294 The Philippine Journal of Science ms 



Of course these figures would require careful analysis if one 

 were to establish a proportion of infections among the British 

 troops as having been derived from the Indians and the Egyp-. 

 tians. The predominance of benign over malignant infections 

 in the British troops might then be found to be due to the com- 

 parative scarcity of anophelines of the species suitable for trans- 

 mitting the malignant parasites. The fact remains, however, 

 that the Indians and Egyptians seem to have been preponderant 

 as harborers of the malignant parasite in a late stage of its 

 development; and, even if they were not responsible for the 

 incidence of the disease among the British, they not only helped 

 to fill the hospitals, but also caused a corresponding decrease in 

 the efficiency of their unit. 



The baleful influence of malaria is by no means restricted to 

 the medical side of the military hospital. Vandenbosche (34) 

 has made a study in Salonika of the effects of malaria on wounds. 

 Many of the phenomena he records are more or less familiar 

 to physicians who have practiced in malarious regions. He 

 states that even slight wounds will bring on an attack of malaria 

 in patients who have previously suffered from the disease and 

 that operations frequently have the same effect, the paroxysm 

 occurring from one to six days after the operation. Such re- 

 lapses, according to Vandenbosche, are prone to follow chloro- 

 form anaesthesia, and he recommends the substitution of ether. 

 From my own experience in connection with a series of recent 

 surgical cases at St. Luke's Hospital, Manila, in collaboration 

 with Dr. A. F. Coutant, I incline to the opinion that relapse 

 may also follow prolonged ether anaesthesia. 



Vandenbosche's observations bear out those of Gill: that, in 

 intensely malarious regions, latent malaria is all the more dan- 

 gerous since in those districts persons, who to all appearances 

 are perfectly healthy, may yet be gametocyte carriers, even 

 though they had manifested no symptoms of the disease. 



In his rounds of the hospitals in Salonika, Vandenbosche was 

 able to observe most diverse haemorrhagic phenomena in mala- 

 rious subjects. These took the form of epistaxis which was 

 occasionally fatal, haemoptysis, haematuria, and petechial and 

 ecchymotic patches. He regards every malarial subject as a 

 potential "bleeder" and advises that surgical procedures be under- 

 taken only under the strictest precautions. He points out the 

 tendency of the disease to blur the clinical picture produced 

 by a wound or by other complications, and admonishes surgeons 

 to remember the possibility of malaria before enlarging or open- 

 ing a wound on elevation of temperature. Malarial gangrene 



