this year. An experiment of this kind is not easy to conduct in the beginning. The name, arsenic, frightens not only those whom we desire to submit to its action, but also the physicians, whose exaggerated fears have sometimes rendered the experiments of no avail, since they were conducted too timidly and the doses of arsenic employed were altogether insufficient. But some intelligent men, especially M. Ricchi, physician in chief to the southern railroads, were able speedily to triumph over these obstacles, and to place the experiment on a firm basis. The general testimony of all the facts which they have collected tends really to prove that when the administration of arsenic is begun some weeks before the presumed season for the appearance of the fever, and when it is continued regularly throughout the whole of this season, the power of resistance of the human organism to malaria is increased. Many individuals gained thereby a complete immunity, others a partial immunity, that is to say, they were sometimes attacked by the fever, but it never, even in very malarious districts, assumed a pernicious form, and was easily subdued by very moderate doses of quinine. Last year, for example, in the district of Borino, where the malaria is very severe, M. Ricchi experimented upon seventy-eight employes of the southern railroads, dividing them into two equal divisions, one of which received no prophylactic treatment, while the other was submitted to a systematic arsenical treatment. At the end of the fever season it was found that several employes among the first half had been attacked by fevers of a severe type; while thirty-six of those in the second division had enjoyed a complete immunity, the three others having been attacked, but so lightly that they cured themselves by quinine without seeking medical aid.

Facts of this sort are very encouraging, and the more so as the general health of those submitted to the prophylactic treatment was much improved. It was found almost invariably, upon the termination of the experiment, that there had been an increase in bodily weight and an amelioration of the anæmia which is so common in milarious districts. But, in order to arrive at such results, it is necessary to be at once bold and prudent. On the one hand, it is necessary to graduate very carefully the daily dose, never exceeding at the commencement the dose of two milligrammes (3/100 grain per diem) for adults, and never giving the arsenic upon an empty stomach. On the other hand, it is necessary to gradually push the dose up to ten or twelve milligrammes (15/100 or 18/100) a day for adults, in districts where the malaria is very severe, giving the arsenic in such a way that there is never an accumulation of the drug in the stomach. Most of the experiments which have been undertaken this year are being conducted on this plan, and there is reason to hope that they will give satisfactory results.

We must not, however, rest here if we wish to attain promptly the end proposed, namely, that of planting colonies in malarious districts without exposing the colonists to grave danger. Even if we realize perfectly the hope which I conceived in 1880, and if we are enabled to prove that arsenic increases man's power of resistance to the assaults of malaria, we must not imagine that everything is accomplished. It will take a long time before the use of a preservative method of this kind becomes generalized; we have first to contend against the fear which nearly every one experiences when arsenic is mentioned, and then there will also be difficulty in establishing everywhere a proper control over its administration. In every attempt at the colonization of malarious regions it will be necessary to combat for a long time the diseases caused by malaria, and we must seek for a method of combating them by a means which is in the possession of everybody, and which shall not be dangerous to the general economy of the human organism. Those who do not know from actual experience the miseries of a malarious country, think only of combating the acute forms of infection, which often place the patient in danger of death. But this danger, though great, is for the most part imaginary, provided that assistance be obtained in time. But that which desolates families, and which causes a physical degradation of the human race exposed to the attacks of malaria, is the chronic poisoning, which undermines the springs of life and produces a slow but progressive anæmia. This infection often resists all human therapeutic measures, and is even aggravated by the use of quinine, which is given during the recurrent paroxysms of fever. Quinine is, when given for a long period of time, a true poison to the vaso-motor nerves. The question, then, is to replace quinine, and the alkaloids which possess an analogous physiological action, by an agent the efficacy of which against, chronic malarial poisoning may be greater and the dangers of its employment less.

THE LEMON FOR MALARIA.

