|Pronunciation||US //, // or UK // KWIN-een|
|Trade names||Qualaquin, Quinate, Quinbisul|
|By mouth, intramuscular, intravenous, rectal|
|ATC code||M09AA01 (WHO) P01BC01 (WHO)|
|Metabolism||Liver (mostly CYP3A4 and CYP2C19-mediated)|
|Biological half-life||8–14 hours (adults), 6–12 hours (children)|
|Chemical and physical data|
|Molar mass||324.42 g·mol−1|
|3D model (Jmol)||Interactive image|
|Melting point||177 °C (351 °F)|
|(what is this?)|
Quinine is a medication to treat malaria and babesiosis. This includes the treatment of malaria due to Plasmodium falciparum that is resistant to chloroquine when artesunate is not available. While used for restless legs syndrome, it is not recommended for this purpose. It can be taken by mouth or used intravenously. Malaria that is resistant to quinine occurs in certain areas of the world. Some quantities are also used in tonic water and gives it its bitter taste.
Common side effects include headache, ringing in the ears, trouble seeing, and sweating. More severe side effects include deafness, low blood platelets, and an irregular heartbeat. Use can make one more prone to sunburn. While it is unclear if use during pregnancy causes harm to the baby, use to treat malaria during pregnancy is still recommended. How it works is not entirely clear.
Quinine was first isolated in 1820 from the bark of a cinchona tree. Bark extracts have been used to treat malaria since at least 1632. It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system. The wholesale price in the developing world is about US$1.70 to $3.40 per course of treatment. In the United States a course of treatment is more than $200.
- 1 Uses
- 2 Contraindications
- 3 Adverse effects
- 4 Mechanism of action
- 5 Chemistry
- 6 Natural occurrence
- 7 History
- 8 Society and culture
- 9 Other animals
- 10 See also
- 11 References
- 12 Further reading
- 13 External links
As of 2006, it is no longer recommended by the WHO (World Health Organization) as a first-line treatment for malaria, and it should be used only when artemisinins are not available. Quinine is also used to treat lupus and arthritis.
In the past, quinine was frequently prescribed in the US as an off-label treatment for nocturnal leg cramps, but this has become less prevalent due to a Food and Drug Administration statement warning against the practice.
Quinine is a basic amine and is usually provided as a salt. Various existing preparations include the hydrochloride, dihydrochloride, sulfate, bisulfate and gluconate. In the United States, quinine sulfate is commercially available in 324-mg tablets under the brand name Qualaquin.
All quinine salts may be given orally or intravenously (IV); quinine gluconate may also be given intramuscularly (IM) or rectally (PR). The main problem with the rectal route is that the dose can be expelled before it is completely absorbed; in practice, this is corrected by giving a further half dose. No injectable preparation of quinine is licensed in the US; quinidine is used instead.
|Name||Quinine base equivalence|
|Quinine base||100 mg|
|Quinine bisulfate||169 mg|
|Quinine dihydrochloride||122 mg|
|Quinine gluconate||160 mg|
|Quinine hydrochloride||111 mg|
|Quinine sulfate dihydrate [(quinine)2H2SO4∙2H2O]||121 mg|
According to tradition, the bitter taste of anti-malarial quinine tonic led British colonials in India to mix it with gin, thus creating the iconic gin and tonic cocktail, which is still popular today. Quinine is an ingredient in both tonic water and bitter lemon. In the US, quinine is listed as an ingredient in some Diet Snapple flavors, including Cranberry-Raspberry.
In France, quinine is an ingredient of an apéritif known as quinquina or "Cap Corse". In Spain, quinine ("Peruvian bark") is sometimes blended into sweet Malaga wine, which is then called "Malaga Quina". In Italy, the traditional flavoured wine Barolo Chinato is infused with quinine and local herbs and is served as a digestif. In Canada and Italy, quinine is an ingredient in the carbonated chinotto beverages Brio and San Pellegrino. In Scotland, the company A.G. Barr uses quinine as an ingredient in the carbonated and caffeinated beverage Irn-Bru. In Uruguay and Argentina, quinine is an ingredient of a PepsiCo tonic water named Paso de los Toros. In Denmark, it is used as an ingredient in the carbonated sports drink Faxe Kondi made by Royal Unibrew.
