88 DISEASES DUE TO PROTOZOA 



sites. Nissl's bodies may be damaged and disappear or degenerate 

 only. There may be degeneration of the neurofibrils. The puncti- 

 form haemorrhages are due to the diapedesis of apparently normal 

 red cells. 



(4) In the chronic malaria of P. vivax. 



(There are no records of post-mortem findings in chronic malaria 

 due to P. malarise.) 



Those of P. vivax are ; — 



Enlarged spleen, which is firm, dark, containing parasites and 

 pigment in the endothelial cells about the Malpighian bodies. Some 

 haemosiderin. 



The liver revealed nothing macroscopical, but microscopically pig- 

 ment could be seen collected in the large intracellular masses in the 

 portal canals. The macrophages contained pigment. 



The bone-marrow was slightly pigmented, showing a few endo- 

 thelial cells with black pigment. 



In one case (Ewing) the patient was ill for twelve months, and died 

 from endocarditis three months after the last malarial attack. 



(5) In chronic malaria due to L. malarice. 



The spleen, liver and bone-marrow are the parts always affected. 



Spleen, enlarged, firm, slaty colour, depending upon the amount 

 of contained pigment, signs of old perisplenitis, e.g., thickened cap- 

 sule; Malpighian bodies stand out boldly, as they are enlarged and 

 non-pigmented. 



The capillaries are dilated, and are separated by splenic pulp or 

 connective tissue containing giant cells. 



The pigment may be scattered diffusely, but is generally collected 

 around follicles or extracellular, and contained in lymphatics of 

 arterioles or septa. 



Liver, large, hard, pigment not always present, seen at times 

 gathered around the periphery of lobules; later the pigment is peri- 

 vascular and finally disappears. The capillaries or lymph spaces are 

 dilated, and by their pressure cause atrophy of the liver cells; the 

 hepatic cells may be seen repairing the damage done. 



Bone marrow, usually pigmented and of a chocolate colour in the 

 small bones, reddish in the long ones. The change of colour is due 

 to replacement of the fat by vascular tissue. 



(6) In malarial cachexia. 



It may follow a few acute attacks, or more commonly coma as a 

 sequel to chronic malaria. 



Anemia is marked. Oedema of the ankles and abdomen frequent. 

 The spleen is enormously enlarged, the liver also. 

 The bone-marrow is yellow, sclerotic or gelatinous. 