A happy chance has led Dr. Magliori to the discovery of an agent of this sort which was traditionally in use by certain Italian families. It is an exceedingly simple thing--merely a decoction of lemon. It is prepared by cutting up one lemon, peel and all, into thin slices, which are then put into three glassfuls of water and the whole boiled down to one glassful. It is then strained through linen, squeezing the remains of the boiled lemon, and set aside for some hours to cool. The whole amount of the liquid is then taken fasting. It is well known that in Italy, Greece, and North Africa, they often use lemon juice or a decoction of lemon seeds, as a remedy in malarial fevers of moderate intensity; and in Guadaloupe they use for the same purpose a decoction of the bark of the roots of the lemon tree. All these popular practices tend to show that the lemon tree produces a febrifuge substance, which resides in all parts of the plant, but which would seem to be most abundant in the fruit. In fact, among the popular remedies employed against malarial infection, that which I have just described is the most efficacious, for it can be employed with good effects in acute fevers. But it is especially advantageous in combating the chronic infection, which is rebellious to the action of quinine, and in removing or moderating its deplorable effects.

Hardly had I learned of this method of medication, when I hastened to induce some proprietors in the Roman Campagna to try it with their farm hands; and, after witnessing the good results there, I endeavored to persuade practitioners to make a trial of the same treatment. I was ridiculed a little at first, for they thought it rather singular that a professor should be trying to popularize on old woman's remedy. In reply to that I answered that practical medicine would not have existed, had it not known how to treasure up from age to age the facts of popular experience; and I ventured to remark that, had the Countess de Chinchon waited until methodical researches had been made into the physiological action of cinchona bark, before popularizing the remedy, the use of which she had learned from the semi-barbarous Peruvians, in all probability humanity would still, as regards malaria, be dependent upon the medication practiced in the middle ages. Happily these arguments had the desired effect upon certain distinguished practitioners, some of whom, especially in Sicily and Tuscany, have already collected together a tolerably large number of very encouraging observations. One of them, Dr. Mascagni, of Avezzo, tried the remedy in his own person, and succeeded in promptly curing an obstinate malarial fever which had resisted the action of quinine.

Gentlemen, in dealing with malaria we ought always to hold popular experience in high esteem, for we owe much to it. We owe to it the fact that we have been liberated from the paludal idea, and furthermore, that we have learned that it is often better, instead of trying to prevent the importation, for the most part imaginary, of malaria from distant marshes, to suppress its production in the soil under our feet or in that immediately surrounding us. We owe to it the knowledge, which we now have, that malaria rises up into the atmosphere only to a limited height, so that by placing ourselves a little above this limit in order to eliminate the possibility of the malaria being carried up to us by oblique atmospheric currents, we are enabled to breathe an air which does not contain this ferment, or which contains it only in insignificant amounts; thus one may even sleep in the open air during the night in very unhealthy districts without running any risks. The knowledge of this fact has led some peoples of Greece, and the inhabitants of the Pontine Marshes, to sleep in the open air on platforms raised on poles four or five meters (twelve to fifteen feet) in height. Some people in the Roman Campagna have built houses for themselves on top of the ancient tombs, the walls of which are perpendicular; the American Indians fasten their hammocks as high up as possible to the trees of the malarious forests; and very recently, the engineers of the Panama Railroad had little wooden huts built in the trees in order to procure safety against the terrible outbreak of malaria which occurred during the construction of that iron way. We owe, finally, to this popular experience the discovery of the specific action of quinine, and the consequent preservation of thousands and thousands of human lives. Why should we reject _a priori_ and without investigation other useful data which it may yet present to our consideration? If we wish to make progress in this question of rendering malarious countries healthy, we must always hold before our eyes a double object--to find a means of prophylaxis which may be accessible to everybody; and, at the same time, to find a means equally within everybody's reach, to overcome chronic malarial poisoning and its evil consequences. Science is still too far behind to permit us to hope that we shall soon succeed in discovering this second means by purely scientific researches. We ought, therefore, to gather together with great care all the facts which point to the possibility of a solution of this problem, and if the measures to which these facts point seem to be incapable of doing harm, we ought to try them boldly, and not be restrained by a false idea of the dignity of science. The social importance of the problem is too great to allow of its solution being retarded by the fear that scientific men may be accused of having been outrun by the ignorant. True science has none of these puerile susceptibilities; on the contrary, it deems it an honor to be able to seize all the observations of fact, whoever may have been their first recorder, to put them to the crucial test of methodical experiment, and to convert them into a new stepping stone on the march of human progress.

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HALESIA HISPIDA.

