The follows
cases
under
analysis
are
made
up
as
:?
Quotidian
...
Tertian
...
Quartan
...
Irregular type Remittent
...
...
7 14 1 16 1
cases
equal
?
?
case
,,
cases
,,
case
From this it appears
?
that
to 17*5 per cent. 35 Jf 2-5 40 ? 2-5 ?
intermitteuts
of
irregular type are most common, next in order come tertians, then quotidians, and last at a long
interval quartau and remittents. This tallies with the experience of all who have to do with fevers of malarial origin. From an examination of the cases of quotidian in the parague (Table A), it will be seen that oxysmal stage, that is to say, at some period of the fever other than that of the actual intermis" " sion, all the cases recorded shewed echiuoid in which cases were 40-41 corpuscles. Cases 23, the paroxysms of a quotidian ague had been held in abeyance by the administration of quinine or quinine aud iron. In the interval, six of the seven cases shewed plasmodic corpuscles ; cases 40 and 41 also shew" ing eehinoid" corpuscles ; aud would most probably have relapsed on the cessation of administration of quinine owing to the blood corpuscles not having sufficient vitality to prevent the breaking up of the "plasmodia" into spores. The cases of tertian ague (Table B) were similar to those of quotidian, except that the " mulberry" bodies were more constantly present. These bodies the writer has already stated are according to his observations phagocyte cells charged with spores. The general rule was "echiuoid" corpuscles during the paroxysm, and "plasmodic" corpuscles during the interval. It is noticeable that no flagellate monads were observed in any of the cases of tertian ague. The solitary case of quartan ague shewed all " eehinoid" corpuscles, the obstinacy of the disease being thus paralleled by the waut of resistance in the red blood cells.
MALARIAL INFECTION. By Surgeon-Major G\ S.
RANKING,
m.d.
(Continued from page 259.) It next remains to consider whether we have any data connecting the developmental stages of the malaria organism with the clinical progress of the disease. For this purpose I propose to give a brief resume of the results of observations on a series of forty cases of malarial iufection-^including all the types of intermittents, quotidian, tertian, quartan and irregular?with aud without coincident splenic enlargement: and remittents: reserving a detailed account of some of these observations for a future paper.
In the agues of irregular type (Table C), the following were the conditions of the blood cells during the interval:? Plasmodic
corpuscles
...
...
Plasmodic and eehinoid
corpuscles Eehinoid corpuscles only
...
...
9 oases.
...
4 cases.
...
3 cases.
In two of these cases observed.
The three
corpuscles only
were
flagellate monads were shewing "eehinoid Nos. 10, 35, 37. No. 10 mouths, was very ancemic.
cases
"
had had ague for many 35 and 37 are the same case at iutervals of There was some days. nothing very special about this case; he was certainly not anannic, in fact, rather robust than otherwise, so that this case rather militates against the theory which would attribute the " plasmodic " corpuscles to
their greater vital energy.
INDIAN MEDICAL GAZETTE.
324
[Nov.
1892.
But whether that theory be true or not, there explained, so that, pending some more satisfacbe 110 question that the resting stage of the tory solution, we are, I think, justified in attrito the condition of buting to the heightened vitality of the red organism corresponding " " plasmodic corpuscles occurs in a large maj- blood cells the prevention of that breaking up ority of cases, coincidently with the cessation of into spores which accompanies and, as I think, the paroxysm. causes the paroxysm. What the actual connection of cause and Summary.?To sum up, malarial infection effect between these phenomena is I do not appears to be due to spores which are to be attempt to say; but it would appear to be a suffi- found in large nnmbers in the air, the water, ciently sound working hypothesis that when the and the soil of malarial regions. Inasmuch as blood cells of a person exposed to malarial in- these spores are so widely distributed, it follows fection have a high resistance the spores become that all animals exposed to their influence do of included in the red cells, and destroyed by infected. become necessity phagocytosis; but that where the resisting power The greater or less degree of infection appears is low, the contained plasmodia continually break to depend, ceteris paribus, upon the degree of up into spores destroying the red cells, causing personal vital power, so that a man who has pyrexia/and multiplying so rapidly as to render sufficient vitality to resist an ordinary dose of adequate phagocytic action impossible. the poison will succumb to the effects of an On this hypothesis we can account for the extraordinary dose: or again the degree of vitafact that large numbers of people will be found lity may be ordinarily sufficient to guard against to have the plasmodic corpuscles, without shewactive infection, while any cause operating to ing active signs of malarial infection;* and for lower the vitality will lead to active infection the other fact well-known to all dwellers in with no increase in the amount of the infecting malarial regions, that any lowering of the vitalagent. ity, such as excessive fatigue, or exposure to The question of the development of these a chill, will induce a paroxysm of ague in an malarial spores, apart from the animal body, is infected subject months after he has been out will require many and careful obone which of a malarial region. Few of these who have All that can be servations for its elucidation. suffered from malarial fevers in the tropics, can at present is that there are grounds for said risk the effect of exposure to cold even in " believing that the so-called plasmodium" is temperate climates. Thus the two principal in an reality only aggregation of the developphenomena of malarial infection seem to be fully mental of these spores. If this be so, products * one stumbling block in the path of malarial inIn these cases phagocyte cells are invariably present in 1 arge numbers. vestigation will have been removed. can
Table
Duration of disease observation.
