Medical Officers of the Army of India.

163

spleen-pulp cell in which they are imbedded. Such masses were so seldom seen
free that their formation in the liquor sanguinis appeared doubtful; and I
considered it more likely that such densely pigmented cells belong to the spleen,
from thence entering the circulation where their presence may, it is held, lead to
embolisms of serious or even fatal degree. It appeared to me physically impos-
sible that these large pigment-clumps were formed by aggregation of particles
derived from dead parasites; and I inferred that even if, as they seem, they be
of the same material, their origin was a common and concurrent one from
hæmoglobin: in the spleen each of such pulp-cells taking up and destroying
numerous infected red blood-corpuscles. The data now mentioned are worthy of
note, and they also serve to confirm the opinion expressed above, that the col-
lateral events of visible infection, co-temporarily occurring, may be of chiefest
clinical import.

     Secondary fever. —The spirillar investigation (Work, pp. 171 and 420) led
me to recognise pyrexial states following closely on the specific, and similar
enough to permit of confusion, which are yet distinct in not presenting the same
visible blood-infection; and I considered such consecutive, residual or sequelar
pyrexia to be the effect of secondary quasi-septic contamination, or possibly of
a re-action of the nervous system. Demonstrated so far for the typical spirillar,
secondary events of this kind may be usual in other infections; and in the
malarial, they appear to be represented by the so-called amphibolic stage of
ague, long since noted by Wunderlich and his English commentators. At the
native hospitals here, confirmed malarious subjects are seen presenting smart,
yet not distressing febrile paroxysms, samples of which in my hands seemed
unattended with pigmented blood-organisms, and therefore were regarded as of
such secondary character: care being, however, needed to distinguish them
from negative intercurrent paroxysms in the visibly infected, such as witnessed
in case No. 3. How far the more prolonged fever of equally idiopathic aspect,
which is often seen in malarious subjects, can be viewed as of this secondary,
or sequelar, character remains for the present undecided; the spleen may be
moderately involved, but the blood contains no pigment organisms; and quinine
has no peculiar efficacy; signs of enteric fever are absent. This class of cases
represent one form of the so-called ‘malarial remittents,’ which amongst natives
take the place of ‘continued fevers,’ so-termed in rather antiquated phrase; and,
upon review, the data at my disposal indicate that in such cases the absence of
visible dotted parasites is not warrant enough to negative an antecedent con-
nection, at least with genuine malarial infection.

Y