r 
337 
colour occurs.) Confirm with phenol-phthalcin to sec that no change of colour occurs; this latter 
is necessary to ascertain whether the solution has become too alkaline or not. At this stage, most 
of the picric acid is dissolved up. Make up the solution to ioo c.c. with distilled water; 3 c.c. 
of this solution is put up in test-tubes and sterilised at 120° C. in the autoclave. As the water 
evaporates in these tubes crystals are deposited, which can be readily dissolved either by slightly 
warming the tube or adding a few drops of sterile distilled water. The injections are no more 
painful than ordinary injections of vaccine, and do not produce any marked reaction, nor is there 
any nodule or swelling noticed at the site of injection. Scarcely any pain is present after 24 hours, 
so that there is no difficulty in injecting about 3 c.c. of this solution on consecutive days. 
It will be noticed from the Table ‘ B ’ showing the percentages 
of recovery and death in these cases, that the percentage of death 
was nearly double in cases not treated with picric acid as compared 
with those treated with the drug. Again a very interesting point 
noticed in all these observations was the fact that the mortality was 
higher in cases where the patient had no obviously enlarged spleen. 
In some of these cases where a post-mortem examination was 
obtained, the weight of the spleen was not much above the normal, 
and in one case it was found quite small and tough. 
Cases of benign tertian fever are generally mild, and splenic 
enlargement is not noticeable in most ; however, in my series of 
twenty-seven cases of a fairly severe type of this infection three 
cases ended fatally, and none of them showed any splenic 
enlargement. In the cases of malignant tertian infection, either 
alone or combined with benign tertian, the mortality was very high 
in cases where the spleen was not found to be obviously enlarged. 
T hus the splenic enlargement may be looked upon as a protective 
response on the part of the organism to the attack of the malarial 
parasite; and in a case where this response does not occur, it has 
a tendency to end fatally. Of course in mild cases the response is 
also slight, but when one considers cases of moderate or extreme 
severity, this fact is most evident. 
1 his appears to be a natural consequence when one considers 
the fact that it is the spleen that is most concerned in the destruction 
°t these parasites. The spleen may be called the battlefield and 
the burial ground of the malarial parasites. Thus the splenic 
response is, to my mind, a very important feature for purposes of 
prognosis. 
There were some minor points noticed in the course of the 
investigation which may be mentioned here. Thus one comes across 
eases where quinine is not 'absorbed at all per os, and no amount of 
