Blood examination: Numerous endoglobular organisms at rest, about one quarter the size of the red blood corpuscle, containing more pigment. This pigment is sometimes scattered and in motion, again concentrated at the border and at rest.
2. Isolated sporulation forms in markedly shrunken blood corpuscles.
3. Many brassy corpuscles.
4. Numerous infected blood corpuscles that are shrunken and decolorized (veil form).
5. Many very young, still unpigmented, actively ameboid parasites clinging to the blood corpuscles (young generation).
5.30 p. m. : Temperature, 40.7°. 7 p. m. : Temperature, 40°.
August 24, 9 a.m.: Temperature. 38° (about 5.30 a. m., 0.66 quinin). Blood examination: 1. Numerous ameboid organisms, either very small or of medium size, all non pigmented. 2. One melaniferous leukocyte. 11 a. m.: Temperature, 39.2°. 4 p. m. : Temperature, 41.6°.
Blood examination: 1. Numerous ameboid organisms of moderate size, among them a few containing pigment. 2. Many brassy corpuscles. 7 p. m. : Temperature, 40.2°; 0.66 quinin; profuse night sweat. August 25, 5 a. m. : 0.66 quinin. 10 a. m. : Temperature, 36.5°.
Blood examination: 1. Numerous small, marginal parasites, usually immotile, all non pigmented.
2. One melaniferous leukocyte.
3. One sygygy (of two moderately large forms). 4 p. m. : Temperature, 37.1°.
Blood examination: The same as before; all parasites without pigment.
7 p. m. : Temperature, 37.5°.
August 26, 9 a. m. : Temperature, 37.5°.
Blood examination: 1. Isolated non pigmented small organisms.
2. Many heavily laden melaniferous leukocytes.
3. Several crescents and spheres of the same order.
After this the patient remained apyretic and he departed before the occurrence of the relapse.
The temperature curve (Fig. 33), containing but one pronounced paroxysm, presents an evident tertian type, in that between the two short periods of apyrexia there are pretty exactly forty eight hours. Moreover, the fever paroxysm shows the features described as typical by Marchiafava and Bignami. The pseudocritical descent and the precritical elevation are pronounced.
Previous to the paroxysm motionless pigmented organisms were found filling the greater part of the red blood corpuscles, which were not enlarged, but rather shrunken. During the paroxysm, and especially after it, the young, non pigmented forms predominated.
Crescents were seen for the first time .on the tenth day of the disease, after conjugation forms had been observed the day before.
A., aged twenty seven, has suffered six days, at irregular times, from chills and fever; he complains of intense headache and pain in the limbs.
August 19, 1892, 4 p. m. : Temperature, 36°; the spleen evidently palpable.
Blood examination: Quite isolated small forms with very fine pigment.
August 20, 9 a. m. : Temperature, 38°.
Blood examination: Isolated small forms, a few containing one pigment clump.
4 p.m.: Temperature, 41°.
Blood examination: 1. Very numerous ameboid non pigmented organisms. 2. Isolated ones containing a small clump of pigment. Plural infection frequent. 3. One crescent, which changes somewhat its form and shows an evident double contour. The pigment in it is scattered and variable in arrangement.
August 21, 9 a. m.: Temperature, 36.2°.
Blood examination: 1. Pretty numerous non pigmented ameboid forms. 2. Isolated organisms, filling about half the blood corpuscle and containing pigment granules which oscillate actively.
5 p. m. : Temperature, 36.3°.
August 22, 10 a. M.: Temperature, 3S.5°.
Blood examination: A very few small forms without pigment.
4 p. m. : Temperature, 39.6°.
7 p. m. : Temperature, 10.2°.
August 23: No paroxysm. Likewise none subsequently.
In this case also the temperature curve (Fig. 34) manifests a tertian type. Moreover, it resembles more the ordinary tertian, since it shows no prolongation of the paroxysm, and a day of complete apyrexia.
The existence of a tertian fever with exclusively small, crescent forming parasites and without Golgi's forms is, therefore, an established fact.
Yet there is still another question, namely, are the parasites found here to be considered a different species from the pigmented quotidian parasites or not? A positive answer to this question cannot at present be given, and we must await the results of further investigation. In stained preparations we find that the structure of the pernicious tertian parasite is similar to that of the other species.
In concluding our remarks on the crescent forming species we wish to detail three histories showing that fever may occur when crescents alone are apparently present:
M., suffering for fourteen days from tertian paroxysms, which begin at about 2 p. m. with a mild chill, and soon after go over into intense fever; the last paroxysm two days ago.
August 18, 1892, 11 a. m. : Temperature, 37.2°.
Blood examination: A very few small ameboid organisms.
2 p.m.: Mild chill.
5 p.m.: Temperature, 39.6°.
August 19, 10 a. m. : Temperature, 36.2°.
Blood examination: One ameboid organism discovered after a long search.
5 p. m. : Temperature, 37.2°.
August 20, 9 a.m.: Temperature, 37.4°. Blood examination: The same as before.
6 p.m.: Temperature, 38°.
August 21, 9 a. m. : Temperature, 36.6°.
Blood examination: Isolated crescents.
5 p. m.: Temperature, 37.1°.
8 p. m. : Temperature, 37.7°.
August 22, 10 a. m. : Temperature, 37.1°.
Blood examination: 1. Several crescents with scattered pigment. 2. Isolated melaniferous leukocytes; no small ameboid organisms.
5 p. m. : Temperature, 38°.
Blood examination: A few crescents; no ameboid organisms.
7 p. m.: Temperature, 39.9°.
August 23, 10 a. m. : Temperature, 36.3°.
6 p. m. : Temperature, 37°. Blood examination: The same. August 24, 10 a. m. : Temperature, 37.7°. 4 p.m.: Temperature, 37.8°.
Blood examination: Isolated spheres of the crescent order.
7 p. m. : Temperature, 40.3°.
August 25, 10 a. m. : Temperature, 36.5°.
Blood examination: Several crescents and spheres.
In this case ameboid organisms were to be seen only on the first two days, and then in exceedingly small numbers, while later crescents alone appeared. The fever was preeminently of tertian type. (See Fig. 35.)
G. C, wharfsman, suffering for three weeks from a fever that showed at first a tertian, later a quotidian, type. The paroxysms consist sometimes of chills, sometimes of fever; profuse night sweats. Patient feels exhausted and complains of pain throughout the body, especially in the head and in the bones. Moderately pale, spleen evidently palpable. October 7, 1891, 4 p. m.: Temperature, 38.7°.