A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
{192} The young organisms appear as small, round, ring-like or
irregular, colorless bodies within red corpuscles. The light spots
caused by crenation and other changes in the corpuscles are frequently
mistaken for them, but are generally more refractive or have more
sharply defined edges. The older forms are larger colorless bodies
containing granules of brown pigment. In the case of the tertian
parasite, these granules have active vibratory motion, which renders
them conspicuous; and as the parasite itself is very pale, one may see
only a large pale corpuscle in which fine pigment-granules are
dancing. Segmenting organisms, when typical, appear as rosets, often
compared to daisies, the petals of which represent the segments, while
the central brown portion represents the pigment. Tertian segmenting
forms are less frequently typical than quartan. Flagellated forms are
not seen until ten to twenty minutes after the blood has left the
vessels. As Cabot suggests, one should, while searching, keep a sharp
lookout for unusually large or pale corpuscles, and for anything which
is brown or black, or in motion.
[Illustration: PLATE VII. EXPLANATION OF PLATE VII.
Various forms of malarial parasites (Thayer and Hewetson).
1 to 10, inclusive, Tertian organisms; 11 to 17, inclusive, quartan
organisms; 18 to 27, inclusive, estivo-autumnal organisms; 1, young
hyaline form; 2, hyaline form with beginning pigmentation; 3,
pigmented form; 4, full-grown pigmented form; 5, 6, 7, 8, segmenting
forms; 9, extracellular pigmented form; 10, flagellate form; 11, young
hyaline form; 12, 13, pigmented forms; 14, fully developed pigmented
form; 15, 16, segmenting forms; 17, flagellate form; 18, 19, 20,
ring-like and cross-like hyaline forms; 21, 22, pigmented forms; 23,
24, segmenting forms; 25, 26, 27, crescents.]
(_b_) _In Stained Films_ (Plate VI).--Recognition of the parasite,
especially the young forms, is much easier in films stained by
Wright's or some similar stain than in fresh blood. When very scarce,
they may sometimes be found, although their structure is not well
shown, by the method of Ruge. This consists in spreading a very thick
layer of blood, drying, placing for a few minutes in a fluid
containing 5 per cent. formalin and 1 per cent. acetic acid, which
removes the hemoglobin and fixes the smear, rinsing, drying, and
finally staining. If Wright's stain be used in this method, it is
recommended that the {193} preparation be subsequently stained for a
half-minute with borax-methylene-blue (borax, 5; methylene-blue, 2;
water, 100).
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