634 THE ANIMAL PARASITES OF MAN 



vomiting and convulsive attacks in young children. The temperature, 

 however, is really above the normal, and continues to rise. After 

 about an hour, the shivering abates and the heat stage succeeds it. 

 The temperature rises rapidly, even to 106 F. The patient becomes 

 very flushed, the pulse is rapid, headache may be intense and the skin 

 dry and burning. This stage, that causes acute distress to the patient, 

 may last for one or often three to four hours, and then the patient 

 commences to perspire profusely, the clothing and bedding often 

 being saturated with sweat. After this, the fever rapidly declines, and 

 when the sweating ceases, the patient may feel almost well although 

 somewhat languid. The sweating stage persists from two to four 

 hours, so that the attack lasts as a rule from six to ten hours. After 

 an interval of one, two or three days, a recurrence takes place. 

 During the early part of the attack, especially at the stage of rigor, 

 there is great splenic enlargement. At first the enlargement disappears 

 in the interval, but in the case of repeated attacks the spleen tends to 

 become permanently enlarged. During malarial attacks and during 

 the intermission period, there is a great increase in the amount of 

 nitrogen excreted by the kidneys, while the excretion of iron and bile 

 in the faeces is increased. 



Stitt 1 (1914) points out that it is characteristic of malignant tertian 

 paroxysms that they set in with chilly sensations rather than a frank, 

 definite chill, and that the fever is of the remittent type. 



Plasm odium malarice and P. vivax rarely produce marked lesions 

 in the bodies of their hosts, as they sporulate in the circulating blood 

 and so do not accumulate in any one organ. On the other hand, 

 Laverania malarice (Plasmodium falciparum) multiplies within the 

 internal organs of its host, and consequently aggregates or clusters 

 of the parasites occur therein. The organ in which most sporulation 

 occurs suffers most. The liver is generally enlarged, soft and con- 

 gested. The capsule of the spleen is tense, but the splenic consistency 

 is less than normal. The bone-marrow is often dark and congested 

 in the spongy bones and brownish-red in long bones. The blood- 

 capillaries of the brain and spinal cord are often filled or blocked 

 with sporulating parasites and large quantities of pigment are found 

 in these organs. Even if the parasites are absent, the pigment is 

 present in the endothelial cells. Pigment is found in most organs of 

 the body. 



Atypical forms of malaria may occur in which some or all of 

 the symptoms are much modified. Irregular fevers also may be 

 produced by successive infections by the same parasite, or by the 

 presence of two different malarial parasites. 



1 "The Diagnostics and Treatment of Tropical Diseases." London : H. K. Lewis. 



