52 TROPICAL MEDICINE AND HYGIENE 



parasites are present. It is much coarser and not 

 obviously intracellular when derived from an old infec- 

 tion. In cases where haemolysis has been great, haemo- 

 siderin may be found abundantly in the. hepatic cells, in 

 cells in the convoluted tubules of the kidneys and some- 

 times in the spleen. Granules giving the reactions of 

 iron (in its inorganic combinations) may also be present. 



Large haemorrhages are exceptional, but small sub. 

 serous haemorrhages or punctate extravasations in the 

 organs such as the brain are more common. The 

 lymphatic glands are sometimes enlarged, and rarely 

 Peyer's patches. More commonly the Malpighian bodies 

 in the spleen are enlarged and, as they are not pigmented, 

 stand out boldly as white spots against the blackish 

 background of the parenchyma. 



Decomposition is not usually rapid, but the parasites 

 die shortly after the death of their host. Blackening of 

 organs from decomposition must not be mistaken for 

 malarial pigmentation. If the examination be made 

 shortly after death the spleen is always firm, but when 

 the rigor mortis of the tissues has passed off, an event 

 that occurs earlier than the disappearance of rigor mortis 

 of the voluntary muscles, it is softer and more flaccid, 

 but only becomes diffluent in the early stages of 

 putrefaction. 



Accumulations of parasites are found in the capillaries 

 in various organs; even in the same case they may be 

 found in -many organs, less commonly they may be found 

 only in the capillaries of one oYgan. 



In fatal cases the capillaries of the brain, heart, intes- 

 tines and other abdominal viscera are thus affected most 

 frequently, but in other organs, such as the lungs, the 

 capillaries may be found in the same condition. 



Whatever organ is involved is markedly congested, and 

 sometimes is of a dull slaty colour from the pigment 

 contained in the parasites or in the cells in the parenchyma. 



The spleen is always engorged and tumid, and this is 

 shown by the tense smooth capsule free from wrinkles 



