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Scientific Memoirs by
“typho-malarial” or “remittent,” have been scrutinised in vain for pigment organ-
isms in the blood, either sessile or free. It appears that other febrile re-action
than the self-generated is capable of checking or interrupting the growth of
malarial blood-organisms ; such as symptomatic fevers and the enteric, so long
as they persist, the parasites re-appearing subsequently. The blood-state of
special significance alluded to above is that termed "melanæmia," and such
as presented by my Nos. 6 and 7, both of which were in a critical state on
admission and might have died : the minute aspect of the blood was remarkable
(see Plate IX, the last figure), and nearly as pronounced as in a fatal case of
"fever" acquired in Northern India, which I have elsewhere described.
Therapy. —The high repute of quinine as an antiperiodic remedy (as well
as antipyretic) in malarious fevers, was fairly confirmed here : thus, case 4 having
no quinine and No. 5 no fever, in Nos. 1, 2 , 3, 6, and 7 the specific pyrexia was
promptly, completely and permanently arrested by this drug in 10-grain doses,
repeated once or twice at close of defervescence, and thence at short intervals
in smaller doses daily : simultaneously with such effect the splenic tumescence
subsiding, and general health improving. As to the modus operandi of quinine
in possible connection with the blood-organisms of ague, my observations were
clinical only ; direct experiment on blood outside the body, not (as in the
spiril-lum-contagion) seeming of much real import : and hence in the absence of a
definite visible relationship of parasite and pyrexia (see above), it was not easy
to make a satisfactory inference from 'the data. Case 4 may be viewed as a
sort of standard ; in the absence of the drug fever persisting though declining,
and the blood-contamination remaining unabated ; the spleen meanwhile lessen-
ing an inch transversely, and the health improving. No. 5 had manifest blood-
infection, without the least degree of fever ; after verifying these points, two in-
grain doses of quinine were given on successive days ; when the body temperature
still continued normal and unchanged ; whilst the blood-organisms began gradu-
ally to diminish, the flagellate disappearing on or after the third day, by the
seventeenth the spherules, and by the twenty-second the crescentic bodies being
no longer visible : here it seemed that a small quantity of quinine had led to a
gradual suppression of the organisms. The remaining five cases, including mild
and severe illnesses, had, after a preliminary watching, quinine administered to
about 20 grains daily, and invariably with the result of a prompt and permanent
arrest of the pyrexia ; but not of a simultaneously quick disappearance of the
blood-parasites, which on the contrary continued to be visible for periods of 4
days (No. 1) to 19 days (No. 3), or possibly longer, after the cessation of fever,
during which time the drug was still being given. In the severer cases, 6 and 7, I
noted that for 6 or 8 days after arrest of fever, there was still an abundance of
pigmented blood-discs ; looking as if a partial or quasi-abortive development of the
organisms were going on, some free organisms being also present : and probably