MALARIA. (^j^7 



in March, 1886. I„ May, 1885, 1 had visited Rome as a deloj^atc to the 

 international Sanitary Conference, convened in that city under the aus- 

 pices of the Italian Government, and while there I visited the Santo 

 Spirito Hospital for the purpose of witnessing- a demonstration by Drs 

 Marchialava and Celli, of that city, of the presence of ihi^^dmmodlam 

 malarut in the blood of persons suffering from intermittent fever. 

 Blood was drawn from the finger during the febrile attack and from 

 individuals to whom quinine had not been administered. The demon- 

 stration was entirely satisfactory, and no dou})t was left in my mind 

 that I saw living parasitic micro-organisms in the interior of red blood 

 corpuscles obtained from the circulation of malarial -fever patients. 

 The motions were quite slow, and were manifested l)y a gradual change 

 of outline rather than by visible movement. After a period of amrje- 

 boid activity of greater or less duration, the body again assumed an 

 oval or spherical form and remained quiescent for a time. While in 

 this form it was easily recognized, as the spherical shape caused the 

 light passing- through it to be refracted, and gave the impression of a 

 l)ody having- a dark contour and a central vacuole, but when it was 

 flattened out and undergoing amceboid changes in form it was necessary 

 to focus very carefulh^ and to have a good illumination in order to see 

 it. The objective used was a Zeiss's one-twelfth inc-h homogeneous oil 

 immersion. 



But, very properl}^, skepticism with reference to the casual relation 

 of these bodies to the disease with which they are associated was not 

 removed by the demonstration that they are in fact blood parasites, that 

 they are present in considerable numbers during the febrile paroxysms, 

 and that they disappear during the interval between these paroxysms. 

 These facts, however, g-ive strong support to the inference that they are 

 indeed the cause of the disease. This inference is further supported by 

 the evident destruction of red blood corpuscles b}^ the parasite, as shown 

 by the presence of grains of black pigment in the am(el)a-like micro- 

 organisms observed in these corpuscles jind the accumulation of this 

 insoluble blood pigment in theliver andspleen of those who have suffered 

 repeated attacks of intermittent fever. The enormous loss of red blood 

 corpuscles as a result of such attacks is shown by the ana'mic condition 

 of the patient and also by actual enumeration. According to Kelsch, a 

 patient of vigorous constitution in the first four days of a (juotidian 

 intermittent fever, or a remittent of first invasion, may suffer a loss of 

 2,000,000 of red blood corpuscles per cubic millimeter of l»lood, and in 

 certain cases a loss of 1,000,000 has been verified at the end of twenty- 

 four hours. In cases of intermittent fever having a duration of twenty 

 to thirty days the number of red blood cells may be reduced from the 

 normal,' Avhich is about 5,000,000 per cubic millimeter, to 1,000,000, or 

 even less. In view of this destruction of the red blood cells and the 

 demonstrated fact that a certain number at least are destroyed during 



