IMUA. 241 



sis between this disease and malaria] and leukemic 

 enlargement of the spleen. In the paper quoted above 

 Captain Donovan gives a detailed account of 31 cases 

 that came under his personal observation during one 

 year with many postmortem findings. 



Captain Donovan describes the clinical features of 

 this disease as follows: "The symptoms are, in typical 

 eases, an irregular pyrexia of two or three months' 

 duration, accompanied with shivering with apyrexial 

 intervals. About this time the spleen becomes enlarged 

 and painful, and edema, of the feet begins; there is 

 usually diarrhea of a dysenteric nature, which comes and 

 goes for a week or so at a time. Later the lungs are 

 affected ; there is cough and expectoration, enlargement 

 of the liver, ascites' (unusual) ; subcutaneous hem- 

 orrhages of a petechial nature; soreness of the mouth, 

 gums or hard palate and cancrum oris. Marked emacia- 

 tion and anemia supervene, the skin becomes dry and 

 furfuraceous and, if the patient is not washed, the skin 

 takes on a dark discoloration. . . . The blood ex- 

 amination, in cases of piroplasma infection, always 

 shows a marked decrease of the red globules ; these vary 

 from two to three millions to the cubic millimeter. 

 There is no actual increase of the leucocytes, but a rela- 

 ive one of the mononuclears, as in malaria. The urine 

 usuall} r contains albumin and invariably pigment, uro- 

 bilin. The feces in some cases contain balantidia, 

 ankylostoma and rhabdonemata. Quinin has been given 

 by mouth, hypodermieally and intramuscularly ad nau- 

 seam, with no appreciable result. The same may be 

 said of other less suitable drugs, i. e., arsenic, salicylate 

 of sodium, carbolic acid, etc." 



I will give here as an illustration the findings of only 

 one postmortem examination: "Case 30. Eaghavan 3 

 aged 30 years, lived at Periyamet,t. Fever irregularly 

 for a month and a half; spleen enlargement noticed a 

 month ago ; during this period he had occasional attacks 

 of diarrhea and soreness of the mouth. Admitted for 



