A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
(_a_) _Asexual Cycle_.--The young organism enters the blood through
the bite of the mosquito. It makes its way into a red corpuscle, where
it appears as a small, pale "hyaline" body. This body exhibits ameboid
movement and increases in size. Soon, dark-brown granules derived from
the hemoglobin of the corpuscle make their appearance within it. When
it has reached its full size--filling and distending the corpuscle in
the case of the tertian parasite, smaller in the others--the
pigment-granules gather at the center or at one side; the organism
divides into a number of small hyaline bodies, the spores or
merozoites; and the red corpuscle bursts, setting spores and pigment
free in the blood-plasma. This is called segmentation. It coincides
with, and by liberation of toxins causes, the paroxysm of the disease.
A considerable number of the spores are destroyed by leukocytes or
other agencies; the remainder enter other corpuscles and repeat the
cycle. Many of the pigment-granules are taken up by leukocytes. In
estivo-autumnal fever segmentation occurs in the {188} internal organs
and the segmenting and larger pigmented forms are not seen in the
peripheral blood.
The asexual cycle of the tertian organism occupies forty-eight hours;
of the quartan, seventy-two hours; of the estivo-autumnal, an
indefinite time--usually twenty-four to forty-eight hours.
The parasites are thus present in the blood in great groups, all the
individuals of which reach maturity and segment at approximately the
same time. This explains the regular recurrence of the paroxysms at
intervals corresponding to the time occupied by the asexual cycle of
the parasite. Not infrequently there is multiple infection, one group
reaching maturity while the others are still young; but the presence
of two groups which segment upon the same day is extremely rare.
Fevers of longer intervals--six, eight, ten days--are probably due to
the ability of the body, sometimes of itself, sometimes by aid of
quinin, to resist the parasites so that a number sufficient to cause a
paroxysm do not accumulate in the blood until after several
repetitions of the asexual cycle. In estivo-autumnal fever the regular
grouping, while usually present at first, is soon lost, thus causing
"irregular malaria."
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