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15-12-02 . . A few medium-sized Simple Tertian parasites; a good many
crescents.
19-12-02 . . A few young Simple Tertian parasites; a few crescents.
23-12-02 . . Crescents only found. Spleen 2 inches below the costal
margin.
26-12-02 . . Crescents; pigmented leucocytes; a few very young rings (? S. T.)
28-12-02 . . Crescents; pigmented leucocytes; rings and large Simple Tertian
parasites.
30-12-02 . . Crescents; a few young rings; a good many medium-sized
Simple Tertian parasites.
2-1-03 . . Many young Simple and Malignant Tertian rings; a few large
Simple Tertian parasites; crescents.
4-1-03 . . A good many large Simple Tertian parasites; a few Malignant
Tertian rings; a good many crescents.
6-1-03 . . 12 noon. Temp. 103°. Many crescents; several pigmented
leucocytes: no rings seen.
      7 P.M. Temp. 102.4°. Many crescents; numerous heavily
pigmented leucocytes; one segmenting Malignant Tertian
parasite; no rings seen.
      10-45 P.M. Temp. 103°. Crescents and pigmented leucocytes ;
two rings after long search.
7-1-03 . . 2-30 A.M. Temp. 103.2°. Many crescents and pigmented
leucocytes; two rings.
      8-30 A.M. Many crescents and pigmented leucocytes; no rings
found.
      4 P.M. Ditto ditto.
      8 P.M. Ditto ditto.
      12 P.M. Ditto ditto.
9-1-03 . . Crescents only found. Spleen 3½ inches below costal margin.
12-1-03 . .   Ditto ditto.
19-1-03 . . Crescents still present in fair numbers; no other parasites found.
28-1-03 . . A few medium sized Simple Tertian parasites; crescents still
present.
8-2-03 . . One Malignant Tertian ring form; two Simple Tertian parasites
in stippled cells.
16-2-03 . . One ring only found after long search.
24-2-03 . . Crescents present in fair numbers. Spleen 3 inches below costal
margin.

     Signs and symptoms; diagnosis by clinical methods.—Although the
infection with Malignant Tertian parasites found in November was probably a new
one, it was known that the patient had suffered from an untreated infection with
Simple Tertian parasites since the previous April, and throughout the summer his
spleen had been enlarged nearly to the umbilicus; so that a diagnosis of " malarial
cachexia " was justifiable. Despite the severe infection there is nothing of note
to record regarding the symptoms. As in the other cases, the illness consisted of
a series of attacks of fever, during which the boy was obviously ill, separated by
intervals of apyrexia, during which he recovered. On the whole, he appeared no

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