MALARIA IN THE PHILIPPINE ISLANDS. 293 



received, the drug was administered throughout in doses of 0.6 of a gram 

 subcutaneously, a total of two or three doses being given on alternate days. 

 The arsenophenylglycin was dissolved in 10 cubic centimeters of sterile 

 water and immediately injected subcutaneously into the muscle of the 

 abdominal wall or under the skin. 2 



Ten cases of malaria were treated, six of the a;stivo-autumnal type, three 

 of tertian, and one of the quartan form. The following brief excerpts 

 are taken from the histories of the cases. 



Case I. — JEstivo-autumnal malaria. Filipino man. Entered the hospital March 

 26, 1909. Present illness began eight months ago with pain in the legs and 

 epigastrium. Fever occurred every other day at different periods during this 

 time. The patient is 1 extremely anaemic, somewhat emaciated; conjunctival and 

 mucous membranes are extremely pale. The spleen is enlarged 3 centimeters 

 below the costal margin and is sharp-edged and appears rather firm on palpation. 



March 29: Crescents, flagellated bodies, and young forms seen in fresh blood- 

 smear. Seventeen crescents found in counting 200 leucocytes. Urine contains 

 albumin, but no easts. March 30: Blood-smear as before; 0.6 gram of arseno- 

 phenylglycin was dissolved in 10 cubic centimeters sterile water and injected sub- 

 cutaneously into the abdominal wall. April 1 : Two days later, the blood picture 

 had not changed. Six-tenths of a gram of arsenophenylglycin given as before. 

 April 2: Eight crescents in 200 white blood cells counted and very few 3'oung 

 forms seen. April 3 : One gram of arsenophenylglycin injected. No young forms. 

 April 7 : Numerous crescents and ovoids seen in the fresh blood-srnear. April 8 : 

 An erythematous rash appeared on different parts of the bod)' surface. April 9 : 

 The patient complains of severe pain in the stomach and cramps in the abdomen. 

 April 12: Extreme pain in the extremities. Absence of knee jerks. The typical 

 "steppage" gait of peripheral neuritis was evident, and later in the day severe 

 spastic contractions of leg muscles. The administration of purgatives (calomel 

 and magnesium sulphate) caused these symptoms to subside in a few days. 



Three differential blood counts were made at different times with the following 

 result: April 2: Polymorphonuclears, 50.4 per cent; large mononuclears, 25.6 

 per cent; small mononuclears, 4.7 per cent; eosinophiles, 17.5 per cent; mast 

 cells, 0.4 per cent; transitionals, 1.4 per cent. April 5: Eosinophiles had in- 

 Creased to 17.5 per cent. March 29 : Polymorphonuclears, 65 per cent ; large 

 mononuclears, 23 per cent; small mononuclears, 6 per cent; eosinophiles, 4 per 

 cent; mast cells, 1 per cent; transitionals, 1 per cent. Crescent bodies could 

 always be found in blood-smears until the patient was discharged. 



Case II. — JEstivo-autumnal malaria. Filipino man. Complaint: Fever. En- 

 tered the hospital May 11. Previous illness: One year ago for two weeks he had 

 the same trouble, with severe chills and diarrhoea. The present illness began 

 three weeks ago with chills and fever, and severe diarrhoea. 



May 1 1 : Blood examination shows blood cells to be rather pale. Numerous 

 crescents and a few half-grown aestivo-autumnal parasites. 



May 16: Red blood cells, 5,000,000. Differential count, polymorphonuclears, 

 40 per cent; large mononuclears, 50 per cent; small mononuclears, 3 per cent; 

 eosinophiles, 2 per cent; mast cells, 1 per cent; transitionals, 2 per cent. 



An examination of the urine showed the presence of albumin. No casts. 



May 17: Six-tenths of a gram of arsenophenylglycin given. May 18: Urine 



2 Arsenophenylglycin is rapidly oxidized in the air, the resulting product being 

 intensely toxic. 