prior
seven
cases
of Quotidian Ague.
to Remarks.
During Ten
days
; fever
ly every day. 20 22
in
Result of Examination of Blood.
Case Serial No.
19
A.?Appearance of Blood
recurring regular
Two days Three days
???
paroxysm.
During intermission. cells charged with spores present -in large numbers.
Echinoid
?Plasmodic
Phagocyte
Echinoid Echinoid
No observation, Plasmodic
Phagocytes present. Phagocyte cells charged "with spores.
23
Two
Plasmodic
Echinoid
days
Five
days ; recurring regularly at
Plasmodic
Echinoid
5 P.M.
40
Constant quotidian for some weeks, contracted in Burma. Free from fever for some time, but
suffering
from hematuria
No observation
Quotidian
:
agne of
some
weeks
duration, contracted on field service in Lushai Hills : very
anieaiic.
Both echinoid and
plasmodic. %
very antemic. 41
...
No observation
Both echinoid and
plasmodic, chiefly p 1 a smodic.
some
free
cells charged with Free plasmodia." Quinine taken prior to observation. Single spores inside red cells seen to develop into rod-like forms, subsequently breaking up into spores. Under treatment with quinine and iron. A boat-shaped
Phagocyte spores.
34
Also
Plasmodia." "
organism Ehabdomonassp (?) and oval flagellate monads. No phagocytes.
Under treatment with quinine and iron. Zaveran's bodies
present.
No
phagocyte
cells.
Nov.: 1892;}
RANKING ON MALARIAL INFECTION.
Table
B.?Appearance of
Blood in 13
of
cases
325
Tertian
Ague.
Result op Examination of Blood. Duration of disease prior to
Case Serial No.
observation.
-
Echinoid
Plasmodic
Several paroxysms
Echinoid
Plasmodic
Several paroxysms
10
4
"
8 11
Some
days
"
a.m.
Temp.
100-6?. Echinoid. 1-30 p.m. T. 102-6?. Echinoid with a few plasmodic
corpuscles.
12
One paroxysm
Echinoid
13 14 24 25
Two paroxysms One paroxysm previous day One paroxysm previous day One paroxysm previous day
Echinoid Not recorded Not recorded Not recorded
2G
One paroxysm previous day
Not recorded
One paroxysm previous day
Not recorded
29
One paroxysm
previous day
Not recorded
30
One paroxysm
previous day
Not recorded
ous
night.
4 p.m. 98*4?. Plasmodic.
One attack
No observation... Plasmodic Plasmodic Plasmodic 'and echinoid.
Spiral, straight,
1" modlc'
circular. J
Plasmodic
...
Plasmodic -and echinoid. Plasmodic
Blood in 16
cases
cells visible.
No
phagocytes. Quinine
No record
Plasmodic
No
phagocytes.
Plasmodic and echinoid. Plasmodic
No
phagocytes.
7
Some time.
Enlarged spleen
No record
10
Several months.
15
Fortnight since
last attack
No record
Echinoid Free spores. Plasmodic
16
Fortnight since
last attack
No record
Plasmodic
No record No record
Echinoid and modic. Plasmodic
No record
Plasmodic
No record
Plasmodic
No record
Echinoid
No record No record
Echinoid ... Plasmodic ; a few echinoid. Echinoid & plasmodic.
No record
Very anaemic
spleen
to
18
internal fever."
