Medical Officers of the Army of India.
143
The spleen became decidedly again enlarged—dulness-area 3 ½ inches by 5 inches—with
this recurrence of fever, subsiding with its close. Finally, the patient's health seemed fully
restored, when he left hospital after a detention of six weeks. Respecting the origin of
the malarial infection in this instance, it appeared that the disease might have been acquired
outside the town of Bombay, when last year during the rains the patient had lived at Kallian
(a malarious locality near) for three months, working as a weaver and then suffering from
fever, though not again since his return to Bombay until the present wet season. No
prior treatment.
The blood, at subsidence of fever on his admission, showed several large pigmented
crescentic bodies, and a few spherules: these persisted during apyrexia until the inter-
current febrile attack, when for the whole period of eight days I failed except once to
detect any organisms in the blood. Yet after the first dose of quinine, with complete arrest
of fever, the crescents and spherules became again apparent and so continued, though
diminishing in numbers, until the patient's discharge. It was doubtful if the flagellate
spheroids were ever present, but from some appearances of active pigmental movements,
I considered it likely that they might have been overlooked on both first and second oc-
casions of defervescence.
4. Intermittent fever (mild).— I. de S., Goanese, æt. 22, a ship's steward, never subject
to fever until landing last month (July) he went to his "coor, " or club, at Cavel (a fever locality
in Bombay); and then, after a wetting, he suffered from an attack, which subsided under
treatment, but had returned a week before his admission. The day after entry, his tem-
perature was normal and remained so for five days; when there began spontaneously a
series of mild daily paroxysms (max. t. 102˚ F.) for four days, and then two quasi-tertian
exacerbations (t. 100˚; F.), after which the patient decamped. The spleen at all times was
but slightly enlarged, its dulness-area not exceeding 2 inches by 3 ½ inches. Quinine was
not given; but only quassia and salines.
The blood on the day after admission (t. 98.5˚;) displayed both crescents and spherules,
there being also indications, as I thought, of the flagellate form: later, during apyrexia, the
crescentic bodies, and at times of renewed pyrexia both the crescentic and spheroidal, with
on the fourth day (t. 100˚;) distinct flagellar organisms: subsequently, the two more com-
mon forms were repeatedly seen.
5. Malarial cachexia: no pyrexia in hospital.— B. M., Mussulman, æt. 40, native of
Bokhara, resident two years in Bombay, a knife-grinder, was admitted in August with
colicky pains, a history of recent fever (? ague) and the spleen enlarged, reaching 1 inch
below the costal margin and having a dulness-area of 5 by 8 inches: he had also had fever
in his native country. General condition fair, but aspect pallid: the temperature, pulse, and
respiration were carefully watched, and at no time was any febrile excitement detected
throughout his detention of six weeks' duration. Arsenic was long administered, and once
two doses of quinine (each 10 grains), which produced little or no apparent general effect;
finally, a sedative soda-mixture was given. His body weight at entry was 110 ½ lbs. and
110 lbs. at discharge.
About a week after this man's admission, my colleague, Surgeon Manser, detected some
crescentic organisms in his blood; and three days later I found, in addition, spheroidal
bodies, both bare and flagellate, which during the next nine days were often seen in large
numbers. The dose of quinine being now given, crescents and spherules still abounded for
twelve days longer at least (arsenic being resumed); but the flagellate organisms were
not again seen: soon afterwards, only crescentic bodies could be found after long search,
and for a week before the patient's discharge the blood seemed free of contamination.