PATHOLOGICAL ANATOMY IN MALARIAL FEVER 51 



Prognosis is good, but energetic treatment may be 

 required, and relapses will generally occur unless the 

 treatment be prolonged for months after the last onset 

 of a febrile attack. When pernicious symptoms super- 

 vene there is great danger, and, unless these can be 

 speedily controlled, death will occur. If. the recognition 

 of the nature of the disease is made early the patient will 

 usually be saved. 



The case mortality among hospital patients is small 

 where the diagnosis is made accurately, and also in 

 private, but the number of deaths due to malaria un- 

 treated or inefficiently treated is large, but impossible 

 to calculate. The high mortality in the Tropics, India, 

 Africa, &c., is largely attributable to fever, both amongst 

 Europeans and natives, and is the main cause of the 

 high infantile mortality from convulsions. 



The prognosis is much less favourable when malaria 

 occurs in persons suffering from other diseases. Organic 

 cardiac disease, and diseases such as beri-beri or chronic 

 alcoholism, which affect the innervation of the heart, 

 render the prognosis less favourable. When there is 

 atheroma of the cerebral vessels, fatal cerebral haemor- 

 rhage may occur. Syphilis in a person with malaria 

 will not yield to antisyphilttic treatment till the malaria 

 is treated. 



Pathological Anatomy. The general appearances may 

 be inferred from the symptoms. In an acute case there 

 is always congestion of some of the organs, and in those 

 in which blood stasis has occurred this may be extreme. 

 Parasites will be found in the cells in the capillaries or, 

 if the examination is too long after death, pigment from 

 the breaking down of these parasites. Cloudy swelling 

 of the cells of the liver and kidneys is usually present. 



The special changes consist of the deposits of malarial 

 pigment in the connective tissue cells of the liver and in. 

 the parenchymatous cells of the spleen. 



This pigment is fine and intracellular when derived 

 from recent malarial infection, and intravascular when 