Quinine (and quinidine) are used as the chiral moiety for the ligands used in Sharpless asymmetric dihydroxylation as well as for numerous other chiral catalyst backbones. Because of its relatively constant and well-known fluorescence quantum yield, quinine is used in photochemistry as a common fluorescence standard.
Quinine can cause abnormal heart rhythms, and should be avoided if possible in patients with atrial fibrillation, conduction defects, or heart block. Quinine can cause hemolysis in G6PD deficiency (an inherited deficiency), but this risk is small and the physician should not hesitate to use quinine in patients with G6PD deficiency when there is no alternative.
Quinine in some cases can lead to constipation, erectile dysfunction, diarrhea, and/or vivid dreams. The New York Times Magazine described a case presenting with fever, hypotension, and blood abnormalities mimicking septic shock, which was judged to be an adverse reaction to quinine. Quinine can also cause drug-induced immune thrombocytopenic purpura. Symptoms can be severe enough to require hospitalization and platelet transfusion, with several cases known to have resulted in death.
Quinine can, in therapeutic doses, cause cinchonism; in rare cases, it may even cause death (usually by pulmonary edema). The development of mild cinchonism is not a reason for stopping or interrupting quinine therapy, and the patient should be reassured. Blood glucose levels and electrolyte concentrations must be monitored when quinine is given by injection. The patient should ideally be in cardiac monitoring when the first quinine injection is given (these precautions are often unavailable in developing countries where malaria is endemic).
Cinchonism is much less common when quinine is given by mouth, but oral quinine is not well tolerated (quinine is exceedingly bitter and many patients will vomit after ingesting quinine tablets): Other drugs, such as Fansidar (sulfadoxine with pyrimethamine) or Malarone (proguanil with atovaquone), are often used when oral therapy is required. Quinine ethyl carbonate is tasteless and odourless, but is available commercially only in Japan. Blood glucose, electrolyte and cardiac monitoring are not necessary when quinine is given by mouth.
Mechanism of action
As with other quinoline antimalarial drugs, the mechanism of action of quinine has not been fully resolved.[medical citation needed] The most widely accepted hypothesis of its action is based on the well-studied and closely related quinoline drug, chloroquine. This model involves the inhibition of hemozoin biocrystallization in Heme Detoxification pathway, which facilitates the aggregation of cytotoxic heme. Free cytotoxic heme accumulates in the parasites, causing their deaths.
The UV absorption of quinine peaks around 350 nm (in UVA). Fluorescent emission peaks at around 460 nm (bright blue/cyan hue). Quinine is highly fluorescent (quantum yield ~0.58) in 0.1 M sulfuric acid solution.
Cinchona trees remain the only economically practical source of quinine. However, under wartime pressure, research towards its synthetic production was undertaken. A formal chemical synthesis was accomplished in 1944 by American chemists R.B. Woodward and W.E. Doering. Since then, several more efficient quinine total syntheses have been achieved, but none of them can compete in economic terms with isolation of the alkaloid from natural sources. The first synthetic organic dye, mauveine, was discovered by William Henry Perkin in 1856 while he was attempting to synthesize quinine.
Quinine was used as a muscle relaxant, by the Quechua, who are indigenous to Peru, Bolivia and Ecuador to halt shivering due to low temperatures. The Quechuas would mix the ground bark of cinchona trees with sweetened water to offset the bark's bitter taste, thus producing tonic water.
The Jesuits were the first to bring cinchona to Europe. The Spanish were aware of the medicinal properties of cinchona bark by the 1570s or earlier: Nicolás Monardes (1571) and Juan Fragoso (1572) both described a tree that was subsequently identified as the cinchona tree and whose bark was used to produce a drink to treat diarrhea. Quinine has been used in unextracted form by Europeans since at least the early 17th century. It was first used to treat malaria in Rome in 1631. During the 17th century, malaria was endemic to the swamps and marshes surrounding the city of Rome. Malaria was responsible for the deaths of several popes, many cardinals and countless common Roman citizens. Most of the priests trained in Rome had seen malaria victims and were familiar with the shivering brought on by the febrile phase of the disease. The Jesuit brother Agostino Salumbrino (1564–1642), an apothecary by training who lived in Lima, observed the Quechua using the bark of the cinchona tree for that purpose. While its effect in treating malaria (and hence malaria-induced shivering) was unrelated to its effect in controlling shivering from rigors, it was still a successful medicine for malaria. At the first opportunity, Salumbrino sent a small quantity to Rome to test as a malaria treatment. In the years that followed, cinchona bark, known as Jesuit's bark or Peruvian bark, became one of the most valuable commodities shipped from Peru to Europe. When King Charles II was cured of malaria at the end of the 17th Century with quinine, it became popular in London. It remained the antimalarial drug of choice until the 1940s, when other drugs took over.
