Intramuscular versus Intravenous Quinine

Sir,?Dr. Soni's letter in your issue of May 1935, page 298, induced me to read once over again my letter and your comments thereon. I find that two very important points seem to have missed both of you, viz, (1) My observations relate only to malaria in Kenya and particularly Nairobi. What holds good here may not hold good elsewhere. (2) Ninety-five per cent of the cases here are subtertian in origin. (Malaria is a notifiable disease here and blood examination is done free of charge.) The gastro-intestinal tract is usually very irritable and it is only in a small percentage of cases that oral administration is a possibility. As a matter of fact even after the cessation of pyrexia vomiting persists in some cases and requires parenteral administration of quinine to control it. But, apart from the availability of the oral route, I do state that oral administration of quinine is not successful in a majority of cases where that route is possible. I do hold that 85 per cent of the cases here do need parenteral administration at the beginning of treatment at least. After my writing to you there has been an epidemic of malaria here and I have to state that my experience during the same warrants no change in my views. Dr. Soni raises the question of relapse; it is hard to