MALARIA 97 



PERNICIOUS SUBTERTIAN FEVER. 



This ivpe is caused by certain viscera being selected by the parasite 

 for sporiilation. The consequent symptoms have local as well as 

 general manifestations owing to that particular viscus being affected 

 not onl\- by the toxins, but because of its impaired nutrition, for the 

 capillaries may be completely blocked by parasites, red cells, swollen 

 endothelial cells, leucocytes loaded with pigment, free pigment and 

 merozoites. These fevers are accompanied by a high mortality. 

 We shall now deal with them seriatim. 

 (i) Algid Pernicious Subtertian Fever. 



The condition of collapse is marked, e.g., sharp nose, sunken 



cheeks, lips and extremities cyanotic, 

 i he pulse is small, soft, frequent. Respirations are laboured. 

 The skin is cold and clammy. 

 There is severe thirst. 

 The patient may die in a few hours. 



(2) Diaphoretic P.S.F. 



The sweating of the fourth stage is excessive, a pool of per- 

 spiration may fall on the floor beneath the bed. 

 Exhaustion and collapse may follow. 



(3) Hccmorrhagic P.S.F. 



There may be haemorrhages from the skin, mucous membrane 

 of the bronchi, intestines, stomach, or generative organs 

 during the attack, but not during the intermission. 



A grave anaemia may follow with : thready pulse, coma, delirium, 

 convulsions and death. 



This variety is rare. 



(4) Scarlatinijorm P.S.F. 



There is a diffuse scarlatiniform rash with desquamation of the 



horny layer and erythema of the fauces. 

 A typhoidal state may carry off the patient, 



(5) Cerebrospinal P.S.F. 



The symptomatic manifestations may resemble : — 

 (a) Coma. — There is a sharp onset, with weakness, sleepiness, 

 headache, disturbance of vision, stupor or delirium, 

 ending in coma. The pupils may be contracted. The 

 speech is scanning in character. There may be haemor- 

 rhages under the skin and into the retina. 



The urine and motions may be passed involuntarily. 



The heart is dilated, pulse slow, becomes quick and thready 

 before death. 



In fatal cases, the tongue becomes dry and the patient colder 

 and colder. 