The form of quinine most effective in treating malaria was found by Charles Marie de La Condamine in 1737. In 1820, French researchers Pierre Joseph Pelletier and Joseph Bienaimé Caventou first isolated quinine from the bark of a tree in the Cinchona genus - probably Cinchona officinalis - and subsequently named the substance. The name was derived from the original Quechua (Inca) word for the cinchona tree bark, quina or quina-quina, which means "bark of bark" or "holy bark". Prior to 1820, the bark was first dried, ground to a fine powder, and then mixed into a liquid (commonly wine) which was then drunk. Large-scale use of quinine as a prophylaxis started around 1850.
It was the first effective treatment for malaria caused by Plasmodium falciparum, appearing in therapeutics in the 17th century. It remained the antimalarial drug of choice until the 1940s, when other drugs, such as chloroquine, that have fewer side effects replaced it. Since then, many effective antimalarials have been introduced, although quinine is still used to treat the disease in certain critical circumstances, such as severe malaria, and in impoverished regions, due to its low cost. Quinine is also present (in minute quantities) in various beverages. It is a white crystalline alkaloid.
Quinine also played a significant role in the colonization of Africa by Europeans. Quinine had been said to be the prime reason Africa ceased to be known as the "white man's grave". A historian has stated, "it was quinine's efficacy that gave colonists fresh opportunities to swarm into the Gold Coast, Nigeria and other parts of west Africa".
To maintain their monopoly on cinchona bark, Peru and surrounding countries began outlawing the export of cinchona seeds and saplings beginning in the early 19th century. The Dutch government persisted in its attempt to smuggle the seeds, and by the 1930s Dutch plantations in Java were producing 22 million pounds of cinchona bark, or 97% of the world's quinine production. During World War II, Allied powers were cut off from their supply of quinine when the Germans conquered the Netherlands and the Japanese controlled the Philippines and Indonesia. The United States had managed to obtain four million cinchona seeds from the Philippines and began operating cinchona plantations in Costa Rica. Nonetheless, such supplies came too late; tens of thousands of US troops in Africa and the South Pacific died due to the lack of quinine. Despite controlling the supply, the Japanese did not make effective use of quinine, and thousands of Japanese troops in the southwest Pacific died as a result.
Society and culture
From 1969 to 1992, the US Food and Drug Administration (FDA) received 157 reports of health problems related to quinine use, including 23 which had resulted in death. In 1994, the FDA banned the marketing of over-the-counter quinine as a treatment for nocturnal leg cramps. Pfizer Pharmaceuticals had been selling the brand name Legatrin for this purpose. Also sold as a Softgel (by SmithKlineBeecham) as Q-vel. Doctors may still prescribe quinine, but the FDA has ordered firms to stop marketing unapproved drug products containing quinine. The FDA is also cautioning consumers about off-label use of quinine to treat leg cramps. Quinine is approved for treatment of malaria, but is also commonly prescribed to treat leg cramps and similar conditions. Because malaria is life-threatening, the risks associated with quinine use are considered acceptable when used to treat that affliction.
Though Legatrin was banned by the FDA for the treatment of leg cramps, the drug manufacturer URL Mutual has branded a quinine-containing drug named Qualaquin. It is marketed as a treatment for malaria and is sold in the United States only by prescription. In 2004, the CDC reported only 1,347 confirmed cases of malaria in the United States.
- History of malaria
- Luis Jerónimo de Cabrera, 4th Count of Chinchón and Jesuit's bark, for the story of its introduction into Europe
- Warburg's tincture
- "Qualaquin (quinine) dosing, indications, interactions, adverse effects, and more". Medscape Reference. WebMD. Retrieved 29 January 2014.
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- Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 47. ISBN 9781284057560.
