﻿IX, B, 6 Willets: Malaria in General Hospital, Manila 451 



Approaching the subject of splenic index from another point 

 of view, one may consider what percentage of cases of clinical 

 malaria with definitely enlarged spleens was positive micro- 

 scopically. Two hundred sixty-six of the 348 cases diagnosed 

 as malaria had enlarged spleens. Of the 266 cases, 2 were not 

 examined in the laboratory. Of the remaining 264, 225, or 85.7 

 per cent, were positive and 39 negative microscopically. 



Of the 39 cases which were microscopically negative, 14 were 

 given no quinine in the hospital excepting that contained in iron, 

 quinine, and strychnine to 2 of them. Six of these were exam- 

 ined once ; 5, twice ; and 3, three times. Sixteen cases had been 

 taking quinine prior to the examination. Thirteen of these were 

 examined once ; 3, twice. One case had been positive in the lab- 

 oratory during a previous admission. He was examined once 

 microscopically. Five of the remaining 8 cases were examined 

 once; 1, twice; and 2, four times. It thus appears that of the 

 39 cases under discussion 24 were examined once; 9, twice; 3, 

 three times ; and 2, four times. 



The factors to be considered in interpreting these negative 

 results are enumerated elsewhere in this report. A number of 

 the cases came from districts known to be malarial, and positive 

 laboratory findings would undoubtedly have been obtained had 

 treatment been delayed ; that is, more than 85.7 per cent of the 

 cases with enlarged spleens and positive clinically for malaria 

 would have been positive microscopically. 



Musgrave, Walker, and others ^ found malarial organisms in 

 the blood of 105, or 41.01 per cent, of 256 individuals with 

 enlarged spleens and enlarged spleens in 105, or 31.91 per cent, 

 of 329 cases which were positive microscopically for malaria. 

 In comparing their results with mine it is perhaps important 

 to note that they were dealing chiefly with unselected persons 

 whereas my cases were hospital patients. 



SUMMARY 



1. A diagnosis of malaria was rendered in 348, or 5.17 per 

 cent, of 6,732 patients ; in 10.6, 2.09, and 0.39 per cent of medical, 

 obstetrical, and surgical cases, respectively. 



2. Tertain, sestivo-autumnal, and quartan parasites were 

 present. 



3. Manila, Mindoro, and Tarlac and Laguna Provinces ap- 

 peared to be the chief sources of infection. Many of the in- 



*This Journal, Sec. B (1914), 9, 137. 



