REVIEW — TROPICAL MEDICINE, ETC. 



109 



of the chief difficulties in diagnosis is when liver abscess stimulates disease of the right Liver 

 lung or pleura or when it is complicated with effusion into the pleura. Pleural infection Abscess— 

 readily occurs, infective matter spreading by way of the lymphatics. continued 



Bousfield' has recorded from Kassala a case of liver abscess, in the pus from which, 

 taken soon after operation, a diplococcus was found simulating the gonococcus in appearance 

 and staining reaction. 



Liver abscess is by no means uncommon in the Sudan. I am unable to give an opinion 

 as regards its relationship to dysentery, but I have recorded a case- of some interest in 

 which the Entamoeba dysenteriee was found. I know now, however, that I was wrong 

 in attributing the fatal termination of this case to shock. It was undoubtedly in the main 

 an instance of delayed chloroform poisoning dependent on the state of the liver, and I only 

 make mention of it here as a warning regarding routine administration of chloroform in 

 cases of operation for liver abscess, or at least such administration combined with the usual 

 preliminary starvation. 



Eeference to this important matter will be found in a paper by Stiles and McDonald,^ 

 which gives the bibliography, and in an article by Hunter,* who states that evil effects may 

 in all probability be completely prevented if, instead of withholding food, particular care be 

 taken that the patient be given a very nutritious and easily digestible meal, well sweetened, 

 two or three hours before the operation. 



Malaria. It seems advisable to classify the various papers for review as far as 

 possible, though some dealing with several or many aspects of the disease cannot be placed 

 in any one group. Pirst then we may consider papers relating to the morphology or life- 

 cycle of the parasite : — 



A question to which a good deal of attention has been directed, both by Ewing'^ and by 

 Craig," is that of so-called intra-corpuscular conjugation. While, so far as I can ascertain, 

 Craig's views on the subject have not been generally accepted, and while Cropper^ has 

 recently shown that when double or treble infection occurs each parasite seems to go on to 

 full development (he found three praesegmenting forms in one cell), still Craig's latest 

 paper on latent and recurrent malarial infection is both able and interesting, and it seems 

 worth while to record some of his opinions. His definitions may be given : — 



By latent malarial infection is meant one in which the plasmodia of malaria may be demonstrated to be 

 present in the blood of an individual, but in which no clinical symptoms of the disease of sufficient gravity to 

 attract attention are to be observed. The term should not be confined to those instances in which no symptoms of 

 malaria have ever been present, for if the parasites be present in the blood in recurrent cases, between the 

 attacks, the disease is as truly latent as it may be before the initial one. 



By recurrences are meant the appearance of symptoms due to the same group of parasites that caused the 

 original infection and not a re-infection by another group. 



By intra-corpuscular conjugation is meant the complete and permanent union of the protoplasm and nucleus 

 of two young amebula (sic) within the erythrocyte. It is absolutely necessary to the maintenance of malarial 

 infection in man, and in the^e instances in which it does not occur, the plasmodia undergo a sexual sporulation for 

 a limited time and then perish, thus leading to spontaneous recovery. It is present most typically in those cases 

 in which the clinical symptoms are most severe, and is present in all the varieties of malarial infection, although 

 most easily observed in the estivo-autumnal infections. 



His conclusions regarding its significance are as follows : — 



1. Intra-corpuscular conjugation is the chief cause of the maintenance of malarial infection. 



2. It maintains malarial infection by producing a resting, or zyyoti; stage of the plasmodia, within the 

 human body, which is resistant to quinine and other injurious influences. 



3. It is the cause of latency and recurrences of malarial infection, the zygote stage remaining dormant or 

 " latent " until conditions are favourable, when it gives birth to several young plasmodia, thus causing a recurrence 

 of the infection. 



' Bousfield, L. (January, 1908), " A Case of Liver Abscess due to a Diplococcus Similar in Appearance and 

 Staining Reaction to the Gonococcus." Journal of the Royal Army Medical Corps, p. 80, Vol. X., No. 1. 



- Balfour, A. (November 21st, 1903), "A Case of Multiple Liver Abscess." Lancet, p. 1425, Vol. II. 



" Stiles, H. J., aud McDonald, S. (August, 1904), "Delayed Chloroform Poisoning." Scottish Medical and 

 Surgical Journal, Vol. XV., No. 2. 



■* Hunter, W. (April 4th, 1908), "Delayed Chloroform Poisoning: Its Nature and Prevention." Lancet, 

 p. 993, Vol. I. 



^ Ewing, .J. (1904), "Clinical Pathology of the Blood." 



' Craig, C. F. (Juno, 1906), "Observations iipon Malaria: Latent Infection in Natives of the Philippine 

 Islands — Intra-corpuscular Conjugation." Philippine Journal of Science, p. 625, Vol. I., and (Jan. 1st, 1907) 

 Journal of Infectious Diseases, Chicago. 



' Cropper, J. (March IG, 1908), " Phenomenal Abundance of Parasites in the Peripheral Cii'culation of a 

 Fatal Case of Pernicious Malaria." Juuriial of Tropical Medicine and Hygiene, p. 91. 