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- "FDA Drug Safety Communication: New risk management plan and patient Medication Guide for Qualaquin (quinine sulfate)". Food and Drug Administration. 2010-08-07. Retrieved 2011-02-21.
- Barennes H, et al. (1996). "Efficacy and pharmacokinetics of a new intrarectal quinine formulation in children with Plasmodium falciparum malaria". Brit J Clin Pharmacol. 41 (5): 389–395. doi:10.1046/j.1365-2125.1996.03246.x.
- Barennes, H.; Balima-Koussoubé, T; Nagot, N; Charpentier, JC; Pussard, E (2006). "Safety and efficacy of rectal compared with intramuscular quinine for the early treatment of moderately severe malaria in children: randomised clinical trial". Brit Med J. 332 (7549): 1055–57. doi:10.1136/bmj.332.7549.1055. PMC . PMID 16675812.
- Center for Disease Control (1991). "Treatment with Quinidine Gluconate of Persons with Severe Plasmodium falciparum Infection: Discontinuation of Parenteral Quinine". Morb Mort Weekly Rep. 40 (RR–4): 21–23. Retrieved 2006-05-06.
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- Ballestero, JA; Plazas, PV; Kracun, S; Gómez-Casati, ME; Taranda, J; Rothlin, CV; Katz, E; Millar, NS; et al. (2005). "Effects of Quinine, Quinidine, and Chloroquine on α9α10 Nicotinic Cholinergic Receptors". Molecular Pharmacology. 68 (3): 822–829. doi:10.1124/mol.105.014431. PMID 15955868.
- Joseph R. Lakowicz. Principles of Fluorescence Spectroscopy 3rd edition. Springer (2006). ISBN 978-0387-31278-1. Chapter 2. page 54.
- Quinine sulfate ogi.edu. Retrieved 16 August 2013
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- Optically active isomers of quinine and quinidine and their respective biological action Accessed 26/1/2009
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- Hobhouse, Henry (2004). Šest rostlin, které změnily svět (in Czech). Prague: Akademie věd České republiky. p. 59. ISBN 80-200-1179-X.
- History of quinine: Friedrich A. Flückiger and Daniel Hanbury, Pharmacographia: A history of the principal drugs of vegetable origin, met with in Great Britain and British India (London, England: Macmillan and Co., 1874), pages 302-331: Cortex Cinchonæ.
- Fernando I. Ortiz Crespo (1995) "Fragoso, Monardes and pre-Chinchonian knowledge of Cinchona," Archives of Natural History, 22 (2) : 169-181.
- David C. Stuart, Dangerous Garden: The Quest for Plants to Change Our Lives (London, England: Frances Lincoln Ltd., 2004), p. 28.
- Nicolás Monardes, Primera, segunda y tercera partes de la Historia Medicinal de las cosas que le traen de nuestras Indias Occidentales y que sirven en Medicina [First, second and third parts of the medical history of things that have been brought from the new West Indies and that are of use in medicine] (Seville, Spain: Fernando Diaz, 1580), pp. 74-75. From p. 74: "Del nuevo Reyno, traen una corteza, que dizen ser de un arbol, que es de mucha grandeza: el qual dize, que lleva unas hojas de forma de coraçon, y que no lleva fruto. Este arbol tiene una corteza gruessa, muy solida y dura, que en esto y en el color parece mucho a la corteza del palo que llaman Guayacan: en la superfiecie tiene una pelicula delgada blanquisca, quebrada por toda ella: tiene la corteza mas de un dedo de gruesso, solida, y pesada: la qual gustada tiene notable amargor, como el dela Genciana: tiene en el gusto notable astriction, con alguna aromaticidad, porque al fin del mascar la respira della buen olor. Tienen los Indios esta corteza en mucho, y usan de lla en todo genero de camaras, que sean con sangre, o sin ella. Los Españoles fatigados de aquesta enfermedad, por aviso de los Indios, han usado de aquesta corteza y han sanado muchos del los con ella. Toman della tanto como una hava pequeña hecha poluos, toma se en vino tinto, o en agua apropiada, como tienen la calentura, o mal: ha se de tomar por la mañana en ayunas, tres o quatro vezes: usando en lo demas, la orden y regimiento que conviene a los que tienen camaras." (From the new kingdom, there is brought a bark, which is said to be from a tree, which is very large: it is said that it bears leaves in the form of a heart, and that it bears no fruit. This tree has a thick bark, very solid and hard, that in this and in its color looks much like the bark of the tree that is called guayacán [i.e., lignum vitae]: on the surface, it has a thin, discontinuous whitish film throughout it: it has bark more than one finger thick, solid and heavy: which, when tasted, has a considerable bitterness, like that of the gentian: it has in its taste a considerable astringency, with some aromaticity, because at the end of chewing it, one breathes with a sweet odor. The Indians hold this bark in high regard, and use it for all sorts of diarrhea, that are with blood [i.e., bloody] and without it. The Spanish [who are] tired of this disease, on the advice of the Indians, have used this bark and have healed many of those with it. They take as much as a small bean, make [it into] powder, take it in red wine or in appropriate water, if they have fever or illness: it must be taken in the morning on an empty stomach, three or four times: otherwise, using the order and regimen that suits those who have diarrhea.)
