66 TROPICAL MEDICINE AND HYGIENE 



As the bronzing of the skin often masks the anaemia, 

 the conjunctival and mucous surfaces must be examined 

 or the anaemia may be overlooked. The spleen if 

 enlarged is hard, and as a rule slightly tender on deep 

 pressure. It may be painful. The degree of enlarge- 

 ment does not correspond to the anaemia. The liver 

 is enlarged in some cases and tender. This tender- 

 ness may be so extreme as to give rise to suspicion of 

 hepatic abscess. Associated with these conditions are 

 anorexia, dyspepsia and muscular weakness. Insomnia, 

 mental depression and neuralgias are common concomi- 

 tants and may be the most prominent symptoms. In the 

 more advanced cases there is oedema of the legs and 

 rarely albuminuria, though in persons suffering from any 

 form of Bright's disease the symptoms of that disease will 

 be aggravated. 



Any latent disease present is likely to recur or be 

 aggravated, and this is specially the case with syphilis. 



Amongst the rarer complications are various ocular 

 disturbances. Optic atrophy or retinitis may occur, and 

 various forms of conjunctivitis. The possibility of a 

 malarial complication must always be considered in any 

 ocular disturbances in the Tropics. Diagnosis may be 

 very difficult. Careful blood examination will often 

 enable the diagnosis to be made. Prolonged examina- 

 tion may reveal the presence of an occasional malarial 

 parasite, sometimes of a crescent, sometimes of a ring 

 form. Failing this, the differential count may show a 

 relative increase in the large mononuclear leucocytes, 

 and if this be not present it is improbable that the case 

 is one of malaria. 



In cases of doubt the patient should be kept in bed, 

 alimentary disturbances attended to, and quinine given 

 in moderate amounts, either by intramuscular injection 

 of 10 gr. on alternate days, or in solution by the mouth, 

 5 gr. three times a day. Food should be light and 

 nutritious, and in a case of malarial cachexia rapid im- 

 provement will take place. When convalesence has 



