﻿444 The Philippine Journal of Science i9u 



ative examinations, no quinine having been given. Eight were 

 discharged recovered, 1 improved. 



Eleven other cases were given quinine in the hospital. The 

 records do not give the quinine history of these cases. Six 

 were negative microscopically once; 3, twice, 2, four times. 

 Seven were discharged recovered; 1, improved; and 1, unim- 

 proved. Two died. Autopsy in one case disclosed chronic 

 splenic hyperplasia of malarial origin, death being due to lobar 

 pneumonia. Autopsy was not obtained in the other case. 



From a consideration of the foregoing facts it appears that 

 failure to find malarial organisms in the peripheral blood of these 

 cases may have been due to several factors, namely : 



1. Rendering a positive clinical diagnosis, upon scanty laboratory work. 



This is evidenced by the fact that 29 cases were examined once; 11, 

 twice; 3, three times; and 2, four times. The practical question as to 

 whether it is justifiable to delay treatment of suspected malarial 

 cases until a positive laboratory diagnosis is made is here involved. 

 In some cases it is justifiable and absolutely indicated, while it is quite 

 contraindicated in others. The last word in an accurate diagnosis of 

 malaria rests with the laboratory. 



2. Absence of malarial organisms from the peripheral circulation. This 



may have been a factor in the seventeen or more cases which had 

 been taking quinine prior to admission to the hospital and, also, in 

 those cases which were apparently convalescent from slight attacks 

 of malaria. 



3. Errors in the laboratory. 



4. Errors in the clinical diagnosis. 



IN FINDING MALARIAL ORGANISMS IN CASES POSITIVE AT AUTOPSY 



Dr. B. C. Crowell, pathologist of the Bureau of Science, found 

 evidences of malarial infection in 19, or 5.6 per cent, of 338 

 autopsies performed upon individuals who died in the Philippine 

 General Hospital during the year. Malaria was the immediate 

 cause of death in 13, or 68.4 per cent, of the cases in which it 

 was present and hence in 3.8 per cent of the total cases which 

 came to autopsy. In 12 of the 13 cases the lesions were acute ; 

 in 1, chronic. The lesions were chronic in the 6 cases in which 

 the immediate cause of death was not malaria, but bacillary 

 dysentery in 1 case; nephritis in 1 case; bronchopneumonia 

 in 1 case ; lobar pneumonia in 2 cases ; and peritonitis in 1 case. 



The Bureau of Health report for 1913 gives 26,138, or 14.2 

 per cent, of 183,236 deaths in the Philippines, excepting Min- 

 danao and Mindoro, due to malaria. 



Of the 19 cases, clinical diagnosis was made of 73.7 per cent. 

 The 5 cases which were not diagnosed clinically were as follows : 

 (1) The patient arrived at the hospital in an unconscious condi- 



