172 Major R. Ross and Dr. D. Thomson. [Oct. 12, 
mononuclears remain (Case 9 especially). But we could not find these 
variations in the absence of fever and many parasites. This mononuclear 
reaction, which we have also seen in our case of trypanosomiasis, appears 
to be exactly comparable to the polymorphonuclear reaction described by 
F. W. Andrewes* as generally occurring in bacterial diseases. 
12. Various Therapeutic Agents—Methylene blue was tried in three cases 
in 12-grain daily doses; the parasites diminished, but we cannot draw any 
conclusions from the figures. In Case 24, altogether 36 grains of soamine 
were injected intramuscularly in 5 to 10 grain doses on five occasions during | 
12 days, and yet a smart relapse occurred during and after the last dose. In 
the same case, just before the same relapse, X-rays had been applied over 
the spleen and abdomen for 20 minutes. The asexual parasite rise had 
commenced before the application. In Case 24, faradic and galvanic currents 
were applied over the spleen, each for 10 minutes, but crescent counts made 
immediately before and two hours after the application remained unaltered. 
13. Hemoglobin.—This was estimated in most of the later cases. The 
percentage always fell during fever, and began to rise rapidly shortly after- 
wards, proving the destructive effect of the parasites and the rapid recupe- 
ration of the patients. The greatest fall was 25 per cent. after four days’ 
fever (Case 20); but more detailed work is required to trace correspondence 
with the number of parasites. The lowest percentage found was 53 per cent. 
All the patients were anemic at first, but the hemoglobin rose rapidly with 
improvement of health, and very rapidly in the more vigorous subjects. We 
decided not to attempt counts of red corpuscles, as these have been made so 
frequently already. The elimination of the hemoglobin and the findings in 
a case of blackwater fever will be dealt with in the following paper by 
Dr. Simpson and in one by ourselves.+ 
14. Summary.—(1) There is a very decided correlation between the number 
of asexual Plasmodia found in the peripheral blood and the fever. 
(2) As a rule, no fever exists unless the asexual forms exceed some 
hundreds per cubic millimetre. 
(3) The asexual forms do not always disappear between relapses (as often 
thought) but tend to persist in small numbers per cubic millimetre, and often 
increase again for some days before the actual febrile relapse occurs. 
(4) These observations give a coherent theory of the malarial invasion, 
according to which the infection is kept alive indefinitely by the ordinary 
sporulation of the asexual forms, and not by parthenogenesis or by resistant 
* ‘Lancet,’ June, July, 1910. 
t+ ‘Annals of Tropical Medicine,’ Liverpool, vol. 4, No. 3. 
