292 BOWMAN. 



neuroses and indefinite conditions which we meet with are due to latent 

 malaria, or to succeeding attacks lasting over periods of years. 



The usual complications of malaria will not be dealt with in this 

 paper, but some of the most common conditions complained of by the 

 natives will briefly be described. The etiology of most of these appears 

 obscure, but it may possibly in the future be cleared up in some 

 measure by a closer questioning of the patients as to the previous diseases 

 from which they have suffered and particularly with reference to the 

 occurrence of "chills and fever." 



A great many patients enter the free dispensary complaining of loss of sensa- 

 tion in the extremities which they describe as "heaviness" of the feet and legs. 

 A large proportion of these patients are extremely ansemic. The conjunctival 

 and mucous membranes are pale, the pateller reflexes absent, and there is some 

 loss of sensation in the extremities. Others present the typical symptoms of a 

 peripheral neuritis. On questioning these patients carefully, a large percentage 

 give a distinct history of recurring attacks, of chills and fever for which the 

 Filipino has a special name, "ngiki." Too many of these cases are diagnosed as 

 beriberi, and a great many of these diagnoses would probably be changed if the 

 previous history of the patient were taken more thoroughly. 



Nephritis among Filipinos from 15 to 30 years of age is also extremely common, 

 and it is not unusual to see in young men perhaps five cases of chronic nephritis 

 in a ward of twenty-five beds; not favorable cases, but those exhibiting anasarca, 

 cedema, shortness of breath, high blood pressure and all the signs of severe kidney 

 trouble. The etiology of a number of these cases of nephritis always has been 

 obscure, and the great proportion of sufferers from malaria encountered, some 

 with serious and others with moderately severe symptoms in which the urine 

 contains albumin and casts, leads the clinician to think of the possibility that 

 malaria is the original cause of the kidney affection. 



Nearly all cases of malaria during and after the pyrexial period have larger 

 or smaller amounts of albumin in the urine. One attack probably causes no 

 permanent symptoms of nephritis, but repeated ones, covering periods of years, 

 undoubtedly have a deleterious effect on the normal action of the kidneys and 

 lead to a definite chronic nephritis; therefore, malaria should not be overlooked 

 in studying the etiology of chronic nephritis in young adults in countries where 

 malaria is endemic. 



Many other conditions are, of course, met with in studying malaria, 

 which from an etiologic standpoint are very indefinite, but these two 

 complaints which I have outlined are so often recounted by the native 

 patients, so many of whom give very indefinite histories of previous attacks 

 of malaria, that they have been particularly discussed. 



THE TREATMENT OE MALARIA WITH AKSENOPHENYLGLYCIN. 



While the treatment of malaria is already on a very satisfactory basis, 

 nevertheless, as previous experiments in the treatment of this disease 

 with atoxyl have been reported, and as arsenophenylglycin, employed 

 in the Biological laboratory of the Bureau of Science was giving such 

 excellent results in the treatment of trypanosomiasis, it was decided to 

 try the effect of this drug on malaria. Acting on the advice which was 



