Tropical Diseases due to Microscopic Organisms. 213 



H/jdrophohia-like Malaria.— 1 was once called by a Ceylonese 

 colleague to see a case which had been diagnosed as hydrophobia. 

 At the time I saw the patient he was in a maniacal condition, 

 temperature 102° F. At the mere sight of water a severe spasm 

 of the larnyx occurred. As he had a large spleen I examined his 

 blood with my portable microscope ; it was full of parasites. 

 Quinine caused all the symptoms of hydrophobia to disappear in a 

 few hours. It may possibly have been a case of hysteric hydro- 

 phobia syndrome in a malaria patient, though the man was not of 

 neurotic tendency and no hysterical stigmata were present. 



Sleeping Sickness Type. — This type of malaria, so far as 1 know, 

 has never been described. I have seen a case in a tropical country 

 where Sleeping Sickness is unknown. The patient l^ad low fever 

 for months, with slight trembling of the hands and tongue and 

 progressive general weakness ; he then became drowsy, and occa- 

 sionally had convulsions. The blood examination was negative 

 for every known parasite, until many months after the onset of 

 the symptoms a few malarial germs were detected. A course of 

 quinine injections cured the patient. A somewhat similar case, 

 tliough not so severe, with general debility, tremljlings of hands 

 and tongue, very marked drowsiness for several weeks, was seen 

 by Dr. Mitchell and myself in Serbia, but the correct diagnosis in 

 this case was made at once, as the blood was teeming with malaria 

 parasites. 



Malaria may simulate various Diseases of the Digestive System : 

 for instance, Dysentery and Cholera. I shall always remember a 

 case with all the symptons of dysentery I -once saw in consultation 

 in a tropical country. The patient had been treated with ipeca- 

 cuanha, anti-dysentery serum, bismuth, salol, nitrate of silver 

 irrigations, etc., for months; the condition very rapidly and 

 completely yielded to quinine within forty-eight hours. Of course 

 one must not forget that there are quite a number of cases of mixed 

 infection— malaria plus bacterial and amoebic dysentery — but the 

 case I have described was certainly not one of these, the examina- 

 tion of the intestinal contents which I made being negative for 

 entamoebffi and other dysenteric germs. I have seen very similar 

 cases also in the South of Italy, in Macedonia and Albania. 



Malaria may simulate Cholera. During the epidemic of cholera 

 in Ceylon in 1914, I was called to confirm the diagnosis of cholera 

 in a European assistant of one of the big tea firms in Colombo, in 

 order that he might be removed to the Infectious Diseases Hospital, 

 a proceeding the patient strongly objected to and was resisting 

 with what little strength he had left. He had been taken ill 

 suddenly in the night with profuse serous diarrhoea. When I was 

 called to see him at 11 a.m. he was feeling very cold, his skin 

 clammy, his cheeks sunken, and he looked very ill indeed. 

 Temperature, 99° F.; pulse, 104. The stools were absolutely 



