25

but from the 25th to the 30th it showed the typical characters of Quartan fever.
On the 27th, Quartan parasites in considerable number were found in a slide of
finger blood and, on the same day, in slides of splenic blood many Quartan
parasites and blocks of malarial pigment were found, but no "Leishman" or other
parasites were seen. Adequate doses of quinine were administered to the patient
on the 30th and subsequent days, and the fever quickly disappeared.

        RAJIA; aged 40; an in-patient of the dispensary at Soneput near Delhi.
The patient stated that he had suffered for more than a year from occasional
attacks of fever similar to the one for which he was admitted. His spleen was
enlarged two inches beyond the level of the umbilicus; no enlargement of the
liver was detected. He was not emaciated nor weak, and complained only of
fever. His temperature was taken every four hours, and the chart exhibited
typical Tertian periodicity. In a slide of finger blood a few Simple Tertian
parasites were found, and two similar parasites were seen in a slide of splenic
blood. No other parasites were found. Quinine was administered to the patient,
and in a few days the fever disappeared, when, being of opinion that he was
cured, he requested to be discharged from hospital. His spleen was still
enlarged beyond the level of the umbilicus.

        TULSA; aged 25; seen in the Civil Hospital at Delhi. The patient had
been admitted for fever, and quinine had been administered to him from the date
of his admission. I saw him on the fifth day after admission, by which time his
fever had ceased. The lower edge of the spleen reached to a point midway
between the umbilicus and pubes, and the liver was enlarged two inches below
the costal margin. A temperature chart had not been kept systematically, but
I was informed that his temperature was 102° at the time of his admission and
that it had risen to between 100° and 101° each evening on the three first days.
From the date when I saw him it did not rise above normal during the
remainder of his stay in hospital. He remained some time for the treatment
of a chronic ulcer on the leg, but when this was healed he left. His spleen and
liver were in much the same condition as at the time of his admission. I
found no malarial parasites nor pigment and no "Leishman" parasites.

        These two cases illustrate the freedom from severe symptoms which, as
I have already pointed out, is characteristic of native patients suffering from
true "malarial cachexia," as well as the shortness of the periods during which
fever is present, the amenability of the fever to quinine treatment, and, above
all, the lack of heed which the patients pay to the fact that their spleens are
enlarged, regarding themselves as quite well and able to carry on their usual
occupations as soon as the attack of fever has passed.

        Finally, I shall give some instances of cases of "malarial cachexia" examined
during apyretic intervals. In hospital practice among natives of India such

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