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Original Articles.

THE BLOOD EXAMINATION OF THREE THROUSAND FOUR HUNDRED CASES OF FEBRILE DISEASE IN BOMBAY.

SEASONAL PREVALENCE OF THE DIFFERENT MALARIA PARASITES.

THE DIAGNOSIS OF THE VARIETY OF THE YOUNG STAINED PARASITES.

Mr. Arthur Powell.

The table before you shows that a definite diagnosis was made by the finding of parasites in 2,652 cases out of a total of 3,413.

These parasites were : —

Malarial Hsemaraoebse 2,542

Spirilla of Relapsing Fever ... 94

Plague Bacilli (out of 117 cases)... 15

Filaria nocturna causing fever ... 1

2,652

Of the remaining 761 cases in whose blood no parasite was seen a definite diagnosis was made by clinical methods in 551, leaving a balance of 210 cases of fever in which the diagnosis of the cause 18 uncertain. The majority were probably mafcirial.

I may say that the greater number of these cases occurred in the Police Hospital, where it is our custom to give no quinine, no matter how like malaria the cases may seem, till parasites have been actually observed. This may seem an improper procedure to some of you, but it is a sound logical one in my opinion, and in practice has the best results. No patient has died since March 1901 among all these malaria cases.

There is a statement frequently made that in the worst cases of malaria we often get no parasites. This is wholly against my experience, except in the case of Black-water fever which some will not admit to be of a malarial origin.

I believe in giving large and continued doses of quinine, and it is most essential before worrying a patient with this drug to know first whether he requires it. Most cases of bronchitis, pneumonia, pleurisy and tuberculosis can be diagnosed without the help of a stethoscope. Nevertheless few of us would care to consult a physician who seldom or never used that instrument in chest affections.

If we may believe the Hospital Reports of this country we find some 55 per cent, of the patients are the victims of malaria. A widely varying proportion suffer from pneumonia, plague, enteric and relapsing fever, tubercle, liver abscess and other febrile diseases. The micro-

• Paper, read 'before the Bombay Medical and Physical

Society, since revised and amplified for publication in the

scope offers the only certain means of distinguish- ing these diseases from malaria at the onset. Yet I venture to say, not one in ten of the practitioners of this country can recognise the malaria parasite, and not one in fifty uses the microscope systematically in the diagnosis of malaria.

Hence we frequently hear such remarks about our friends who are ill, as " the doctors think he may have malaria." "It may be malaria or enteric, but the doctors cannot eay for some days." " The doctor thinks she has a touch of malaria." " They fear it is plague, but the doctor hopes it is malaria."

I hope I am not rude in saying that in three out of four such cases the doctor has no business to think, to Iwpe or to fear. It is his duty to know, and he has neglected the only means of obtaining that knowledge which most truly is power in the case of malaria. I do not say that the doctor must examine the blood in all cases of suspected malaria, but I maintain he should never administer quinine without first making a dry smear of the blood, which can be referred to and examined should the diagnosis subse- quently become doubtful.

We know that in many districts of this country two-thirds of the inhabitants harbour the ankylostoma, a worm that can only be ex- pelled by dangerous and poisonous drugs. When we know also that the presence or absence of these worms can in a few moments be diagnosed by the microscope, we must admit that this in- strumcTit is, above all others, the most important and essential for the general practitioner in the Tropics.

The elaborate table I have produced when condensed shows that in the past two and-a- half years there has been no great seasonal pre- valence of the parasites such as has been re. marked in Italy, Algeria, America and elsewhere

The cause of this, if I may be permitted to theorise, is perhaps to be found in the fact that Bombay is a low-lying, badly drained city, with a moist equable temperature, an abundant arti- ficial water-supply, for the surplus of which there are no eflScient drains. The result is the presence of tanks, ponds, fountains and puddles which allow of the continuous breeding of mos- quitos at all seasons.