Medical and surgical reports . e spots. The plasmodia malaria? were found. The Widal testwas negative on September 30. On the night of October 4 he wasseized while in the act of defecation with some pain in the abdomenand the temperature dropped 2=. (See Chart 1, 4-hourly record.) The next morning the abdomen was found moderately distended,muscles rigid, tympany general except in left tlank. when there wasdulness. He failed during the day and died at , Octo-ber 0. The autopsy, October 6, showed a marked malarial spleen, muchenlarged (weight, 430 grammes), symmetrical, of dark slate c
Medical and surgical reports . e spots. The plasmodia malaria? were found. The Widal testwas negative on September 30. On the night of October 4 he wasseized while in the act of defecation with some pain in the abdomenand the temperature dropped 2=. (See Chart 1, 4-hourly record.) The next morning the abdomen was found moderately distended,muscles rigid, tympany general except in left tlank. when there wasdulness. He failed during the day and died at , Octo-ber 0. The autopsy, October 6, showed a marked malarial spleen, muchenlarged (weight, 430 grammes), symmetrical, of dark slate follicles could not be made out. spleen fairly firm, little pulp onscraping, microscopically much black pigment in the cells. Therewere also numerous tj^phoidal ulcers, one of which at a point 55 the ileo-cecal valve had perforated the bowel, causing generalfatal peritonitis. The foregoing case is, of course, conclusive of a simul-taneous double mfection. I next quote a number of cases COINCIDENT MALARIA. 183. 184 COINCIDENT MALAEIA. in which the probability seems very strong of a typhoidsupervening upon a malaria. The evidence of primarymalarial infection while in Cuba is as strong as it can bewithout microscopic demonstration, but the malaria wasgenerally in abeyance during the progress of the typhoid, thelatter disease running its course in some cases typically, inothers more or less atypically. But in cases IV. and VIII.,as well as in I., the malarial organisms were present duringthe typhoid, so that the two diseases coexisted. In theother cases one infection took the right of way over theother for the time. Case II.—¥. L. W., aged 19, 2d Mass, Vols. (Med. Kecords,vol. C. 133, p. 134.) Entered hospital August 30. Had been iu bed five weeks in Santiago. Chills and tympanitic, not tender, except over enlarged spleen. Korose spots. Four searches were made for plasmodia, always with negativeresult. On September 5 Widal reaction positive. Te
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