- Fragoso, Juan, Discursos de las cosas Aromáticas, árboles y frutales, y de otras muchas medicinas simples que se traen de la India y Oriental y sirven al uso de la medicina [Discourse on fragrant things, trees and fruits, as well as many other ordinary medicines that have been brought from India and the Orient and are of use to medicine] (Madrid, Spain: Francisco Sanchez, 1572), p. 35. From p. 35: "En el nuevo mundo ay un grande arbol que lleva las hojas a forma de coraçon, y carece de fruto. Tiene dos cortezas, la una gruessa muy solida dura, que assi en la sustancia como en el color es muy semejante al Guayacan: la otra es mas delgada y blaquezina, la qual es amarga con alguna estipticidad: y de mas desto es aromatica. Tienen la en mucho nuestros Indios, porque la usan contra qualesquier camaras, tomando de poluo peso de uno drama o poco mas, desatado en agua azerada, o vino tinto." (In the new world, there is a big tree that bears leaves in the form of a heart, and lacks fruit. It has two barks, one [is] thick, very solid, [and] hard, which in substance as well as in color is much like guayacan [i.e., lignum vitae]: the other is thinner and whitish, which is bitter with some styptic [i.e., astringent] quality: and besides this, it is aromatic. Our Indians regard it highly, because they use it against any diarrheas, taking a weight of a dram or a bit more of the powder, mixing it in mineral water, or red wine.)
- Juan Eusebio Nieremberg and Alonso de Andrade, Varones Ilustres en Santidad, Letras, y Zelo de las Almas. De la Compañia de Jesus. [Illustrious men in holiness, letters, and zeal for souls. Of the Society of Jesus (i.e., Jesuits).] (Madrid, Spain: Joseph Fernandez de Buendia, 1666), vol. 5, Vida del devoto Hermano Agustin Salumbrino (The life of the devout Brother Agustin Salumbrino), pp. 612-628 ; see p. 612. From p. 612: "Nacio el Hermano Agustin Salumbrino el año de mil y quinientos y sesenta y quatro en la Ciudad de Flori en le Romania, … " (Brother Agustino Salumbrino was born in the year 1564 in the city of Flori [Note: This is an error; he was born in Forli.] in Emilia-Romagna, … )
- Francisco Medina Rodríguez (July 2007) "Precisiones sobre la historia de la quina" (Details about the history of quinine), Reumatología Clínica, 3 (4) : 194-196. (in Spanish) From p. 195: "De hecho, aunque no esté dicha la ultima palabra, hay escritos jesuitas que mencionan que la quina llegó a Roma en 1632, con el provincial de las missiones jusuitas del Perú, el padre Alonso Messia Venegas, como su introductor, cuando trajo una muestra de la corteza para presentaria como primicia, quien había partido de Lima 2 años antes, ya que consta que estuvo en Sevilla en 1632, donde publicó uno de sus libros y siguió su camino hacia Roma en calidad de procurador." (In fact, however, it is not the last word: there are Jesuit writings that mention that quinine arrived in Rome in 1632, with the provincial of the Jesuit missions of Peru, Father Alonso Messia Venegas, as its introducer, when he brought a sample of the bark so that it could be presented as a novelty, which had left Lima two years before, since in fact it had been in Seville in 1632, where he published one of his books and [then] he went his way toward Rome in the capacity of procurator.)
