Notes on the etiology of relapse in malarial infections / W.M. James.

  • James, W. M.
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Notes on the etiology of relapse in malarial infections / W.M. James. Source: Wellcome Collection.

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    daily for a month, a relapse, with the finding of parasites in the blood, followed almost immediately. Dr. Molloy’s case also shows an acquired immunity against quinine on the part of some of the asexual parasites. Cases very similar to these have been observed here not infre- quently. Dr. Molloy states that he has seen -relapse even after intravenous injections. I have observed one such case in which it was possible to say that the attack was a relapse. As far as I can determine, cases that relapse after intravenous doses of quinine, are those in which small doses have been given, or that have been treated with quinine by mouth previously. Mannaberg™ is of the opinion that it is difficult to attack organisms in the parenchyma of the spleen and marrow with the drug, and I think that there are very good reasons for this belief. For, in cases dying from malaria after three or four days of vigorous treatment, very often it is only in the spleen and marrow that parasites can be found. Several times at autopsy I have seen a large number of parasites in the placenta, after three or four days’ treatment, when the peripheral blood was negative after prolonged search, and when but few parasites were found in the spleen and marrow. Smears of the spleen and marrow contain relatively a much smaller number of erythrocytes (in which the asexual cycle lives) than do smears of the peripheral blood, so that when parasites are found without trouble in the former when the latter is negative, it is obvious that in the former, for some reason, the parasites have not been affected asin the latter. In fact, in the spleen and marrow not a few of the parasites appear normal, although most of them show the effects of the quinine. I have also noted, in following at autopsy cases that have died of malaria after three to five days’ treatment, that parasites, though perhaps absent from the peripheral blood at death, are found most frequently in the spleen and marrow after oral administration of quinine, less frequently after treatment by hypodermic injections,’ and with least frequency after three or four doses of 22.5 grains intravenously. It used to be not at all uncommon to find large 1 Op. cit., DP. 344. 2 These are given in a dilution of 1:20 of normal salt solution, as first originated by Dr. W. E. Deeks.
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