.1 *IVE CASES OF QUARTAN FEVER. 291

January, 1901, the tremors disappeared, but the FIVE CASES OF QUARTAN FEVER. knee jerks were still increased and exophthalmos and ankleclonus still present. On 23rd 1901, the M.A January, By A. N. BRAHMACHAR1, , M.B., \/ exophthalmos had markedly diminished, and the tremors and ankleclonus had all The knee House Physician, Medical College Hospital, Calcutta. disappeared. jerks were still increased. On 25th January, 1901, the patient left hospital against advice. At the time of of were was This following cases quartan fever discharge exophthalmos very slightly present, but treated in the wards of the 1st Physician at the the other nervous symptoms had all disappeared. Medical between College Hospital, Calcutta, Sep- Remarks.?Quartan Fever is considered to tember 1900 and . The diagrams be very rare in India. In Ins presidential address of the in each case are parasites observed ap- on the fevers of India in the Indian Medical Con- pended. gress Dr. Grombie remarks that he had seen Case No. 1.?Akawon, Chinaman, (tit., thirty, was ad- one case in his whole in India.1 1900. only experience mitted on 23rd Patient was one September employed Dr. records doubtful case in an in the division in a tea- Maynard Jalpaiguri in Rajahahye in the Medical garden during 1898 and 1899. While there, he was outpatient College Hospital, attacked with malarial fever for the first time and was Calcutta.2 Ross found only two patients to be treated with quinine. He came to Calcutta in May suffering from quartan fever out of 112 cases 1900 and suffered from fever from time to time, and as of malarial fever examined by him in the the attacks more frequent he came into became hospital Madras The Case No. 2.?Dhookmooia, Hindu, female, cet., sixteen, Infantry.8 following table, mostly taken from treatise on was admitted on 2nd October, 1900, suffering from Mannaberg's malarial was of malarial fever. Patient employed in 1899 in fevers shews the number observations made Lilooah, a station three mile3 fr<>mHowrah, as a labourer in the other parts of the world by different in the railway construction works for about eight observers:? months. While there, she was attacked with intermit- tent fever. came to Calcutta in June and She 1900, Total num- had often suffered from malarial fever since then. ber of c^ses Case No. 3.? Lord, European, male, adult, was ad- Name of ob- of malaria Seat of obsen server. ation. mitted on 13th . He had the first attack of fever malarial fever in Hyderabad (Deccan) in 1899, and was observed. admitted for treatment into the Residency Hospital in June there for a 1899 and remained about fortnight. Moil lot Algiers. was for the same in He readmitted there complaint Krch I tidy. in , and remained hospital for about three Fin ah Algiers. weeks. He came to Calcutta from Hyderabad in Durand Tunis. . While in Calcutta he had frequent Osier Haltimore. attacks of fever and eventually sought admission into Laveran Algiers. hospital. Giiegenyer ... Tiibenger. Case No. 4.?Abdul Huq, Mahomedan, male,

