Medical Officers of the Army of India.
should entail a positive diagnosis of actual malarial infection ; and were the
affirmative strictly maintained, I doubt not some of the instances above would
be differently estimated, and the asterisk numbers be correspondingly increased.
This qualification (and it may be there are others) it is right to mention here ;
and the remark applies also to series B, wherein some cases affected with a
" malarious taint" (so called) must on current views have been likewise in-
cluded.
Adverting now to the positive instances, I note that in the 9 examples 2 of
intermittents showed pigmented spheroids so few and seldom that it will suffice to
mention the fact ; both, clinically, being of mild and irregular illness. The remain-
ing 7 were under continuous daily observation from three to six weeks, or more,
and were closely watched : all being adult males, as regards history, aspect, and
severity of illness none were obviously peculiar (only that quartan ague is sel-
dom seen at Bombay) ; none were fatal, or complicated with marked local in-
flammation ; and, briefly, their ascertained blood-state alone served as a distinctive
feature. None were first attacks, and none were seen at early stage of illness.
The intensity, form, and duration of fever were varied ; and once no actual pyrexia
was ever present. The general condition of patients was fair or even good, and
but twice seriously impaired ; the splenic enlargement being never extreme, and
uneasiness always either moderate or slight. The quartan ague of No. I was
typical, and distinct quotidian and tertian paroxysms were watched in Nos. 3
and 4. Treatment by quinine prior to admission was usually denied, and sub-
sequently this drug was purposely withheld so long as deemed desirable. If these
instances be few in number, still they are all genuine and unselected represent-
atives of ordinary experience ; and the study of each being more sustained than
in records I have met with, the results attained seem as trustworthy as could be
expected in so plain a research. The notes following are much condensed, and
they are arranged so as to permit of independent judgment and future compa-
rison. These seven patients were 203 days in hospital (of which 40 fever and 163
non-fever days) ; and their blood was examined, commonly twice and frequently
oftener, on 127 days (of which 29 fever and 98 non-fever days); blood organisms
being found on 109 days, and not seen on 18 days of later convalescence after
fever.
CASE I .—Quartan ague.— I . P. N. , Goanese, æt. 28, servant on board an ocean-going
steamer, had never suffered from fever until three months ago, when seven days after
landing for a day at Colombo, he was seized while en . route to Bombay. Apparently the
type of fever contracted was that of an obstinate intermittent. After his admission here
in August, the symptoms were those of regular quartan ague, seven paroxysms being wit-
nessed : upon the exhibition of arsenic only a single interruption ensued with no other
benefit obvious, and the attacks again augmenting (last t. 105˚F.), two 10-grain doses
of quinine were administered, with the effect of perfectly arresting all further mani-
festation of fever after one quasi-abortive periodic rise : the doses of quinine being reduced
U 2