To the Editor:—
The remarks by Commander Fred A. Butler in the January 5 issue of The Journal deserve a little additional comment. He states that "the use of quinine as a provocative measure has not, to my knowledge, ever been reported before and requires confirmation." My own experience at a Southwest Pacific naval hospital revealed several cases in which the thick blood smear showed malarial parasites for the first time after the administration of 1 Gm. of quinine. That this experience was not unique is indicated by the statement on page 90 of Stitt's Diagnosis, Prevention and Treatment of Tropical Diseases (ed. 6): "Provocative measures to produce a relapse with a reinvasion of the blood by malarial parasites are occasionally employed for diagnostic purposes. Among these may be mentioned fatigue, refrigeration, exposure to sunlight, administration of small doses of quinine for ten to fourteen days..."