264 THOMPSON YATES LABORATORIES REPORT 
Dr. Shekleton, of Bonny, states that he found the ring forms of aestivo-autumnal fever 
in the blood of his patient on the first day of the attack, but none subsequently. 
On the sixteenth day of the disease (two days after arrival at Old Calabar) an estimation 
of the number of corpuscles gave 4,384,000 red, and 15,000 white per cm., by the Thomas 
Zeiss apparatus ; and the haemoglobin was estimated at 90 per cent. Three attempts to obtain 
micro-organismal cultivations from the blood on agar-agar and serum failed. A peculiar tendency 
of the blood to rapid coagulation was noted. Dr. Thompstone states he has never been able to find 
malarial parasites in other cases of this disease which have come under his observation. It is to 
be pointed out that these cases occur during the dry season, at a time when the number of cases 
of malarial fever is smallest. There is often a history of exposure to the sun's heat, rough con- 
ditions of life, and hard work. 
The onset, symptoms, and course of the disease are quite atypical of malarial fever : there 
is absence of rigors, shivering, vomiting, severe headache, etc., etc. ; the liver and spleen are not 
enlarged nor tender : consciousness is preserved often to the end. The disease may last about a 
week, or be extended to three or four. There is a continual tendencv to hyperpyrexia, only 
checked by cold baths, by which means the temperature is easily reduced, but it gradually creeps 
up again directly the cold applications are removed. After a hyperpyrexial stage of one to three 
weeks' duration, there is always a very long period during which the temperature continues above 
the normal — a very extended lysis — varying during the day not more than a degree, and falling 
gradually degree by degree every four or five days. 
Drugs, including quinine and phenacetin, seem to have no effect on the course of the 
disease. 
Lung trouble caused the death of the second case on the evening of the day previous to our 
departure from Old Calabar, and, through the kindness of Dr. Thompstone, we were able to hold 
a post-mortem examination on the case two hours after death, the details of which we are able to 
record : — 
No rigor mortis : but little wasting : no jaundice : small clean sore over sacrum : 
no trace of syphilis. 
Abdomen — No fluid in peritoneal cavity : serous membrane appeared normal, except- 
ing two small patches, one of old, one of recent perihepatitis, on the upper 
surface of the right lobe of the liver. 
Pancreas — Somewhat large and firm. 
Spleen— Did not extend below the costal margin — about the size of one's hand ; firm 
in texture — externally of slaty appearance ; on section, firm, dark in colour. 
Liver — Two small patches of perihepatitis on upper surface of right lobe. Somewhat 
enlarged and firm ; on section, firm and dark in colour : no sign of fatty 
degeneration nor cloudy swelling. 
Kidneys — Large — capsule stripped uniformly, somewhat adherent all over. On 
section, red and granular — ' large red granular kidney.' 
Stomach — Contained a quantity of gruesome, blackish-brown stained mucus in flakes 
between the rugae. Mucous membrane pale, shewed very small petechial 
areas to which the blackish shreds were attached. 
