44 TROPICAL MEDICINE AND HYGIENE 



Children are said by some- to suffer little or not at all,, 

 and there is a certain amount of truth in this as they 

 may, whilst harbouring the parasites, be capable of 

 playing about and taking interest in their surroundings. 

 Careful inquiry, however, will usually show that during 

 a great part of the day they are listless, do not take food, 

 or otherwise show signs of ill-health. They have usually 

 a definite enlargement of the spleen. 



Labial herpes is common in malaria, but as a rule does 

 not occur till late in the attack, and frequently occurs 

 when the fever begins to subside. 



The great peculiarity of subtertian fever is the liability, 

 with little or no warning, to the so-called pernicious 

 manifestations. These are in the main due to blood 

 stasis in different organs of the body, caused by the 

 numbers of red corpuscles containing the parasites ad- 

 hering to the walls of the capillaries and to each other, 

 and so obstructing the circulation in that organ. This 

 may occur in any organ, and the effects and clinical 

 manifestations vary accordingly. 



(i) When stasis of the blood occurs in the capillaries 

 of the central nervous system the danger is great, and a 

 large number of deaths are due to this condition. The 

 symptoms vary in adults and in children. 



In adults the patient usually has a flushed face and 

 appears to be dull and stupid with slow speech and 

 uncertain gait. In appearance and demeanour he is not 

 unlike a man in the early stages of intoxication. This 

 stupor may pass off in mild cases, but in others rapidly 

 increases, and a condition of coma supervenes. There 

 are no convulsions in the great majority of cases and no 

 localizing symptoms. In a fatal case the coma deepens, 

 the breathing becomes stertorous and the conjunctivas 

 insensitive. Even at this stage recovery may occur with 

 energetic treatment, or rarely even without it. Recovery 

 when it occurs is rapid and complete, the patient in 

 twenty-four hours may appear to be in fair health. 

 There is no more striking instance of the effects of 

 vigorous treatment than in a case of this kind. 



