anæmia so pronounced as to be discernible to the eye in the intense pallor of the skin and visible mucous surfaces. On counting the corpuscles in such a case we note a regular drop in their number of from 5 to 10 per cent, per paroxysm. Often, after a single paroxysm of some pernicious fever, as many as half a million or even one million corpuscles per c.mm. drop out of the normal five millions; and this reduction may go on, as paroxysm follows paroxysm, until the corpuscular richness has fallen to one million, or even less.
Diminished hœmoglobin value of corpuscles.—— Not only is there in many, in fact in most, cases of malarial disease a pronounced oligocythæmia, but there is, in addition, a marked diminution in the hæmoglobin value of the surviving corpuscles; it may fall 10, 20, or even as much as 50 per cent.
Diminished amount of blood.—— And not only is there this marked diminution in the proportion of the corpuscles to the bulk of the blood and in their hæmoglobin value, but there is, furthermore, in all malarial conditions of any considerable standing a marked diminution in the volume of blood. Thus it comes that at the post-mortem examination of such a case we do not always meet with that congestion of the organs which is so usual a feature in most specific fevers. On the contrary, although in quite recent cases visceral congestion may be marked enough, if a malarial fever has been of any considerable duration the venous system, with the exception of that appertaining to the spleen, liver, and portal system generally, may be markedly empty. And thus it is that often, when we would make a preparation of blood from the living malarial patient, we may find that not only is the blood thin and watery, but that it does not flow freely from the pricked finger.
Destruction and reparation of blood in first attacks and in relapses.—— There appears to be no very definite or manifest law governing the degree, progress, and quality of the anæmia of malarial disease. On the whole, and as rough general rules, it may be laid down that in any given case the anæmia is in pro-
