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Scientific Memoirs by
POSTSCRIPT.—It has been possible to review the above statements with aid of other
cases, 20 in number and, as more selected examples of malarial fever, furnishing 6 in--
stances of the distincter blood-parasitism (not alone pigmental), which closely accord
with the 7 earlier instances detailed. Thus, no other than the monad organism being
present, again its flagellated stage was first detected two or three days after cessation
of pyrexia both spontaneous and induced ; and more clearly than before the liberated
flagellar filaments have been seen, knobbed or knotted, as originally described by
Laveran : the phagocyte rapacity was also common, if not always manifested so eagerly
as described above ; and as regards the characteristic pigmentation, it has seemed more
likely that the large black particles within leucocytes are derived from involuted organisms.
I have again observed a tendency of the spheroid-bodies to subside during the height and
persistence of pyrexia, subsequently to re-appear with crescents, if quinine have not been
administered. Renewed attention being paid to the asserted diagnostic import of certain
blood-disc changes ( vide Indian Medical Gazette, January 1886) in remittents and typho-
-malarial fever, it has still appeared to me here that the intra-cellular aspects in ques--
tion are neither constant nor uniform enough to be solely relied on as a sure diagnostic
means ; whilst all forms of pigmented bodies have seemed to be pathognomonic. An
example of marked urobilinuria, concurrent with melanæmia and the monad-infection of
ague, is detailed below.
CASE 8.— Ague and Urobilinuria, concurrent with Melanæmia and monad Blood-orga-
-nisms.—Patient, a stalwart Hindu, æt. 30, labourer, was admitted on 25th November 1887,
immediately after arrival at Bombay from a neighbouring marshy district, where for a month
he had been engaged in cutting fresh grass ; and owing, he said, to the exposure to sun,
hard labour, and scanty food, had become ill with fever about a week before resorting
to hospital : no medicine taken. On evening of admission, t. 103.4° (rising to 104.2°)
p. 108, : r. 40 ; there was general distress, vomiting of bile and burning sensation in the
epigastrium and splenic region : no hepatic or splenic enlargement, and no gastric tender--
ness. Rigors preceded and sweating followed the febrile paroxysm ; t. on the follow--
ing morning 97° F. Under salines and diaphoretics, four succeeding smart daily paroxysms
were watched ; maximum axillary temperatures of 105° being noted at second and third
paroxysms ; and at the fourth being still 104°. Quinine in two 10-grain doses was given on
the 30th November, which did not, however, check the fever, another paroxysm (m.
t. 104°) ensuing. On December 1st, therefore, m. t. 98°, three 10-grain doses of
quinine were administered, after the last of which the t. did not surpass 99.8°; during
the next three days the body-heat remained at 97°—98°, and for the eleven days following
it never rose beyond 98.4°. Not more than 50 grains of quinine were given, nor any other
antiperiodic drugs ; and with good food the patient made a gradual and continuous
recovery, only slowly, however, regaining weight. Without the signs of jaundice, this man
was noticed as having a peculiar bronzed complexion, which seemed on his rallying to
subside too soon for mere solar darkening of the skin.
The urine was copious, assuming a deep blood-like hue when passed at night during the
febrile state, and soon decomposing ; whilst during the non-febrile intervals it presented
simply a high colour and remained tolerably clear. As samples, the night’s urine of the
27th measured 35 ounces, had a deep-red coloured hue, and by early morning had become
ammoniacal, with (as described), a copious, flocculent, somewhat ‘sticky’ sediment ; sp.
gr. 1017, giving the re-action of bile-pigment, and with heat and acid a cloudiness only
indicative of albumen ; the chlorides ⅓ volume of liquid, of sugar no trace : whilst the fresh