which were even sometimes blood corpuscles of his discharge from the hospital after he had smaller than normal and never lost their colour. I been treated with for more than a were seen in all quinine The characteristic rosettes fortnight. in case No. 5, in whose blood, however, except Some of the above cases presented some were not looked for at the time when they they farther points of clinical which to The within importance generally begin develop. spores may be mentioned here. the rosettes never exceeded 10 in number, Case No. 2 after a course of cinchona febri^ were sometimes as few as 6 through they had a of for some time The of the fuge period apyrexia (vide diagrams). arrangement and then began to suffer from a of fever in the forms was type spores segmenting quite at first intermittent and then remittent. characteristic and differed from what is found During these attacks the blood was examined on several in those of the tertian parasites. occasions, but no were found. The forms well merit the term hcemosporidia segmenting This latter fever did not yield to or or rosette forms so quinine "Marguerite" frequently cinchona and ended to them. the rosettes febrifuge fatally. applied Occasionally, The post-mortem examination shewed no shewed some evolution, while on the peculiar tubercle in the or any other organ of the slide under the but their have lungs microscope, changes bod}r. There was no evidence of fever. not been shewn in the While observ- typhoid diagrams. The mesenteric glands were and a the in one case under the enlarged, ing parasites microscope section shewed a number of I noticed that the after re- large pigmented pigment granules leucocytes. The liver was very and the in the centre of a rosette fatty, maining clumped up spleen shewed an increase of fibrous tissue with for commenced a most active twenty-four hours, a number of " very large pigmented leucocytes. movement described as a boiling move- (well The post-mortem diagnosis of the case was ment which continued for ten The " ") days. chronic malaria." The case shews how some within the rosette became indistinct spores very of the intermittent fevers may become remittent, after hours, so that it was forty-eight practically resist and end fatally. It is possible converted into a more or less quinine hyaline spherical that many of the remittent fevers of India with a of body clump very actively moving with such intermittent attacks, and such in the centre. After ten began pigment grannies days a termination of intermittent fever is difficult to the the parasite disintegrated, leaving pigment the free. The slide the of the explain by parasite theory. containing specimen Case No. 4 is also interesting. The blood was in the the of tempera- kept wards, range ture chart exhibited a double fever with from 80?F. to 85?F. The quartan temperature being a It supports the state- cover was with vaseline to simple quartan relapse. glass painted prevent ment of observers that fever is the blood many quartan drying up. the most obstinate of all the intermittent fevers. On one occasion a rosette was seen to rupture The case shews the beneficial effect of small within an hour after the blood had been drawn, doses of in the treatment of and in several other cases a similar quinine quartan phenomenon fever as has been by was observed at a later within suggested Legrain.1 period, generally Case No. 5 is in the nervous symp- twelve hours. The let free did not unique spores appear toms manifested in it. Cases dis- to attack of the red In the simulating any corpuscles. seminated selerosis have been recorded as of the rosette and being process rupture, got bigger, due to the restivo-autumnal parasite,2 and the seemed to have an active motion. exoph- spores thalmos has been shewn as being caused by the The appearance of the after a course parasites tertian No such symptoms have, as of cinchona or has not been parasite.3 febrifuge quinine far as I am-aware, been shewn to have resulted shewn in the After a course of these diagrams. from a infection. The the often looked and the quartan parasite tempera- drugs parasites fatty, ture chart was also interesting as, instead of peripheral distribution of the pigment granules steadily coming down the next after ague, in them was not so well marked. day the temperature shewed only a morning fall and In case No. 4, rosettes were found on 19th then a rise resembling the curve of malignant 1901, there was no fever on January, though tertian fever as described by Machiafava and that date. This was not due to treat- apyrexia Bignami.4 The fits of ague came on, however, ment with quinine or cinchona and febrifuge every fourth The blood shewed an un- remains It shews that sometimes day. unexplained. number of quartan parasites, and in the course of intermittent fever of usually large periods the nervous may possibly be thus occur In this symptoms apyrexia may spontaneously. accounted for. The case may be described as case also, the that were found in the parasites one of malignant quartan. blood on 1st March, 1901, were in it for present A of great interest in the case is that a long time after the had and point patient quinine the patient suffered from intermittent fever after the fever had ceased. These parasites be 1 may considered to further evolution Legrain's Fievres Des Pays Chands. undergo 2 in the blood of the were still Americal Journal of Medical Sciences, December, 1900. mosquito. They 3 Knies' Eye in general diseases. in the blood of the on the 4 present patient day Thayer's Malarial Fevers. The Indian Medical Gazette, Aug. 1901.

FIVE CASES OF QUARTAN FEVER. By A. N. BRAHMAOHARI, M.A.. M.B.,

were Abbe's camera The drawings made with the assistance of lucida from specimens of fresh blood A Leitz microscope objective (Oil immersion) ocular two was used.

(i)(I) SIMPLE QUARTAN FEVER. (AKOWON)

0 082S 28. 3.1900. 00 0 2 9.9 1900. 8 A.M. 8 A.M.

28. 9.1000. 4 P.M. (II) SIMPLE QUARTAN FEVER. (DUKHMOONIA) ^ rr\?

10. 1900. *? a 5. V l0- 1900 P.M- 5) 2 a A.M. 7. 10. 1900. 5 P.M.

(m)(IU) DOUBLE qUARTANQUARTAN FEVER. (LORD) 09 Q Or /OO 17 . 10. 1900. 7.30 P.M During (ixjvlc Very few TTLoUure 0 purcvsites in/ the peripheral circuLcxtvmy. 16.10.1900. 17. ID. 1900. 17-10.1900. 17.10.1900. I P. "7 A.M. M. 4 P. M.

(IV)(IV) DOUBLEDOUBLE QUARTANQUARTAN FEVERFEVER. Q 0 (ABDUL(ABDUL HUQE)HUCjE) ? Q ^ I ? (i) (j) ? ?

13.12. 190?- 2.21901. 3.2*. 1901. 1.3.1301 3 P. M. 1 A.M. 2 P.M. 5 P.M. (V)(V) SIMPLESIMPLE QUARTANQUARTAN FEVER.FEVER. (D'COSTA)(D'COSTA)

22. I. I9?'- 24.1.1901. I P. M. 8 A. M. August 1901.] THE ENTERO-COCCUS OF DYSENTERY. ?93

every year between the months of September and February?the time in fact during which all the other cases were admitted into the hospi- tal. These months are apparently those during which this tj^pe of intermittent fever is most prevelent. Since the above was written, another case has been admitted into the wards of the 1st Physi- cian, the patient being a Chinaman and comin< from Jalpaiguri.