Complaining of Temp, subnormal. Occasional
one on
days
with
with
charged
Plasmodic
No record
Attacks infrequent; vious day. Same case as (35) ten
cells
No record
(Neuralgia)
35
spores.
Phagocyte
previous
Masked ague
32
charged
phagocyte
previous day
"
cells
Free plasmodia. spores. Rhabdomonas sp (?). Phagocyte cells charged with
No
6
28
over-
Quinine overnight.
Plasmodic
One attack
Great enlargement umbilicus.
plasmodia. Quinine night.
Free
No record
5
17
with
charged
of Irregular Ague.
Uncertain.
of
cells
Ditto. Ditto. Ditto.
Phagocyte
2
night.
Phagocyte
previ-
One attack
Some months.
...
with
spores.
C.?Appearance of
Table
...
charged
Spleen enlarged. Phagocyte cells charged with spores. Taking cinchonidine. Phagocyte cells charged with spores.
No observation...
...
cells
spores.
spores.
27
l
Phagocyte
Plasmodic
Echinoid
Two paroxysms
3
Remarks.
During intermission.
During paroxysm.
pre-
later
37 38
Occasional
39
Occasional. Attack same morning
T. 202-5? Echinoid.
plas-
taken.
Cinchonidine taken. Free plasmodia ; few phagocyte cells. Iron and quinine. Phagocytes charged with spores many. Many phagocytes charged with spores. Many phagocytes charged with spores.
" bodies ; phagoWlieatsheaf cytes full of spores. Free plasmodia ; phagocytes full of spores.
"
taken. Flagellate monads. Phagocytes full of spores. One rosette form.
Quinine
Flagellate
monads.
monads. Free spores.
Flagellate
42
INDIAN MEDICAL GAZETTE.
32G
Table
D.?Appearance of
Blood in
one case
[Nov.
1892.
of Quartan Ague.'
"Result op Examination op Blood. Serial No.
Duration of disease prior to observation.
Remarks.
During
During
interval.
paroxysm.
33
visible.
Table 21
Very anyemic
Echinoid
One year
E.?Appearaace of
Blood in
a case
of
No
; no plasmodia phagocytes to bo
Remittent Fever.
Two weeks.
Date of observation? 27th February 1891, 3-30 2nd March 1891, 10 30
p.m.
a.m.
11-45 A.M.
T. 103-8? Echinoid. T. 100? Plasmodic. T. 99-4? Echinoid and
Phagocyte cells full of spores. After quinine mixture.
and
arsenic
plasmodic.
1
P.M.
1-35 p.m. 3-30 p.m.
T. 100-8? Echinoid. Plasmodic. T. 101-4? Echinoid. T. 101-4?
Free plasmodia and monads. Free spores.
Echinoid. 3rd March 1891, 10
a.m.
Plasmodic. T. 99-4? Plasmodic.
flagellate
Quinine and Arsenic. Many phagocyte cells charged with spores.
In connection with this paper the following will be found to be of interest in connection with one or other of the points now brought forward. To economise space I cannot do more than refer to the various papers with a general indication of their purport. .Roman Malarial Fevers.?Celli, Marchiafava, Weyl (Fieri. Klin. Woch of November 3, 1890.) Organisms of Ague.? Vandyke Carter. Sc. Mem. by Officers of Indian Army, Part III, 1880. Hcematozoa of Ague.?Laveran-Journal des Connaissances Medicales, January 8, 1891. Parasite of Quartan Ague.?Golgi, Zeitschrift fur Hygiene, Vol. X. p 137. Parasite of Irregular Malarial Fevers.?Sakharoff. Annales de 1' lust. Pasteur, July 25, 1891.
Experimental
di Mattel.
Malarial Injection in Alan and Animals Reforma Medica, May 30, 1891.
Pneumonia.?Hadji-Costa. Revue de Med.. November 10, 1891. Alkalinity of the ilood in disease.?Rumpf. Centrl. f. Klin Med., No. 24, 1891, and Centralbl. f. d. Med. Wiss No. 41, October, 1891.
Postpaludal
blue in Malaria.?Lava, November 29, 1891.
Methylene Methylene
Gazz.
Degli Ospitali,
Hue in Malaria.?Guttmann and Ehrlich. Berl.
Klin.
Woch., September 28, 1891. Indications for Quinine.?Manquat. Lyon. Med., 1891.
October 25,
An epitome of most of these papers will be found in the Epitome of Current Medical Literature of the British Medical Journal for 1891.
cases
under
analysis
are
made
up
as
:?
