PLASMODIUM MALARIA. 635 



particular change took place in the intracorpuscular 

 tertian parasite while undergoing destruction by the 

 specific. 



The following points, nevertheless, about the action 

 of quinine on the parasites seem to be well established : 

 First, that under its use the intracorpuscular varieties, 

 whether tertian, quartan, or sestivo-autumnal, rapidly 

 disappear from the circulating blood; second, that 

 quinine administered some hours before a paroxysm 

 will not interrupt the cycle of their development, but 

 will usually destroy the products of segmentation, and 

 so check the succeeding paroxysm; third, that the cres- 

 centic and ovoid bodies which develop in sestivo- 

 autumnal fevers are very slightly affected by the action 

 of quinine. 



Mixed Infection in Malarial Fever. It is now a well- 

 known fact that along with a malarial infection there 

 may exist another due to the typhoid bacillus, to one 

 of the pyogenic cocci, or to other micro-organisms. 

 Such mixed infection may make a complete diagnosis 

 a very difficult matter. 



Diagnosis. The diagnosis of malaria in all its forms 

 has been greatly simplified by Laveran's discovery. 

 This is not a matter of so much importance in the 

 simple typical intermittents, but in the atypical forms 

 of the disease, and especially in pernicious malaria, the 

 symptoms of which are readily overlooked, serious 

 errors in diagnosis may be made. Moreover, par- 

 oxysms of intermitting fever, which are common in 

 other diseases, may be mistaken for those of malaria 

 such as occur in the early stages of tuberculosis, in 

 ulcerative endocarditis, in suppuration associated with 

 septicaemia or pyaemia, in pyelitis; etc. In all such 



