MALARIA IN THE PHILIPPINE ISLANDS. 295 



showed red blood cells very pale and vacuolated with poikiloeytosis and aniso- 

 cytosis. Numerous hyaline amoeboid forms seen in the cells, sometimes two in 

 one red blood cell. Red blood cell count, 2,500,000. 



May 31: Six-tenths of a gram of arsenophenylglyein given. June 1: Hyaline 

 bodies numerous. June 2: Hyaline bodies numerous and 0.6 gram of arseno- 

 phenylglyein given. June 3: A few hyaline bodies seen. June 5: The patient 

 was in a semicomatose condition and a hypodermic injection of 1 cubic centimeter 

 hydrochloride of quinine was given, when the temperature fell and the patient 

 rapidly improved under quinine sulphate. After the injection the patient de- 

 veloped two severe abscesses which were sterile. 



Case VIII. — Quartan malaria. Filipino woman. Complaint: Pain in the legs 

 and abdomen. Previous illness: Ten years ago the patient had chills and fever, 

 and was treated with quinine. Present illness: This began six months ago and 

 the patient now complains of severe pains and tenderness in the muscles of the 

 calves of the legs. The spleen is enlarged to 1 centimeter below the costal margin. 

 Knee jerks are absent. A blood-smear shows numerous quartan parasites. 



June 7: Six-tenths of a gram of arsenophenylglyein given. June 8: Parasites 

 present. June 9: Half-grown and nearly mature parasites present. Severe ten- 

 derness over the sites of the injection. Six-tenths of a gram of arsenophenylglyein 

 given. June 11: Sterile abscesses present, which on being drained quickly healed. 



Case IX. — JEstivo-autumnal malaria. Filipino man. The patient is almost 

 in a comatose condition and answers questions very unsatisfactorily. The spleen 

 is enlarged to 2.5 centimeters below the costal margin. Numerous young forms 

 as well as crescents were present in the blood. 



June 7 : Crescents numerous. Many ovoids present. Six-tenths of a gram of 

 arsenophenylglyein injected. June S : Tenderness over the area of injection. 

 Crescents present. June 9 : Six-tenths of a gram of arsenophenylglyein given. 

 The temperature at the time of injection was 40° C. June 12: An abscess at the 

 site of inoculation. Quinine, 1 gram, given hypodermically as the temperature 

 is rising and the blood shows numerous parasites. June 16: The abscess evacu- 

 ated, the pus proving to be sterile. 



When the patient was discharged crescents could still be found in a blood- 

 smear, although no young forms were seen. 



Case X. — Tertian malaria. Filipino man. Present illness:' Began three months 

 ago with chills and fever. The history and examination show nothing of im- 

 portance except an enlarged spleen 3 centimeters below the costal border. A 

 blood-smear shows numerous adult tertian parasites. 



June 16: Six-tenths of a gram of arsenophenylglyein given. The patient had 

 no fever at the time of injection, which was given not on the day of the usual 

 paroxj'sm. June 17: The patient had a paroxysm as usual. June 18: No tem- 

 perature. Six-tenths of a gram of arsenophenylglyein given. Later in the day 

 the patient had chills and high fever. June 19: The temperature did not return 

 to normal. June 20: The temperature again rose. June 21: One cubic centi- 

 meter of hydrochloride of quinine given and the temperature returned to normal 

 and remained so until the time of patient's discharge from the hospital. 



All the cases treated complained of severe pain at the time of in- 

 jection. 



Case I, diagnosed as wstivo-autumnal fever, received altogether 2.2 

 grams of arsenophenylglyein and in five days developed symptoms of 

 arsenical poisoning. 



