A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
The sexual cycle can take place only within the body of one genus of
mosquito, _anopheles_. Absence of this mosquito from certain districts
explains the absence of {190} malaria. It is distinguished from our
common house-mosquito, _culex_, by the relative lengths of proboscis
and palpi (Fig. 79), which can be seen with a hand-lens, by its
attitude when resting, and by its dappled wing (Fig. 80). Anopheles is
strictly nocturnal in its habits; it usually flies low, and rarely
travels more than a few hundred yards from its breeding-place,
although it may be carried by winds. These facts explain certain
peculiarities in malarial infection; thus, infection occurs
practically only at night; it is most common near stagnant water,
especially upon the side toward which the prevailing winds blow; and
the {191} danger is greater when persons sleep upon or near the ground
than in upper stories of buildings. The insects frequently hibernate
in warmed houses, and may bite during the winter. A mosquito becomes
dangerous in eight to fourteen days after it bites a malarious person,
and remains so throughout its life.
(2) Detection.--Search for the malarial parasite may be made in either
fresh blood or stained films. If possible, the blood should be
obtained a few hours before the chill--never during it nor within a
few hours afterward, since at that time (in single infections) only
the very young, unpigmented forms are present, and these are the most
difficult to find and recognize. Sometimes many parasites are found in
a microscopic field; sometimes, especially in estivo-autumnal
infection, owing to accumulation in internal organs, careful search is
required to find any, despite very severe symptoms. Quinin causes them
rapidly to disappear from the peripheral blood, and few or none may be
found after its administration. In the absence of organisms, the
presence of pigment granules within leukocytes--polymorphonuclears and
large mononuclears--may be taken as presumptive evidence of malaria.
Pigmented leukocytes (Plate VI) are most numerous after a paroxysm.
(_a_) _In Fresh Unstained Blood_ (Plate VII).--Obtain a small drop of
blood from the finger or lobe of the ear. Touch the center of a
cover-glass to the top of the drop and quickly place it, blood side
down, upon a slide. If the slide and cover be perfectly clean and the
drop not too large, the blood will spread out so as to present only
one layer of corpuscles. Search with a one-twelfth-inch objective,
using very subdued light.
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