REVIEW — TEOPICAL MEDICINE, ETC. 113 



12. When kala-azar and seven days' fever occur the large mononuclear increase is not much of a diagnostic Malaria — 

 aid, hut it helps to exclude early enteric. The increase is less marked during high fever than when the continued 



temperature is normal and it is distinctly more marked and frequent in benign than in malignant tertians, because 

 in the former the blood film is more often made when the temperature is normal than in the latter where the 

 apyretic periods are very short. 



Plehni* regards the supposed immunity of the black races as a mere tolerance, a 

 symbiosis of the parasite and the organism, a relative immunity, the equilibrium of which 

 is liable to be disturbed by change of climate, excessive exertion, etc. This particular 

 resistance to the malarial virus seems to be special, in a sense, for the black races. It 

 appears to result from a tolerance to the toxines, which will often commence in the foetus for 

 if the parasites themselves cannot traverse the placenta presumably the toxines can do so. 



In this connection, however, one would cite Moffat's- case of undoubted congenital 

 malaria, while the following quotation from Sir Thomas Browne, quoted by Monro,'' is so 

 quaint and withal so convincing that one perhaps may be pardoned for inserting it here. 

 The date is 1679 :— 



Mr. John Earle's wife, Sir Ralph Hare's sister, fell into a genuine quartan, when she was yong with child, 

 which held her long, and when she cime to her time she was delivered of a daughter in the fitt, and the child was 

 so ill that none thought she would live; butt it grewe better; butt, on the third day about the hower of its birth, 

 fell into a fitt of an ague, and so agayne the third day after, and that quartane settled and lasted for divers moneths 

 till she was emaciated to skinne and bone, and was so lowe that she was fayne to use bathing for a good while; but, 

 she is now of the age of 18 yeares and a very full young woeman. I called to mind this account, because shee dined 

 with mee lately ; her father was your loving friend. 



Eeturning to Plehn and his views on immunity, we find that he thinks that Europeans 

 can acquire a relative immunity analogous to that of negroes by preventive quinisation. 



D'AUocco^* describes a case of malaria with cerebellar symptoms, i.e. speech slow, 

 difficult and scanning in character, anxious expression, marked tremor, deliberation and 

 inco-ordination on attempting voluntary movements, whether of upper or lower limbs. This 

 intention tremor was more marked on attempting delicate movements. Worthy of note is 

 the fact that when the patient got over the fear of standing alone she could stand for a long 

 time without fatigue. 



Brun'* observed in Constantinople the frequent presence of an area of total dullness of 

 the apex of the lung in one or other side in patients who are infected by malaria. Although 

 the condition is ushered in with marked febrile symptoms there are no rales or crepitations 

 to be heard. Quinine rapidly dispels the consolidations as a rule, but in some cases the 

 dull patch does not clear up, remaining in a passive state permanently. This is rather an 

 important matter as, under such circumstances, it would be easy to make a mistaken 

 diagnosis. 



Burgess" discusses the question as to whether there is such a thing as malarial 

 pneumonia, and from his Indian experience decides that there is. In this view he is 

 supported by Paterson.' The latter speaks highly of the value of effervescing quinine in 

 such conditions. 



It is interesting to note that among the Nilotic negroes of the Southern Sudan, 

 practically all of whom as children probably suffer from malaria (vide Dr. Wenyon's report — 

 Third Report), pneumonia is a common and frequently fatal complaint. Whether or not 

 there is any relationship between the two conditions I cannot say, but the matter 

 might repay investigation by medical officers at southern stations. 



Passing now to general measures, personal prophylaxis and treatment, one may note at 

 the outset Sambon's advocacy of hyperparasitism as an ally of man in his struggle with the 

 malarial parasite. The brown spores of Eoss have been shown to be a species of Nosema, 

 and to be parasitic upon the malarial parasite iu the mosquito. 



As regards general measures, vai'ious recent papers may be consulted, for example those 



' Plehn, A., Archiv.f. Sddgs. u. Trap. Hyy., Vol X., No. 2. 



2 Moffat, R. N. (May 4th, 1907), " Congenital Malaria." British Medical Journal, p. 10,54, Vol I. 

 ' Jlonro, T. K. (June 8th, 1907), " Congenital Malaria." Brilish Medical Journal, p. 1396, Vol. I. 

 ■• D'AUocco, 0. (January 5th, 1907). Eif. Med. 



» Brun, H. de, Presse Med., Vol. XV., Nos. 32-34. Quoted in Epit., Brilish Medical Jmimal, April 27th, 1907. 

 " Burgess, J. H. (April, 1907), " Malarial Pneumonia." Indian Medical Gazette, p. 131. 

 ' Paterson, J. P. (February, 1908), " Malarial Pneumonia." Indian Medical Gazette, p. 75. 



• Article not consulted iu the original. 