Quotidian
...
Tertian
...
Quartan
...
Irregular type Remittent
...
...
7 14 1 16 1
cases
equal
?
?
case
,,
cases
,,
case
From this it appears
?
that
to 17*5 per cent. 35 Jf 2-5 40 ? 2-5 ?
intermitteuts
of
irregular type are most common, next in order come tertians, then quotidians, and last at a long
interval quartau and remittents. This tallies with the experience of all who have to do with fevers of malarial origin. From an examination of the cases of quotidian in the parague (Table A), it will be seen that oxysmal stage, that is to say, at some period of the fever other than that of the actual intermis" " sion, all the cases recorded shewed echiuoid in which cases were 40-41 corpuscles. Cases 23, the paroxysms of a quotidian ague had been held in abeyance by the administration of quinine or quinine aud iron. In the interval, six of the seven cases shewed plasmodic corpuscles ; cases 40 and 41 also shew" ing eehinoid" corpuscles ; aud would most probably have relapsed on the cessation of administration of quinine owing to the blood corpuscles not having sufficient vitality to prevent the breaking up of the "plasmodia" into spores. The cases of tertian ague (Table B) were similar to those of quotidian, except that the " mulberry" bodies were more constantly present. These bodies the writer has already stated are according to his observations phagocyte cells charged with spores. The general rule was "echiuoid" corpuscles during the paroxysm, and "plasmodic" corpuscles during the interval. It is noticeable that no flagellate monads were observed in any of the cases of tertian ague. The solitary case of quartan ague shewed all " eehinoid" corpuscles, the obstinacy of the disease being thus paralleled by the waut of resistance in the red blood cells.
MALARIAL INFECTION. By Surgeon-Major G\ S.
RANKING,
m.d.
(Continued from page 259.) It next remains to consider whether we have any data connecting the developmental stages of the malaria organism with the clinical progress of the disease. For this purpose I propose to give a brief resume of the results of observations on a series of forty cases of malarial iufection-^including all the types of intermittents, quotidian, tertian, quartan and irregular?with aud without coincident splenic enlargement: and remittents: reserving a detailed account of some of these observations for a future paper.
In the agues of irregular type (Table C), the following were the conditions of the blood cells during the interval:? Plasmodic
corpuscles
...
...
Plasmodic and eehinoid
corpuscles Eehinoid corpuscles only
...
...
9 oases.
...
4 cases.
...
3 cases.
In two of these cases observed.
The three
corpuscles only
were
flagellate monads were shewing "eehinoid Nos. 10, 35, 37. No. 10 mouths, was very ancemic.
cases
"
had had ague for many 35 and 37 are the same case at iutervals of There was some days. nothing very special about this case; he was certainly not anannic, in fact, rather robust than otherwise, so that this case rather militates against the theory which would attribute the " plasmodic " corpuscles to
their greater vital energy.
INDIAN MEDICAL GAZETTE.
324
[Nov.
1892.
But whether that theory be true or not, there explained, so that, pending some more satisfacbe 110 question that the resting stage of the tory solution, we are, I think, justified in attrito the condition of buting to the heightened vitality of the red organism corresponding " " plasmodic corpuscles occurs in a large maj- blood cells the prevention of that breaking up ority of cases, coincidently with the cessation of into spores which accompanies and, as I think, the paroxysm. causes the paroxysm. What the actual connection of cause and Summary.?To sum up, malarial infection effect between these phenomena is I do not appears to be due to spores which are to be attempt to say; but it would appear to be a suffi- found in large nnmbers in the air, the water, ciently sound working hypothesis that when the and the soil of malarial regions. Inasmuch as blood cells of a person exposed to malarial in- these spores are so widely distributed, it follows fection have a high resistance the spores become that all animals exposed to their influence do of included in the red cells, and destroyed by infected. become necessity phagocytosis; but that where the resisting power The greater or less degree of infection appears is low, the contained plasmodia continually break to depend, ceteris paribus, upon the degree of up into spores destroying the red cells, causing personal vital power, so that a man who has pyrexia/and multiplying so rapidly as to render sufficient vitality to resist an ordinary dose of adequate phagocytic action impossible. the poison will succumb to the effects of an On this hypothesis we can account for the extraordinary dose: or again the degree of vitafact that large numbers of people will be found lity may be ordinarily sufficient to guard against to have the plasmodic corpuscles, without shewactive infection, while any cause operating to ing active signs of malarial infection;* and for lower the vitality will lead to active infection the other fact well-known to all dwellers in with no increase in the amount of the infecting malarial regions, that any lowering of the vitalagent. ity, such as excessive fatigue, or exposure to The question of the development of these a chill, will induce a paroxysm of ague in an malarial spores, apart from the animal body, is infected subject months after he has been out will require many and careful obone which of a malarial region. Few of these who have All that can be servations for its elucidation. suffered from malarial fevers in the tropics, can at present is that there are grounds for said risk the effect of exposure to cold even in " believing that the so-called plasmodium" is temperate climates. Thus the two principal in an reality only aggregation of the developphenomena of malarial infection seem to be fully mental of these spores. If this be so, products * one stumbling block in the path of malarial inIn these cases phagocyte cells are invariably present in 1 arge numbers. vestigation will have been removed. can
Table
Duration of disease observation.
