MALARIA 83 



Peru, Chili, many of the Southern States of Xorth America, Russia, 

 Italy, Greece, Turkey, Austria-Hungary, Southern France, even 

 amongst the soldiers of the present War. In Switzerland, along the 

 Rhine in Germany. Some parts of Sweden. 



For malarial epidemics there must be malarial parasites, carrying 

 mosquitoes, man, heat and moisture. 



High altitudes and strong winds diminish its prevalence. 



Malaria does not exist in : — 



The Seychelles, Indian Ocean, Fiji, Society and Friendly Islands, 

 Southern Pacific, Barbados and St. Helena in the Atlantic. 



Where malaria is prevalent children tend to become immune about 

 the twelfth year (Ross). 



PATHOLOGY. 



The febrile phenomena are explained b}- various malarial 

 products : — 



(i) Toxins that act on the heart controlling centre. 



(2) Haemolytic toxins. 



(3) Toxins acting on the innervation. 



Blood serum taken before a rigor and passed through a Berkefeld 

 filter will, when injected into a healthy man, cause a febrile paroxysm 

 resembling malaria (Daniels). 



The heat output during the cold stage of an attack is diminished, 

 but the causative metabolic changes are but little known. 



The urine is increased during this stage, probably due to the con- 

 traction of cutaneous vessels and increased B.P. internally. The 

 specific gravity is raised as a result of the increased metabolism caused 

 by the toxins. The colour is dark and the acidity increased. Nitrogen 

 is in excess owing to urea. The salts are all increased, except 

 phosphates, which are diminished during an attack, and increased 

 during the intermission, therefore phosphoric acid is retained during 

 the attack. The excretion of iron is increased in the h^mozoin and 

 hasmosiderin. The increase commences just after the attack. 



There may be a considerable quantity of urobilin excreted, and the 

 indigo blue may be increased. To test for urobilin : — 



Add to urine equal parts of ZnSo4 solution (ZnSo4 10, absolute 

 alcohol, 90). Shake the mixture. Add a few drops of lugol, stir and 

 filter. Fluorescence equals urobilin. 



The diazo reaction is present in 5*5 per cent, of cases. 



During the intermission the quantity of urine is diminished, but the 

 nitrogen keeps up. 



During convalescence there is polyuria with low specific gravity, 

 especially in subtertian cases. 



