SUBTERTIAN MALARIAL FEVER 45 



If untreated and the patient recovers, the attack usually 

 recurs, and is then fatal ; very rarely does he survive two 

 attacks at short intervals without antimalarial treatment. 



In children the onset is less gradual ; usually the first 

 thing noticed is a convulsion. When this has occurred 

 other convulsions rapidly follow, the child remains coma- 

 tose between the convulsions, and death occurs in four 

 to twelve hours from the first attack. 



Even when the convulsions have continued for two or 

 three hours, recovery is the rule with energetic treatment, 

 and is complete. 



Such convulsions are the usual evidence of cerebral 

 malaria up to the fifth year of life. After this period 

 coma without convulsions begins to be more common, 

 and after the tenth year convulsions are highly excep- 

 tional. In these cerebral cases the temperature may be 

 little raised, or temperature up to 105 F. may be noted. 

 They are not associated with hyperpyrexia. 



(2) The lungs may be a preferential site, and there is 

 increased rapidity of breathing. Provided that the con- 

 dition of the heart and lungs is sound there is compara- 

 tively little danger. The congestion of the lungs induced, 

 though it may give rise to suspicion of pneumonia, does 

 not seem to be serious in itself. In any condition of 

 cardiac disease, or in pulmonary conditions such as 

 emphysema and bronchitis, the danger is greater, as the 

 effect of such diseases is aggravated. In cases of tuber- 

 culosis there is often haemoptysis. 



(3) If the abdominal viscera, and particularly the 

 intestinal capillaries, are blocked, the congestion induced 

 may lead to a condition of collapse the algide form of 

 malaria. In such cases the congestion of a part or the 

 whole of the intestinal wall may be sufficient for haemor- 

 rhage to take place into the lumen of the alimentary 

 canal, and haematemesis, melaena, or haemorrhage from 

 the rectum may result, according to the portion of the 

 alimentary canal involved. Occasionally, with or without 

 such haemorrhage, the nutrition of the superficial layers 