prior
seven
cases
of Quotidian Ague.
to Remarks.
During Ten
days
; fever
ly every day. 20 22
in
Result of Examination of Blood.
Case Serial No.
19
A.?Appearance of Blood
recurring regular
Two days Three days
???
paroxysm.
During intermission. cells charged with spores present -in large numbers.
Echinoid
?Plasmodic
Phagocyte
Echinoid Echinoid
No observation, Plasmodic
Phagocytes present. Phagocyte cells charged "with spores.
23
Two
Plasmodic
Echinoid
days
Five
days ; recurring regularly at
Plasmodic
Echinoid
5 P.M.
40
Constant quotidian for some weeks, contracted in Burma. Free from fever for some time, but
suffering
from hematuria
No observation
Quotidian
:
agne of
some
weeks
duration, contracted on field service in Lushai Hills : very
anieaiic.
Both echinoid and
plasmodic. %
very antemic. 41
...
No observation
Both echinoid and
plasmodic, chiefly p 1 a smodic.
some
free
cells charged with Free plasmodia." Quinine taken prior to observation. Single spores inside red cells seen to develop into rod-like forms, subsequently breaking up into spores. Under treatment with quinine and iron. A boat-shaped
Phagocyte spores.
34
Also
Plasmodia." "
organism Ehabdomonassp (?) and oval flagellate monads. No phagocytes.
Under treatment with quinine and iron. Zaveran's bodies
present.
No
phagocyte
cells.
Nov.: 1892;}
RANKING ON MALARIAL INFECTION.
Table
B.?Appearance of
Blood in 13
of
cases
325
Tertian
Ague.
Result op Examination of Blood. Duration of disease prior to
Case Serial No.
observation.
-
Echinoid
Plasmodic
Several paroxysms
Echinoid
Plasmodic
Several paroxysms
10
4
"
8 11
Some
days
"
a.m.
Temp.
100-6?. Echinoid. 1-30 p.m. T. 102-6?. Echinoid with a few plasmodic
corpuscles.
12
One paroxysm
Echinoid
13 14 24 25
Two paroxysms One paroxysm previous day One paroxysm previous day One paroxysm previous day
Echinoid Not recorded Not recorded Not recorded
2G
One paroxysm previous day
Not recorded
One paroxysm previous day
Not recorded
29
One paroxysm
previous day
Not recorded
30
One paroxysm
previous day
Not recorded
ous
night.
4 p.m. 98*4?. Plasmodic.
One attack
No observation... Plasmodic Plasmodic Plasmodic 'and echinoid.
Spiral, straight,
1" modlc'
circular. J
Plasmodic
...
Plasmodic -and echinoid. Plasmodic
Blood in 16
cases
cells visible.
No
phagocytes. Quinine
No record
Plasmodic
No
phagocytes.
Plasmodic and echinoid. Plasmodic
No
phagocytes.
7
Some time.
Enlarged spleen
No record
10
Several months.
15
Fortnight since
last attack
No record
Echinoid Free spores. Plasmodic
16
Fortnight since
last attack
No record
Plasmodic
No record No record
Echinoid and modic. Plasmodic
No record
Plasmodic
No record
Plasmodic
No record
Echinoid
No record No record
Echinoid ... Plasmodic ; a few echinoid. Echinoid & plasmodic.
No record
Very anaemic
spleen
to
18
internal fever."
