3o8 



2. There is a terminal infection with the 

 diplococcus pneumoniae. 



Spleen. — The trabeculae of the pulp are dis- 

 tended by infected red cells, and pigmented large 

 mononuclears are abundant. The malpighian 

 follicles, on the contrary, are non-pigmented. 



Liver. — Endothelium of capillaries is swollen 

 and pigmented. Pigment is also found in Kupfer's 

 cells. The liver cells contain only haemosiderin, 

 not melanin. Pigmentation is most intense around 

 the central veins. 



Kidneys. — Pigmentation is much less marked. 

 Changes may occur in the epithelium of the tubules, 

 independent of the presence of parasites. 



Bone Marrow. — Parasites and melanin, free, 

 and in large mononuclear, leucocytes and macro- 

 phages are found. Crescents may be found here 

 when absent or sca.nty elsewhere, as in the spleen 

 and brain ; it is consequently supposed that they 

 principally develop here. 



In cases of malaria of long standing the yellow 

 marrow becomes red. 



Stomach and Intestines. — In malaria with 

 choleraic or haemorrhagic symptoms, parasites 

 may abound in the capillaries of the villi. 



Chronic Malaria 



Spleen. — As is well known, the spleen may 

 in these cases fill the whole abdomen. Dilata- 

 tion of the various lacunae occurs with a 

 thickening of the splenic reticulum. The pigment 

 tends to become deposited eventually in the 

 connective tissue surrounding the follicles. The 

 splenic septa become thickened. 



