Medical Officers of the Army of India.

155

case 4 of old quotidian ague, demonstrated the occurrence of free organisms
at least, with apyrexia of 5 days’ duration; and with the onset of fresh intermit-
tent attacks, their persistence with the occasional addition of flagellate organ-
isms for other 9 days’ observation, suddenly closed: quinine not given. Case
5 presented the phenomenon of continuous complete apyrexia for at least 42 days,
during the first 15 of which the blood was examined repeatedly on 10 days, and
found always to contain numerous crescents and spherules, bare and flagellate,
no quinine being given: after a brief exhibition in total of 20 grains of this drug,
the organisms began to diminish, the flagellate not being seen, but the other
forms continuing for 15 days longer, after which the blood was clear for 11 days
more: how long before his admission this patient had been fever-free, was uncer-
tain; his only complaint in hospital was splenic enlargement and uneasiness,
which had not quite subsided when he left. Cases 6 and 7 were much alike, both
being examples of ague of severe continued ( ? remittent) type; at the time of
pyrexial arrest by quinine, abundant organisms in the blood, and, in addition, pig-
ment-loaded cells, both leucocytal and endothelial: after continued exhibition
of the drug, these bodies subsided in the course of 11 or 12 days and; in both
cases, shortly after the arrest of fever (3 or 4 days), flagellate organisms were for
the first time seen; in No. 6 three times in 6 days, and in No. 7 once only:
following which, the blood seemed healthy for 17 and 7 days’ stay respectively.
This review is offered because, after allowing for defects, the data appear adequate
for determining the fundamental question of visible relationship of organism to
pyrexia and other disturbance of the system; and it demonstrates the absence
of a direct connection between the phenomena compared, as regards actual
concurrence in time (a ), kind of organism to kind or severity of fever (b ) or to
other general affection of the system (c ). So far as I learn, these results are in
main accord with those arrived at elsewhere; and they render it needless to dis-
cuss the precise relation of special organism to special symptom, because already
proving the absence of such relation.¹This is not to assert the impossibility of
otherwise demonstrating a general or special connection, for, judging by other ex-
perience, e.g., the spirillar, some such is likely; and even here, if the morphological
data be allowed to include excessive splenic or hepatic pigment-formation, very
serious symptoms (as in cases 6 and 7) may be seen to happen simultaneously.

      Diagnostic imports of the visible Blood-state. —As hitherto estimated by
history and symptoms, the diagnosis of the malarial infection is so often
obscure that clinicians would welcome any additional aid afforded by micro-
scopical scrutiny of the blood. This obscurity in diagnosis being attributable
mainly to the chronicity and variableness of clinical signs, it might a priori
be anticipated that contemporary blood-states, as now revealed, would vary
likewise; and, as matter of fact, it is found that the monad-parasite of ague

¹Later experience has confirmed these inferences: see the Postscript at end.

x