214 Transactions of the Society. 



cholera-like, of the well-known rice-water appearance. Examining 

 the patient I found the spleen just palpable, but very hard. On 

 questioning him I elicited the fact that he had had an attack of 

 malarial fever three weeks previously, on an estate where he had 

 gone for a short holiday. The blood was examined at once; it 

 was swarming with malaria germs. Quinine was given immedi- 

 ately by intramuscular injection, and the diarrhoea stopped within 

 a very few hours. The patient was up two days later. The 

 complete bacteriological examination of the intestinal contents 

 revealed entire absence of the cholera vibrio, or of vibrios of the 

 para-cholera group. A somewhat similar case, which also had 

 been taken for cholera, was seen by me in Northern Macedonia in 

 1915. This case also recovered very quickly on quinine. Cases 

 of the same nature, though not so typically cholera-like, have been 

 observed by me more recently in Corfu, and at Salonika. 



I have mentioned certain internal diseases which may be 

 simulated by malaria, but this infection may even give rise to 

 symptoms pointing to surgical conditions such as appendicitis, 

 acute colo- cystitis, abscess of the cerebellum, abscess of the liver. 



A young Serbian soldier was admitted to hospital with 

 symptoms pointing to acute appendicitis : violent pain in the 

 appendicular region, vomiting and fever, but no rigors ; severe 

 tenderness and well-marked rigidity all over the right lower 

 abdomen. A surgeon advised operation, and the appendix was 

 removed, but did not appear to be much affected; the temperature 

 fell during the night, and the day after the patient was feeling 

 quite well. On the following day, however, he again complained, 

 greatly to the surprise of the surgeon, of very severe pain in the 

 lower right abdomen, though not so localized. Vomiting set in 

 and the temperature rose to 105. Examination of the blood 

 showed presence of an enormous number of parasites. Quinine 

 given at once by intramuscular injection in large doses made all 

 the symptoms disappear very rapidly. 



Another patient in Uskub suffered from very severe headache 

 for months, became nearly blind, had giddiness and vomiting, 

 could hardly stand, and walked like a drunken man. Every night 

 the temperature rose to 100. His medical attendants naturally 

 thought that it might be a case of cerebellar abscess, and operative 

 measures were suggested. However, after repeated examination 



s 



the blood was found to contain malaria parasites, and quinine 

 caused a complete cure of the condition. 



One could go on indefinitely describing the various strange 

 appearances under which malaria can camouflage itself; but I 

 will now say a few words on the prognosis of the malady. 



Prognosis. — In the Balkans, as in any other malarial country, 

 providing an appropriate treatment be given, the prognosis is good 

 in the enormous majority of cases. It must be remembered, 