This fine hardy shrub is perhaps best known under the name of Pterostyrax, but we think gardeners will, quite independently of botanical grounds, be inclined to thank Messrs. Bentham and Hooker for reducing the genus to the more easily remembered name of Halesia. Halesia hispida is a hardy Japanese shrub of recent introduction, with numerous white Deutzia-like flowers in long terminal racemes. A peculiar appearance is produced by the arrangement of the flowers on one side only of the branchlets of the inflorescence. The botanical history of the plant is well known, and our illustration is sufficient to show the general appearance of the plant. It is decidedly one of the best recent additions to the number of hardy deciduous flowering shrubs. For the specimen whence our figure was taken we are indebted to W.E. Gumbleton, Esq.--_The Gardeners' Chronicle_.

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WINDFLOWERS.

The genus Anemone has a great future. Even at present its popularity is only a little less than that of roses and daffodils, but when we trust to seeds as a means of reproducing the best of windflowers instead of buying dried roots from the shops, then, and then only, will "coy anemone" become a garden queen. A. coronaria, if treated as an annual, furnishes glowing blossoms from October until June, after which A. dichotoma and A. japonica in all its forms--white and rosy--carry on the supply and complete the cycle of a year's blossoming. By sowing good, newly-saved seed in succession from February until May in prepared beds out of doors, the common crown anemone may in many sunny, sheltered gardens be had in bloom all the year round. This is saying a great deal, but it is true; indeed, it is questionable if we have any other popular garden flower which is at once so showy, so hardy, and so continuous in its blossoming. A friend beside me says: "Ah! but what of violas?" To which I reply: "Grow both in quantity, since both are as variable as they are beautiful." But when viola shrinks in foggy November from the frost demon, anemone rises Phoenix-like responsive to the first ray of sunshine. Besides, fair Viola, richly as she dresses in velvet purple or in golden sheen, has not yet donned that vivid scarlet robe which Queen Anemone weareth, nor are her wrappers of celestial azure so pure; and blue is, as we all know, the highest note of coloring in floral music. But comparisons are not required, Anemones are variable and beautiful enough to be grown for themselves alone. No matter whether we look at a waving mass of sparkling windflowers in a vineyard or cornfield by the Mediterranean, or walk knee deep among the silvery stars of A. nemorosa in an English wood--"silvery stars in a sea of bluebells"--they are alike satisfying. I believe that there is any amount of raw material in the genus Anemone--hardihood, good form and habit, and coloring alike delicate and brilliant; and what we now want is that amateurs should grow them with the attention and care that have been lavished upon roses and lilies and daffodils. But, alas! we have some capricious beauties in this group. A. coronaria and some other species succeed well treated as seedling hardy annuals, and others, as A. apennina, A. Robinsoni, A. Pulsatilla, A. dichotoma, and A. japonica, may be multiplied _ad infinitum_ by cuttings of the root. It is when we come to the aristocratic Alpine forms, to A. alpina, A. sulphurea, A. narcissiflora, etc., that difficulties alike of propagation and of culture test our skill to the uttermost. Tourists fond of gardens walk over these plants in bloom every year; they dig up roots and send them home; but they are as yet very rare in even the best of gardens. Nor is it easy to rear them from seeds. A year ago I sowed seed by the ounce each of A. alpina and of A. sulphurea, but as yet not a single plantlet has rewarded me for my trouble. Even freshly gathered seeds of A. narcissiflora will not germinate with me, but I live in hopes of surmounting little difficulties of this kind, and in the mean time, perhaps, others more fortunate will tell us how to amend our unsuccessful ways. One of the prettiest species which is now in flower in our gardens is the pure white A. dichotoma, which carries on the succession after the Snowdrop anemone (A. sylvestris) has passed away. Then we have dreams, and lend willing ears to the oral traditions of Anemone alba. Is this species in cultivation, or where may a figure of it be seen? It is said to be of neat habit, 12 inches high, with erect, saucer-shaped, white blossoms 3 inches in diameter. The species we now figure is well worth a place, being easily raised from seeds. It is called Anemone decapetala, and if not by any means a showy species, tufts of it three years from seed have this season been very pretty. It grows less than a foot in height, and bears pale creamy yellow flowers the size of a shilling on branched flowering stems; each blossom has eight or nine sepals around a yellowish green center. Some of our clumps had from a dozen to twenty flowers open at the same time, and the general effect in the early morning sunshine is a very pretty one. We have another species similar in habit which is just now a mass of rosy buds, and if you blow open its sepals, they are of a bright magenta color inside, but I never yet saw a flower open naturally on this plant. Just as the sepals open at the tips, and you think they are about to expand, they shrivel and fall away, leaving a tuft of greenish yellow stamens in the center. Is it A. Hudsoni? Another species not often seen, but well worth culture, is A. coerulea, a kind with finely cut leaves and purplish blue flowers. Then A. coronaria, The Bride, a pure creamy white kind, with flowers 3 inches across, raised by Van Velsen, of Haarlem, is really a good addition to these dainty blossoms, and affords a vivid contrast to the fiery A. fulgens. I have received this year some roots of anemones, iris, and other hardy flowers from the site of ancient Troy, and trust that some of these, if not new, will be beautiful additions to our gardens. The true A. vitifolia from northern India does well in mild localities; but best of all of this perennial large-leaved race is A. japonica alba, the queen of all autumnal kinds, rivaling the best of all hardy border flowers in purity and freedom of blossoming. Taken as a class, windflowers are so beautiful that we cannot grow them too plentifully, and but few other genera will so well repay cultural attention at all seasons.--_F.W.B., in The Garden_.

