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administered intravenously in patients with fulminatingcerebral malaria.

3. In the therapy of vivax malaria.-Neither mepacrinenor quinine can be relied on to prevent relapses in vivaxmalaria following the discontinuation of therapy,although the interval between attacks is significantlylonger following mepacrine than following quinine inthe dosage schedules currently used by the armed forces.

4. In the therapy of falciparum malaria.-There isconvincing evidence -that mepacrine not only suppressesthe clinical symptoms of falciparum malaria but alsocures this malignant form. The evidence of a similarcurative effect of quinine is not conclusive.

5. Totaquine (USP).-Because of its content ofcrystallisable cinchona alkaloids, totaquine (USP) hasactivity which approximates to that of quinine and

. therefore can be used as a substitute for quinine whengiven orally. The antimalarial activity of totaquine(USP) is dependent on the amount of crystallisablealkaloids in the preparation rather than on the specificamount of each individual alkaloid. Gastrointestinaldisturbances occur more frequently following the use ofthe present totaquine (USP) than they do following theuse of quinine or mepacrine.On the basis of the foregoing statement it is resolved :

. (1) That no advantage, and possible disadvantage,would accrue to the armed forces were quinine or

totaquine to replace mepacrine for the routine suppres-sion and treatment of malaria. (2) That the large-scaleproduction of quinine or totaquine is not now considereda matter of importance for the management of malariaamong Army and Navy personnel. It is possible thata supply of totaquine in excess of the present stockpilesmay be required for therapy in civilian populationstemporarily under the jurisdiction of-the armed forcesin occupied territory where immediate dissemination ofinformation concerning the use of mepacrine (atabrine)is not practicable. In this connexion it should be keptin mind that after the war the overall need for allestablished antimalarial drugs will continue to be great.The personnel of the Board is : R. F. Loeb (chairman),

W. M. Clark, R. G. Coatney, L. T. Coggeshall, F. R.Dieuaide, A. R. Dochez, E. G. Hakansson, E. K.Marshall, jun., O. R. McCoy, F. T. Norris, W. H. Sebrell,J. A. Shanrion, and G. A. Carden, jun. (secretary).

BRITISH CONCLUSIONS

The above resolution was considered by the Drug-Prophylaxis and Therapy Subcommittees of the MedicalResearch Council Committee on Malaria at a jointmeeting on August 23, 1944. The members of thesesubcommittees are: Major-General A. G. Biggam(chairman), Brigadier F. A. E. Crew; FRS, Colonel S. P.James, FRS, Dr. W. D. Nicol, Lieut.-Colonel B. G.

Maegraith, Colonel C. S. Ryles, Mr. P. G. Shute, BrigadierJ. A. Sinton, FRS, Air Marshal Sir Harold Whittingham,and Dr. F. Hawking (secretary). The various itemswere discussed and it was agreed that British experienceand the extensive investigations carried out in Australia,under the direction of Brigadier N. Hamilton Fairley,led to the same conclusions as those reached in America.In particular, the subcommittees endorsed the resolutionthat if quinine or totaquine replaced mepacrine for theroutine suppression and treatment of malaria, the

change would not be advantageous and might possiblybe disadvantageous.

It is not possible during war-time to disclose all theextensive investigations upon which these officialAmerican and British resolutions concerning the relativemerits of mepacrine and quinine have been based, butwhen peace returns full details will doubtless be publishedin the scientific press. Meanwhile the position may besummed up by saying : under proper administration

mepacrine is no more liable to cause serious toxic effectsthan quinine is ; mepacrine is as effective as quinine inthe therapy of vivax malaria, but neither compoundwill prevent relapses ’at a later date ; mepacrine ifproperly given will practically always suppress and curefalciparum malaria, while the action of quinine in thisrespect is less certain.

Accordingly it must be realised that mepacrine is notan inferior substitute for quinine forced upon us by theloss of Java, but it is a more effective agent againstmalaria which would still be employed even if the

supplies of quinine were unlimited.

BRITISH MEDICAL STUDENTS’ ASSOCIATION

MR. WILLINK ON THE WHITE-PAPER

THE second annual general meeting of this associationwas held in London 6’a. Nov. 10-11. In a discussion ofthe findings of the BMSA questionary on the NationalHealth Service white-paper (see Lancet, Aug. 19, p. 258),Mr. IE),AVID PYKE, the president, said that the repliesreceived represented the opinions of about 25% of allBritish medical students. There was an almost 3 to 1agreement that a complete medical service should beavailable to everyone free of charge, but there wasqualified welcome to a number of proposals in bhe white-paper, which would be more generally popular if changeswere made.

Representatives from many schools voiced their con-stituents’ doubts about centralised control of theprofession: At St. Mary’s some 80% of students attend,ing meetings were unsatisfied with this control. Durham

University medical students were uncomfortable aboutthe composition of the proposed Central Medical Board ;they suggested that a nucleus of full-time membersshould perform its day-to-day work, whilst a larger com-mittee, including part-time members who were practisingdoctors, should decide questions of policy. Liverpool.University pleaded for " democracy at every level";they asked that local and national policy should be con-trolled by representatives elected by the profession, and-that these should publish an annual report. London.Hospital students believed that the Central HealthServices Council should be elected by the profession, notselected by the Minister. Another school, which alsowanted the Central Medical Board to be elected, claimedthat cooperation was more easily obtained at a local than,a central level. Speakers from Manchester and St.Andrews further underlined the danger of the medicalservices coming under the control of an organisation farremoved from the profession as a whole. A Cambridgerepresentative, however, suggested that demands forprofessional self-government might undermine theestablished principles of our political democracy-prin-ciples demanding that an elected representative of thepeople should be responsible to the people for the conductof any national service. A member of the executivecommittee warned delegates not to forget the immenseadvance proposed in the white-paper, which permittedthe profession very considerable measures of executiveand administrative authority.

Mr. H. S. SOUTTAR, FRCS, took the chair at a publicsession when he warmly welcomed Mr. Henry Willink,Minister of Health. Mr. PYKB, in presenting the resultsof the questionary to the Minister, said that the BMSAdid not think a reformed medical service alone sufficientto safeguard the health of the nation. In 5 years’ timethe medical students of today would constitute about afifth of the profession. While they were conscious of thenecessity of change, and approved the conception ofhealth centres, they would want to be free in their medical’practice and under no compulsion to enter a nationalservice.Mr. WILLINK said that the BMSA had grown rapidly

in wisdom and stature, and was of mutual benefit tostudents and their seniors. He described the impetus’that the war had given to social reform and explainedhow the white-paper had been designed to deal withseveral important deficiencies in the existing services bymeans essentially evolutionary. Answering questionsfrom delegates, he emphasised that there was nothingdefinitive about the white-paper and said he hoped to-start detailed discussions with the profession very soon.Any. future service would be based on "the traditionalpersonal confidential relationship 6f people with doctorsof their own choice," and would not involve compulsionof the doctor nor his metamorphosis into a Civil servant.The Minister announced that he would consult with theBMSA again before the white-paper was formed intobill.