- Enrique Torres Saldamando, Los Antiguos Jesuitas del Perú [The old Jesuits of Peru] (Lima, Peru: Imprenta Liberal, 1882), pp. 180-191 ; see especially p. 181. (in Spanish) From p. 181: "Al siguiente año se dirigieron á Europa los Procuradores P. Alonso Messía Venegas y P. Hernando de Leon Garavito, llevando gran cantidad de la corteza de la quina, cuyo conocimiento extendieron por el mundo los jesuitas." (In the following year [i.e., 1631] there went to Europe the procurators Father Alonso Messia Venegas and Father Hernando de Leon Garavito, taking a great quantity of cinchona bark, knowledge of which the Jesuits spread throughout the world.)
- Alberto Bailetti, Blog: "La Misión del Jesuita AgustÍn Salumbrino, la malaria y el árbol de quina" (The mission of the Jesuit Agustin Salumbrino, malaria and the quinine tree), Chapter 10: La Condensa de Chinchón (The countess of Chinchon). (in Spanish) From Chapter 10: "A últimas horas de la tarde del treinta y uno de mayo de 1631 se hizo a la vela la armada real con dirección a Panamá llevando el millonario cargamento de oro y plata.
- En una de las naves viajaban los procuradores jesuitas padres Alonso Messia y Hernando León Garavito custodiando los fardos con la corteza de quina en polvo, preparados por Salumbrino. Después de casi veinte días de navegación el inapreciable medicamento llegó a la ciudad de Panamá, donde fue descargado para cruzar en mulas el agreste camino del itsmo palúdico hasta Portobelo para seguir a Cartagena y la Habana, cruzar el Atlántico y llegar a Sanlúcar de Barrameda en Sevilla. … Finalmente siguió su camino a Roma y a su destino final el Hospital del Espíritu Santo."
- (Late in the afternoon of the 31st of May, 1631, the royal armada set sail in the direction of Panama, carrying its multimillion [dollar] cargo of gold and silver.
- On one of the ships traveled the Jesuit procurators Fathers Alonso Messia and Hernando León Garavito, guarding the cases of powdered cinchona bark, prepared by Salumbrino. After almost 20 days of sailing, the priceless medicine arrived in the city of Panama, where it was unloaded in order to cross, on mule back, the rugged path of the malarial isthmus as far as Portobelo, in order to continue to Cartagena [in Columbia] and Havana, [then] to cross the Atlantic and reach Sanlúcar de Barrameda in Seville, [Spain]. … Finally it followed the road to Rome and to its final destination, the Hospital of the Holy Spirit.)
- Rocco, Fiametta (2004). Quinine: malaria and the quest for a cure that changed the world. New York, NY: Perennial.
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- de la Condamine (1738) "Sur l'arbre du quinquina" (On the quinquina tree) Histoire de l'Académie royale des Sciences, pages 226-243.
- See also: Joseph de Jussieu, Description de l'arbre à quinquina: mémoire inédit de Joseph de Jussieu (1737) (Description of the quinquina tree: unpublished memoir of Joseph de Jussieu (1737)). De Jussieu accompanied de la Condamine on the latter's expedition to Peru.
- Pelletier and Caventou (1820) "Suite: Des recherches chimiques sur les quinquinas" (Continuation: Chemical research on quinquinas), Annales de Chimie et de Physique, vol. 15, pages 337-365. The authors name quinine on page 348: " … , nous avons cru devoir la nommer quinine, pour la distinguer de la cinchonine par un nom qui indique également son origine." ( … , we thought that we should name it "quinine" in order to distinguish it from cinchonine by means of a name that also indicates its origin.)
- Conner, Clifford D. (2005). A People's History of Science: Miners, Midwives, and 'Low Mechanicks'. New York: Nation Books. pp. 95–96. ISBN 1-56025-748-2. Also cites Porter, Roy (1998). The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W. W. Norton. pp. 465–466. ISBN 0-393-04634-6.
- Louis Morton (1953). "29". The Fall of the Philippines. Washington, D.C.: United States Army. p. 524.
- Alan Hawk. "Remembering the war in New Guinea: Japanese Medical Corps -- malaria".
- Lt. Gen. Leonard D. Heaton, ed. (1963). "8". Preventive Medicine in World War II: Volume VI, Communicable Diseases: Malaria. Washington, D.C.: Department of the Army. pp. 401 and 434.
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