030 ACUTE INFECTIOUS DISEASES. 



size of the spleen, we have concluded that the great pallor of the 

 patients after the first attacks of intermittent does not solely, and, at all 

 events, does not exclusively, depend on general impoverishment of the 

 blood, but mostly on the lack of blood in the skin, which must be induced 

 by its collection in the spleen. While Junod's boot is applied to one 

 extremity, there is great hyperaemia of that limb, and consequent 

 anaemia of the rest of the body ; if the boot be removed, the normal 

 distribution of blood is soon reestablished. We do not, however, 

 mean to say that the fever of intermittent differs from other fevers in 

 regard to the consumption of the body ; on the contrary, intermittent 

 fever would be one of the most dangerous of diseases, if those inex- 

 plicable pauses did not occur between the paroxysms, during which 

 the consumption is interrupted, and the tissues of the body restored 

 by plentiful supply of nourishment, more than in any other feverish 

 disease. From the high temperature (106 Fahr. or more), reached in 

 intermittent fever, the consumption of the body is very marked. This 

 is evident, not only from the increased production of urea, but also 

 from the emaciation and hydraemia that occur in protracted cases. 

 There is no doubt that the production of urea is only increased during 

 the paroxysm, and not during the apyrexia ; on the other hand, in two 

 cases of quartan intermittent, I found that the excretion of urea was 

 increased during the apyrexia also, or, in other words, that the in- 

 creased amount of urea produced during the paroxysm was not all ex- 

 creted till some time during the following apyrexia. If the paroxysms 

 be not temporarily or permanently arrested by the administration of 

 quinine, or if they do not soon cease spontaneously, the hydrsemia at 

 length becomes so excessive, that in many cases more or less dropsy oc- 

 curs, without the urine being diminished in quantity, or containing albu- 

 men. This dropsy is analogous to those occurring during other exhaust- 

 ing diseases, although it is probable that the organic and functional 

 disturbances of the spleen accompanying protracted intermittent fever 

 add to the degree of hydrsemia, and to the frequency of the dropsy. The 

 longer the affection lasts, the more reason there is to fear the devel- 

 opment of permanent organic change in the spleen, liver, or kidneys 

 this usually assumes the form of lardaceous degeneration, with coinci 

 dent deposit of pigment, and leads to incurable disease. Continued 

 intermittent fever often induces chronic parenchymatous nephritis also, 

 and, in other cases, a haemorrhagic diathesis. These severe sequelae 

 of simple intermittent fever are generally prevented by proper treat- 

 ment ; and, even where intense malaria is endemic, under careful man- 

 agement, excessive dropsy, fatty degeneration of the abdominal or- 

 gans, and cachexia, rarely occur. It is true, neither quinine, nor any 

 other known remedy is so certain an antidote for malarial poison ag 



