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Scientific Memoirs by

6.     Continued (remittent) malaricus fever.— A. R., Mussulman, æt. 24, a railway
employé, three years in Bombay, but lately resident for three months at Ahmedabad,
whither he had gone for work and where he fell ill: was brought to hospital 13th Sep-
tember by the police from a neighbouring hamlet, where he had been found in a state of
great prostration while on his way back to Bombay. Temperature on admission 105°,
pulse 124, respirations 24; next morning t. 99.8°, rising to 104.8°, in spite of two
10-grain doses of quinine; after declining on the following day, however, fever did not
again recur during the remainder of his month's stay in hospital. At first the spleen was
but moderately enlarged, dulness reaching from eighth rib to 1/2 inch below costal margin.
and the organ was not particularly tender: soon afterwards it subsided to normal dimen-
sions The predominant early symptoms were pronounced anæmia and extreme debility,
a hæmic bruit and dicrotous pulse; about six days after the cessation of fever an anal
abscess formed, brief hemicrania set in, and six days later there was noted some anasarca,
most perceptible in the feet, where desquamation of the sole occurred: no hæmorrhagic
spots, and no albumen in the urine; convalescence steady and complete. This patient had
been liable to fever at his home in the Deccan: the present attack had come on three
weeks before admission, fever being at first intermittent and then persistent, the chills very
marked and no medicine taken. In hospital quinine was given daily (22 grains) for ten
days, and followed by cinchona alkaloids and iron.

The blood was examined during the febrile remission on the morning after admis-
sion (t. 100°), and several pigmented spherules and leucocytes seen; and next morn-
ing (t. 99.2°) I found numerous spheroids and crescents, and, in addition, many enormous
endothelial cells, densely loaded with masses of black pigment, identical with such seen
by me previously in a fatal case of febrile " melanæmia." On the same afternoon and
next day, the pigment-masses had considerably diminished. On the third day after the
cessation of fever, I found flagellate organisms; and on the two following days, sphe-
rules and crescents were seen in decreasing numbers, and the red corpuscles showed
pale pigmented spots on their surface; then again the flagellate bodies were noticed,
and next day, the seventh after defervescence, the blood appeared to be free of visible
contamination of any kind: but on the ninth several very active flagellate bodies were
detected: on and after the tenth day, for a further period of eighteen days, the blood
showed daily some spotted red-discs in gradually decreasing number and degree.

7.     Continued (remittent) malarious fever.— S. M., Mussulman, æt. 22, a mason
from Jeypore, one month in Bombay (crowded locality) and twelve days ill with fever,
was admitted 10th October in the incipient typhoid state, with t. 101.4° F. and spleen
enlarged to two inches below the costal cartilages and very tender: signs of enteric
fever were absent and stools seen were few, scanty, liquid yellow and alkaline, but
not ammoniacal; urine scanty, high-coloured yet clear, sp. gr. 1012 and no albumen
present. Quinine, in 10-grain doses, at three-hour intervals, being given thrice, pyrexia
thenceforward declined, with some sweats, to 99.4° F. at midnight; the temperature
further subsiding next day (quinine repeated), with abatement of splenic tumescence, yet
a continued general depression, with clammy skin, reminding me forcibly of the state
attending the lytic defervescence of the spirillar fever. Next day temperature rose to
99.6°, 'but declined again to normal on the two following days, quinine being repeated in
smaller doses: the splenic signs were more persistent, and so marked as to suggest a local
infarction: shallow fissures formed on the tongue, and a few days later some ear-ache, or
possible parotiditis appeared, and about ten days after admission the indications of slight
lobular pneumonia, on the left side above, and not conterminous with, the splenitis, resonant