48 TROPICAL MEDICINE AND HYGIENE 



follow an acute cerebro-spinal attack. Neuralgia is often 

 attributed to malaria, and migraine has been ascribed 

 to the same cause, but there is little evidence that there 

 is any connection between these diseases and malaria. 

 Attacks not unlike " petit mal " may occur with malaria, 

 and may recur as long as the malarial infection persists, 

 but they are rare. 



Repeated congestion may be in part the cause of the 

 chronic enlargement of the spleen, of some of the fibrotic 

 changes in the liver and other organs, and of the tendency 

 of pregnant women to abort, but the influence of toxins 

 in inducing these conditions cannot be excluded. 



(6) The mechanical effects due to the temporary blood 

 stasis caused by the capillaries of one or two or more 

 organs being partially blocked by corpuscles containing 

 parasites will lead to congestion of those organs and to an 

 inadequate supply of freshly oxygenated blood. Waste 

 products also are not removed sufficiently rapidly, and, it 

 has been pointed out that the interference with the cir- 

 culation will result in a local accumulation of the malarial 

 toxin. Cerebral or other local symptoms are mainly a 

 combination of the effects in each organ, but in such 

 cases extra work is always thrown on the heart, and 

 cardiac failure may be the result. The immediate effects 

 of this condition have been considered ; they constitute 

 the main danger to life in this disease. Sequelae of the 

 condition are not so common, though even temporary 

 impairment of the nutrition of certain parts of the body, 

 rendering the tissues more vulnerable, may lead to chronic 

 changes. The frequency with which tuberculosis in the 

 West Indies dates from attacks of malarial fever may be 

 taken as an instance. The blood changes, according to 

 Newham, do not as a rule affect the opsonic index, and 

 therefore do not, in themselves, render the person more 

 susceptible to bacterial diseases. 



In subtertian malaria, as in other forms of malaria, 

 the effects of toxins must be considered as well as 

 the effects of the blood stasis this only peculiar to 



