212 Transactions of the Society. 



of Malaria is quite common in the Balkans, and may clinically 

 resemble cerebrospinal meningitis very closely indeed. A patient 

 was admitted to one of the Uskub hospitals in September 1915, 

 with extremely severe headache, vomiting, fever, retraction of 

 head, Kernig's sympton. A diagnosis of cerebrospinal meningitis 

 was made, the patient isolated, and a lumbar puncture performed. 

 The cerebrospinal fluid escaped with higher pressure than normal, 

 but was completely clear. Blood again examined and numerous 

 malaria parasites found. All the symptons disappeared after a 

 few intramuscular injections of quinine. 



Malaria may simulate various specific infectious diseases : for 

 instance. Enteric, Malta Fever, Tetanus, Sleeping Sickness, and 

 even Hydrophobia. The typhoid-like type of malaria was far from 

 rare in South Serbia and Macedonia in 1915, and I have again 

 seen similar cases near Monastir ; more recently still at Taranto 

 and on the Piave Front. From Gevgheli, on the Greco-Serbian 

 Frontier, it was reported in September 1915 that an epidemic of 

 typhoid had broken out. My friend Dr. Strong, head of the 

 American Sanitary Commission, Dr. T. Jackson, and later on 

 myself, went there, and soon found out that more than 90 p.c. of 

 the so-called typhoid cases were cases of typhoid-like malaria. 

 This type, as a matter of fact, was fairly common also in Skopolje, 

 and numerous cases were admitted to the Lady Paget Hospital in 

 September 1915. In practically all my cases the onset was slow ; 

 the patient looked apathetic and complained of headache ; tongue 

 very coated ; the fever was continuous or subcontinuous ; abdomen 

 slightly tumid ; spleen generally palpable, but neither very large 

 nor very hard. The patient had certainly all the appearance of a 

 typhoid case. The blood showed as a rule numerous malarial 

 germs, but quinine given in lar^e doses had practically no influence 

 for a long time either on the fever or on the parasites. All the 

 bacteriological examinations for typhoid, paratyphoid, and inter- 

 mediate germs were, as a rule, negative ; very occasionally a case 

 of mixed infection, malaria and typhoid, was found. 



Malta Fever Type. — The undulant type of malaria is extremely 

 rare, but it certainly exists. I have seen a case in Macedonia in 

 1915 ; the fever, of a typical undulant type, continued many 

 weeks, and was not influenced in the least by quinine 10 gr. t.i.d. 

 given by the mouth for long periods. Malarial parasites were 

 found in the blood repeatedly ; all serological and bacteriological 

 examinations for Malta Fever were negative. The fever finally 

 yielded to quinine given intramuscularly. 



Teta7ius-likc Malaria. — I have seen a typical case in Macedonia 

 in 1915, and three in the Tropics, closely resembling lock-jaw. 

 The patient had a normal temperature with trismus, opisthetonus 

 and typical tetanic spasms. In all the cases the blood contained 

 malaria parasites, and an intensive quinine treatment induced a cure. 



