abundance of cerebro-spinal fluid, and the enlarge- ment of the liver and spleen. The latter in 29 examinations averaged 22 ounces in weight, whilst the liver was frequently well over 70 ounces.
These cases coincide very closely with those described by Pewintzky of St. Petersburg in his essay on Pernicious Swamp Fever. (Journal of Tropical Medicine, July 1902).
The possibility of some of these cases being cerebro-spinal fever was considered, but no de- finite evidence of this disease was obtained, either clinically or microscopically.
Some of these remittent cases yield readily to treatment, but others are most intractable. Hypodermic injections of quinine are freely given, in some cases with much benefit, only rarely with none. Large doses of quinine by the mouth and by the rectum have also been tried. Methylene blue acts well in some obstinate cases. Latterly we have been giving " mass doses" of 30 grains of quinine by the mouth or hypodermically, and in most cases with good effect. Often the temperature falls at once and remains down. In no case have we noticed ill-effects from these large doses, nor is haemaglobinuria known.
An attempt is now made to examine micro- scopically the blood of every patient who comes to hospital complaining of fever, and in this way the blood of 4,304 patients has been searched. In many cases two, three or even more examinations were made.
Parasites^ were found in 2,338 cases. The chief varieties noted are : —
Intracellular hyaline, 776 cases ; hyaline ring form (malignant tertian), 438 cases; pigmented intracellular, 704 cases; pigmented extracellu- lar, 273 cases ; crescents, 123 cases; segmenting forms, 20 cases ; and flagellfe, 2 cases.
More attention was paid to the presence or absence of parasites than to the particular vari- ety, but it is interesting to note that quartan parasites were far from rare, and would often resist quinine for some days.
It has been stated (Report of Royal Society's Malaria Commission) that native children fre- quently harbour parasites without symptoms or rise of temperature. This I can partly con- firm. Many children in whose blood we found parasites said they were perfectly well, but on investigation were found to be suffering from fever or from enlarged spleens.
For example, all the children in the Female Jail and attending the Aberdeen School were examined :
Number of children, 158; parasites found in 58 cases ; of these on examination, 40 had fever or enlarged spleen ; whilst 18 had no fever. Varieties of parasites: — Intracellular hyaline, 22 cases; intracellular pigmented, 23 cases; extracellular, 10 cases, and crescents, 2 cases.
Again at Haddo, 68 healthy-looking persons (including Andamanese adults and children, school children, &c.), were examined. Parasites
were found in 11 cases, but all of these on exa- mination were found to be suffering from slight fever.
With regard to the diagnosis of malaria by means of differential blood counts, our results do not altogether agree with those of Rogers. Over 63 counts, and never of less than 500 leucocytes, the average is :
Large mononuclears ... 14*00
lArmphooytes ... 25*00
Neutrophiles ... 69 00
Eosinophiles ... 6*00
Others ... 2*00
Rogers claims 15 per cent, of large mononu* clears as a diagnostic sign in malaria, but we do not always get such a high percentage.
We have taken specimens in which the cres- cents were double the large mononuclears, and yet the percentage of the latter was only 14 per cent.
For instance :
Large mononuclears ••• 14 per cent.
Lymphocytes ..» 2 I'd
Neutrophiles ... 600
Eosinophiles ••• 2*8
Others ... 1*4
100-00
Actual Count, 501 ; crescents found, 137; red blood corpuscles, 4,026,000 per c. millimetre ; and white blood corpuscles 6,000 per c. millimetre.
On the other hand, in a case of dysentery not complaining of fever, the following count was made :
Large mononuclears
Polynuclears
Lymphocytes
£oBinophiles
Others
. 16-3
. 46 9 Total count, 609.
. 34 2
1 Crescents present, 68.
. re
Here the malarial factor of large mononuclears was present, even though the usual dysenteric increase of lymphocytes was marked.
Altogether, 265 differential blood counts have been made, and many results of considerable clinical interest elucidated.
The convicts that 1 have trained for micro- scopical work have been of the greatest use. These men are now well conversant with the different forms of parasites, can make and stain their own preparations, and in some cases can perform differential blood counts.
"LIVER CHILL," AS A FACTOR OF DISEASE IN THE TROPICS.
By A. H. GRANT,
Major, I. M. S.
Take the case of a man whose night suit has shrunk to most unsuitable proportions owing, most probably, to the handiwork of the un- speakable dhobi. He goes to bed, let us say, comparatively cool and comfortable, but fails to get sound sleep. During the night he tosses, tumbles and becomes bathed in sweat. At dawn ^ a light breeze springs up and lulls him into ^
