MALARIA 89 



Parasites may be found or may be absent. 



Sometimes there are amyloid changes in the kidneys with parenchy- 

 matous nephritis, associated more rarely with amyloid changes in the 

 intestine, spleen and liver. 



SYMPTOMATOLOGY. 



A typical febrile malarial attack. 



In all types of malarial fever there are definite attacks every twenty- 

 four, forty-eight, or seventy-two hours. Each attack has four stages, 

 followed by an interval of apyrexia. 



(i) Premonitory stage. 



This is sometimes absent. 



When present it lasts from a few hours to a few days. 



There are : Lassitude, aching of bones, headache, anorexia, yawn- 

 ing, sometimes vomiting. 



Two-thirds of actual agues take place between midnight and mid- 

 day, most other febrile diseases from midday to midnight (Manson). 



(2) Cold stage. 



This lasts about an hour. 



Teeth chatter, patient shivers and shakes from head to foot. 

 Wraps himself in blankets to keep himself warm. 

 Vomiting may be distressing. 



The features are drawn and the skin blue, but the body temperature 

 may be several degrees above normal and rapidly rising. 



The urine is abundant and passed frequently. Urea is increased 

 Young children may have convulsions. 

 Then follows the — 



(3) Hot stage. 



This lasts four hours. 



There are waves of warmth, intense heat. 



Blankets are thrown off; there is a desire for more air. 



The face is flushed, pulse rapid, full and bounding. 



Headache intense, vomiting frequent, respirations hurried. 



Conjunctivae injected, sometimes erythematous rash. 



Skin dry and burning. Body temperature 40'6° C. — 41 '0° C. 

 (104O— 106° F.). 



Urine scanty, loaded with urea and chlorides. Phosphates 

 diminished. 



Bile pigment present in urine. 



Then follows the — 



(4) Sweating stage. 



This last from two to four hours. 



There is profuse perspiration, clothes and bedding are soaked. 



