﻿IX. B, 5 



Willets: Malaria in General Hospital, Manila 



449 



contributed to the leucopenia. The faecal findings among per- 

 sons of foreign birth were excluded and those among Filipinos 

 alone considered, but the general rules were not changed appre- 

 ciably. It is not overlooked that the urinary findings were due 

 doubtless to malaria itself in many of these cases. 



The cause of many of the normal and the abnormally high 

 counts in this series of cases is, therefore, considered to be 

 undiscovered. Despite the unconvincing evidence presented in 

 the tables, I am inclined to hold intestinal parasitism and genito- 

 urinary disorders responsible for some of them. 



SPLENIC INDEX 



To determine the splenic index of malaria, the records of the 

 first 1,000 cases for the year in which a complete physical exam- 

 ination had apparently been made were examined. In 799 of 

 these cases the spleen was not enlarged; in 201, or 20.1 per 

 cent, it was enlarged. Eight, or 1 per cent, of the cases with 

 negative spleens were positive for malaria both clinically and 

 microscopically. In these cases the spleen was tender in 1 case, 

 not definitely mentioned in 3 cases, and not enlarged in 4 cases. 

 Of the 201 enlarged spleens, 100, or 49.75 per cent, occurred 

 in malarial, 67 in miscellaneous, and 34 in typhoid cases. 



A number of the spleens were stated to be enlarged to percus- 

 sion or palpable upon deep inspiration only. In order to arrive 

 at a practical splenic index for malaria, it is deemed justifiable 

 to exclude these cases. They were distributed as follows: 



Table IX. — Spleen enlarged to percussion or palpable on deep 



inspiration only. 



Cases. 



Enlari;ed 

 to percus- 

 sion. 



Palpable 

 on deep 

 inspira- 

 tion. 



Total. 



Malarial — 



7 



17 



3 



2 



10 



9 



27 



3 



Miscellaneous - _- . . 



Typhoid. 



Total 





27 



12 



39 





Subtracting these cases from the original ones, there remain 

 definitely enlarged spleens in malarial cases 91, or 56.1 per cent, 

 in miscellaneous cases 40, in typhoid cases 31. If those in ty- 

 phoid fever are excluded, the splenic index of malaria would be 

 69.5 per cent, or 91 in 131 cases. 



An analysis of the 40 miscellaneous cases with definitely en- 

 larged spleens is given in Table X. It indicates that the pres- 



