MALARIAL CACHEXIA 65 



If premature birth occurs, the child is frequently still- 

 born. If born alive it is not infected with the malarial 

 parasites at birth in the great majority of cases, but 

 exceptions occur, and even in England the child of a 

 person suffering from malaria, though born in England, 

 may be found to have malaria, which must have been 

 acquired from the mother. 



A patient who has had blackwater fever must be given 

 quinine very cautiously. Unless there is danger to life, the 

 doses must be very small, commencing with | gr.and gradu- 

 ally increased till the minimum effective dose is reached. 



Malarial Cachexia. The term has been and is much 

 abused and used to cover many mistakes in diagnosis. 

 Conditions such as kala-azar, ankylostomiasis, chronic 

 dyspepsia and its results are so frequently mistaken for it 

 that some authorities are tempted to abandon the term. 



A real cachexia does follow repeated attacks of malaria, 

 and is still more marked in the chronic malarial condition 

 where parasites are present in small numbers in the 

 blood, but are rarely sufficiently numerous to cause sharp 

 febrile attacks, and may not cause any rise of temperature 

 at all. The condition does not necessarily occur in all 

 cases of chronic malaria, badly or irregularly treated, 

 or even if not treated at all, and there are many degrees 

 of it and varying complications. 



The usual condition is one of anaemia with some dis- 

 coloration of the skin and associated with an obviously 

 enlarged spleen and sometimes liver. 



The anaemia may be very marked and the red corpuscles 

 reduced to 2,000,000 per cubic millimetre. Such cases 

 are not common ; more frequently the reduction in the 

 number of corpuscles is moderate, say to three and 

 a half or four and a half millions, but many of the 

 corpuscles show signs of degeneration polychromatic 

 corpuscles, corpuscles with basophilic granules, poikilo- 

 cytes and great variation in size and colour of the 

 individual corpuscles (Plate II., i to 9). The average 

 haemoglobin value of the corpuscles is usually maintained. 



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