Tropical Diseases due to Microscopic Orgamsms. 211 



erythrocytes present ; leucocytes, 5000 with a large increase in the 

 lymphocytes (55 p.c.) instead of the large mononuclears, as one 

 would expect in a malarial condition. He was considered to be a 

 case of pernicious anieaiia, and accordingly was treated with arsenic 

 for several months, when suddenly one day he had a rigor, the 

 temperature going up to 105" F. ; the spleen became just palpable, 

 and a few malarial parasites were found in the blood. A quinine 

 treatment by intramuscular injections was immediately started, 

 and within two months the patient was so improved that he 

 returned to his regiment. 



In old individuals the profound an?emia may give rise to the 

 suspicion of internal cancer. A man aged sixty was admitted to 

 Sorowich Hospital, near Monastir, in 1917, in a condition of 

 profound ansemia ; he was greatly emaciated, with no fever, no 

 enlargement of the spleen or liver ; the dyspeptic symptoms dated 

 from several months ; complete loss of apetite, pain after food, and 

 vomiting, which he said was of a very dark colour. The doctor 

 who attended him very naturally suspected cancer, especially as 

 the usual treatment for dyspepsia, dieting, etc., had completely 

 failed. Here, too, the microscope revealed the true nature of the 

 cimdition. A quinine treatment caused all the symptoms to 

 disappear within a few weeks. 



Malaria may simulate Diseases of the Nervous System. The 

 Polyneuritic Type. — This type has been denied by many observers, 

 . but I have come across a number of cases both in the Tropics and 

 in the Balkans. I would call attention to the type of polyneuritis 

 which simulates wet beri-beri very closely. The patient is cede- 

 matous ; there is the characteristic gait, knee jerks absent. No 

 fever nor enlargement of the spleen or liver. In two such cases 

 the blood showed Laveran's crescents. They both recovered on 

 quinine given in large doses by the mouth and by intramuscular 

 injection. 



The Comatose Type of Malaria, for instance, was quite common 

 in Skopolje and the surrounding districts in Serbia during August 

 and September 1915, In this type the patient is brought into 

 hospital unconscious ; he cannot be roused to answer questions. 

 The respiration may be stertorous, or sometimes quiet. The 

 pupils are often contracted, there may be high fever, or the tem- 

 perature may be normal or subnormal, and in this case a diagnosis 

 of morphia poisoning may occasionally be made. The comatose 

 condition becomes deeper and deeper, and the patient often dies a 

 few hours after admission. The exact diagnosis can be made by 

 microscopical methods. 



The Delirious Type. — In this type, of which I have seen seven 

 cases in Skopolje, delirium is the most marked feature ; it may be 

 followed by coma and death. These cases have occasionally been 

 confused with alcoholic delirium tremens. The Cerebrospinal Type 



Q 2 



