46.
Para. 26
differs from the classical type, and that "many of the patients do not have.
rigors and scarcely perceive that they have fever"; and that quinine, even
in strong doses, suppresses only some of the attacks Davidson mentions
[p. 186] that the fevers "show a tendency to run on interminably" if untreat-
ed; and Thayer remarks [p. 191] "There are often frequently recurring slight
febrile attacks, and commonly a regular evening exacerbation of temperature,
rising as high as from 100° to 162°. Mannaberg mentions [28, p. 387],
that "the Italian investigators, as well as Sacharoff, say that there is a
Febis recondaria pust malariam,, a fever which lasts for some days or even
weeks after the parasites have ceased to be found, and which does not react
to quinine ; "but adds that he has not been able to observe it.
These statements, except Mannaberg's, are not express enough to assist
us much. It is obvious that as long as attacks of typical malarial pyrexia
appear, so long shall we find parasites; and it is evidently to such cases that
Manson refers. The difficulty of finding parasites in very advanced cases
is also noted; but there is no record touching the question of their gradual
disappearance and that of the melanin. As regards fever, while Davidson
and Thayer seem to refer to something like the low fever found in many cases,
they do not appear to .question that it is a parasitic fever. The "Italian in-
vestigators," however, have a definite statement to this effect (I regret I cannot
obtain the reference).
It may be said here, however, that these quotations appear to suggest
that the parasites are found more persistently in the European cases than in
mine—which seems to be just opposite to the inference I have attempted to
derive from the infection being probably milder in the former than in the
latter. The matter is one of great interest, and I shall presently endeavour to
to account for it (paragraph 30)
The literature on the parasites in India is contained chiefly in papers by
Vandyke Carter [29], Crombie [30, 31]. Maynard [32], Rogers [33], Murray
[34], Sturmer [35], and myself [18, 23]. Those papers are mostly concerned
with the parasites themselves, and I can find in them no very apt refer-
ences to the present matter—except one in the admirable essay of Vandyke
Carter, to be quoted presently. Maynard, however, gives a table of 70 cases
with very exact details, from which I collect that he found no parasites in
advanced cases of paludism. The passage which I refer to in Vandyke Carter's
Work [p. 163] is headed Secondary fever," and is so important that it should
be quoted in extension. It is as follows.—
"Secondary fever.—The spirillar investigation (Work, pp. 171 and 420)
led me to recognise pyrexial states following closely on the specific, and
similar enough to admit oil confusion, which are yet distinct in not present-
ing the same visible blood infection; and I considered such consecutive,
residual or, sequelar pyrexia to be the effect of secondary quasi-septic
contamination, or possibly, of a re-action of the nervous system. Demon-
srated so far for the typical spirillar, secondary events of this kind may be
usual, in other infections; and in the malarial, they appear to be represented
by the so-called amphibolic stage of ague, long since noted by Wunderlich
and his English commentators. At the, native hospitals here, confirmed
malarious subjects are, seen presenting, smart yet not distressing febrile
paroxysms, sample of which in my hands seemed unattended with pigment-
ed blood organisms and, therefore, were, regarded as of such secondary charac-
ter; care being, however, needed, to distinguish them from negative
intercurrent paroxysms in the visibly infected, such as witnessed in Case
No. 3. How far the more prolonged fever, of equally idiopathic aspect
which is often seen in malarious subjects can be viewed as of this secon-.
dary or sequelar character remains for the present iindecided; the spleen may,
be moderately involved, but the blood contains no figment, organisms;
and quinine has no peculiar efficacy; signs, of enteric, fever are absent.
This class of cases represents one form of the so-called 'malarial remittents,'
which amongst natives take the place of 'continued fevers,' so termed in,
rather antiquated phrase; and, upon, review, the data at my disposal indicate
that in such cases the absence of visible dotted parasites is not warrant
enough to negative, an antecedent, connection, at least, with genuine malarial
infections."