Complaining of Temp, subnormal. Occasional
one on
days
with
with
charged
Plasmodic
No record
Attacks infrequent; vious day. Same case as (35) ten
cells
No record
(Neuralgia)
35
spores.
Phagocyte
previous
Masked ague
32
charged
phagocyte
previous day
"
cells
Free plasmodia. spores. Rhabdomonas sp (?). Phagocyte cells charged with
No
6
28
over-
Quinine overnight.
Plasmodic
One attack
Great enlargement umbilicus.
plasmodia. Quinine night.
Free
No record
5
17
with
charged
of Irregular Ague.
Uncertain.
of
cells
Ditto. Ditto. Ditto.
Phagocyte
2
night.
Phagocyte
previ-
One attack
Some months.
...
with
spores.
C.?Appearance of
Table
...
charged
Spleen enlarged. Phagocyte cells charged with spores. Taking cinchonidine. Phagocyte cells charged with spores.
No observation...
...
cells
spores.
spores.
27
l
Phagocyte
Plasmodic
Echinoid
Two paroxysms
3
Remarks.
During intermission.
During paroxysm.
pre-
later
37 38
Occasional
39
Occasional. Attack same morning
T. 202-5? Echinoid.
plas-
taken.
Cinchonidine taken. Free plasmodia ; few phagocyte cells. Iron and quinine. Phagocytes charged with spores many. Many phagocytes charged with spores. Many phagocytes charged with spores.
" bodies ; phagoWlieatsheaf cytes full of spores. Free plasmodia ; phagocytes full of spores.
"
taken. Flagellate monads. Phagocytes full of spores. One rosette form.
Quinine
Flagellate
monads.
monads. Free spores.
Flagellate
42
INDIAN MEDICAL GAZETTE.
32G
Table
D.?Appearance of
Blood in
one case
[Nov.
1892.
of Quartan Ague.'
"Result op Examination op Blood. Serial No.
Duration of disease prior to observation.
Remarks.
During
During
interval.
paroxysm.
33
visible.
Table 21
Very anyemic
Echinoid
One year
E.?Appearaace of
Blood in
a case
of
No
; no plasmodia phagocytes to bo
Remittent Fever.
Two weeks.
Date of observation? 27th February 1891, 3-30 2nd March 1891, 10 30
p.m.
a.m.
11-45 A.M.
T. 103-8? Echinoid. T. 100? Plasmodic. T. 99-4? Echinoid and
Phagocyte cells full of spores. After quinine mixture.
and
arsenic
plasmodic.
1
P.M.
1-35 p.m. 3-30 p.m.
T. 100-8? Echinoid. Plasmodic. T. 101-4? Echinoid. T. 101-4?
Free plasmodia and monads. Free spores.
Echinoid. 3rd March 1891, 10
a.m.
Plasmodic. T. 99-4? Plasmodic.
flagellate
Quinine and Arsenic. Many phagocyte cells charged with spores.
In connection with this paper the following will be found to be of interest in connection with one or other of the points now brought forward. To economise space I cannot do more than refer to the various papers with a general indication of their purport. .Roman Malarial Fevers.?Celli, Marchiafava, Weyl (Fieri. Klin. Woch of November 3, 1890.) Organisms of Ague.? Vandyke Carter. Sc. Mem. by Officers of Indian Army, Part III, 1880. Hcematozoa of Ague.?Laveran-Journal des Connaissances Medicales, January 8, 1891. Parasite of Quartan Ague.?Golgi, Zeitschrift fur Hygiene, Vol. X. p 137. Parasite of Irregular Malarial Fevers.?Sakharoff. Annales de 1' lust. Pasteur, July 25, 1891.
Experimental
di Mattel.
Malarial Injection in Alan and Animals Reforma Medica, May 30, 1891.
Pneumonia.?Hadji-Costa. Revue de Med.. November 10, 1891. Alkalinity of the ilood in disease.?Rumpf. Centrl. f. Klin Med., No. 24, 1891, and Centralbl. f. d. Med. Wiss No. 41, October, 1891.
Postpaludal
blue in Malaria.?Lava, November 29, 1891.
Methylene Methylene
Gazz.
Degli Ospitali,
Hue in Malaria.?Guttmann and Ehrlich. Berl.
Klin.
Woch., September 28, 1891. Indications for Quinine.?Manquat. Lyon. Med., 1891.
October 25,
An epitome of most of these papers will be found in the Epitome of Current Medical Literature of the British Medical Journal for 1891.