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STORY OF LIEUT. GREELY'S RECOVERY.

The story of Lieut. Greely's recovery after his rescue from Cape Sabine is given by Passed Assistant Surgeon Edward H. Green, U.S.N, of the relief ship Thetis, in a communication to the _Medical Record_. The cases of Greely's six fellow survivors, it is remarked, were very similar to his. The condition of all was so desperate that a delay of two hours in the camp was necessary before they could be removed to the relief vessels. Brandy, milk, and beef essence were administered.

Lieut. Greely's disease is called by the surgeon asthenia, a diminution of the vital forces. Greely fainted after being carried to the wardroom of the Thetis. When he was brought to, a teaspoonful of minced raw fresh beef was given to him. His clothes were carefully cut off of him, and heavy red flannels, previously warmed, were-substituted. He was excessively enacted, and his body emitted an offensive odor. His skin hung from his limbs in flaps. His face, hands, and scalp were black with a thick crust of soot and dirt. He had not washed himself or changed his clothing for ten months. He had lived a long time at a temperature inside the hut of from five to ten degrees above zero. He was nervous and irritable, at times almost irrational, and his eyes were wild and staring. He insisted on talking, craving news, and demanding food, but he complained of no pain.

His tongue was dry and cracked, and coated a brownish black. He was ravenously hungry. His pulse was 52, and soft or compressible. His skin was cold, clammy, shriveled, and sallow. His temperature under the tongue was 97.2 deg. There was great muscular waste, and he was unable to move or to stand without support. Before leaving Fort Conger in August, 1883, he weighed 168 pounds. He now weighed 120 pounds. He was carried aboard the Thetis about 11 P.M. on June 22, it being then broad daylight in that region, and his treatment from that hour until 8 o'clock the next morning was a teaspoonful of minced raw beef, alternated every half hour with a teaspoonful of milk punch. Strict quiet was enjoined.

On June 23 Surgeon Green was compelled to allow him to read some letters from home, after which he seemed less restless. He talked rationally, but showed a loss of memory in often repeating what he had previously said. He had not closed his eyes in sleep since his rescue. There was excessive constipation. The treatment was the same as during the night, except that finely cut raw onion was added to the minced beef, and half an ounce of milk punch was given every two hours.

On the next day, June 24, although he had yet had no sleep, and he showed a great desire to talk and read, there were signs of improvement. He was less persistent in demanding food, his tongue presented a moister appearance, he began to complain of soreness in his limbs, and his heart sounded stronger. Surgeon Green had him sponged with tepid water, and briskly rubbed with flannels. He gave him a small quantity of oatmeal thoroughly boiled, beef essence, and scraped beef and onion.

On the next day, June 25, Lieut. Greely slept for the first time. He awoke after two or three hours, much refreshed. He talked without excitement, and his tongue and skin began to look more natural. His muscles felt sore, and his ankles were puffed.