112 REVIEW — TROPICAL MEDICINE, ETC. 



Malaria— Cropper' in Palestine, and by Smith-* in the United States. A good account of these rod, 

 contintied spindlo-shapcd and motile melon-seed bodies is given in an article on Piroplasniosis by 

 Nuttall and Graham-Smith, ^ who observed the bodies in the blood of normal dogs and of 

 those suffering from the disease. 



In Palestine they appear to be specially numerous in the blood of persons suffering 

 from so-called " Syrian Fever," which is not malarial (.vcc " Fevers," page 66). Smith also 

 found these bodies associated with fever. They cannot be well stained. Indeed it is 

 diflScult to stain them at all, and so far their true nature and significance is undetermined. 



It is quite possible that some of the febrile cases met with in Khartoum, and from 

 which dried blood films are invariably sent to the laboratories for examination, might be 

 found to exhibit these bodies if opportunities for examining fresh films were presented. 



Secondly, one may consider papers dealing with malaria from a more or less general 

 point of view, and lastly with those indicating prophylaxis and treatment. 



James^ has argued that malaria, as met with in India, is, in reality, a benign disease, 

 and that the serious effects and fatal results attributed to it in the past should in large 

 measure have been laid to the charge of kala-azar. He points out that in malaria the 

 tendency is not towards cachexia and death, but to the acquiring of immunity ; thus, 

 "natives who have resided during a number of years in a malarious place acquire an 

 immunity to malarial fever." 



Doubtless in Africa, as well as in India, the cachexia of kala-azar has been in the past 

 attributed to malaria, but none the less it is certain that pernicious African malaria does 

 produce a chronic cachectic condition and may be a very fatal disease. At the same time, 

 in the Sudan, deaths from acute malaria or chronic malarial cachexia are, I believe, not very 

 common, and there is probably more than a grain of truth in the arguments adduced by 

 Captain James. 



At the same time, we find that Rogers-' thinks that 20 to 25 per cent, of the total fever 

 mortality in India is due to malaria, and he speaks definitely as to the terrible mortality 

 from malaria amongst native children. He gives a very full description of the disease as 

 met with in India, from which we cull the following information : — 



1. The condition of the tongue aids the diagnosis, for the furring, whether marked or otherwise, is uniform 

 in distribution, and does not show the red edges of enteric and seven days' fever tongue. 



2. The pulse rate helps, for one rarely gets a slow rate accompanying a high temperature, which is very 

 frequently the case in seven days' fever. 



3. In true malarial cachexia the liver may be markedly enlarged even down to the navel. 



4. In order to get the characteristic temperature curves, four hourly charts should be kept. 



5. The longest period Rogers has seen a fever showing malarial parasites in the blood, under efficient 

 quinine treatment, is six days, a point of great practical importance. 



6. In India, Rogers believes there is no evidence to show that distinctive quotidian fevers exist. 



7. The prolonged rise of temperature (24 to -36 hours) is characteristic of malignant tertian, and is the most 

 distinguishing clinical point between it and the benign forms. 



8. In benign tertian malaria in India a double infection is the general rule, and typical single tertian charts 

 are quite exceptional. 



9. Quartan malaria is much rarer than the other forms, and a double type is the most common variety of 

 infection in India. 



10. Malarial fevers in India are not more persistent under adequate quinine treatment than those of Europe 

 and America, hence, provided the dose is adequate and is being assimilated, undue persistence of fever points to 

 another or an additional cause. 



11. As a rule there is a diminution in the number of the leucocytes, though sometimes even a leucocytosis 

 may be encountered when an enormous number of parasites are present. The important point is the ratio of the 

 white cells to the red in malarial cachexia. It rarely falls to lower than 1 white to 1000 red, while in kala-azar 

 the ratio is almost always below 1 to 1500 and is frequently much lower than this figure. 



• Cropper, J. (May 1st, 1905), " Note on a Form of Malarial Parasite found in and around Jerusalem." 

 Jcrurnal of Tropical Medicine, p. 132, Vol. VIII., and Journal of the lioijal Institute of Public Health, Pebruarj', 1907. 



» Smith, A. M. (October 7th, 1905), Am. Med., p. 607. 



' Nuttall, Q. H. P., and Graham-Smith, Q. S. (October, 1906), " Canine Piroplasmosis." Journal of Hygiene, 

 p. 586, Vol. VI. 



* James, S. P. (1905), "On Kala-azar, Malaria and Slalarial Cachexia." iicic7itific Memoirs of the Oovcrnment 

 of India, No. 19. 



' Rogers, L., " Fevers in the Tropics." 



• Article not consulted in the original. 



