MORBID ANATOMY 



1223 



degenerative changes such as polychromatophilia and basophilia, 

 while megaloblasts and normoblasts are present. Malarial parasites 

 or pigment may be seen. During the fever there is marked leuco- 

 cytosis, with polymorphonuclear and mononuclear increase, but 

 when the fever disappears there is leucopenia, with a mononuclear 

 increase. 



The Urine. — ^The urine is dark red to brownish-yellow in colour, 

 becoming sometimes black, like stout, the reddish tinge not being 

 seen until it is diluted, when it shows with the spectroscope the ab- 

 sorption bands of oxy- or methaemoglobin — ^the latter only if the 

 urine has stood some time. The reaction is faintly alkaline, and 

 the specific gravity is often less than normal. A considerable 

 amount of sediment falls when the urine is left to stand. This 

 sediment is composed of dark brown granular material, which is 

 the debris of the broken-down red cells, very few of which remain 

 intact. Haematoidin crystals are sometimes met with. On boiling 

 the urine, and then allowing it to stand for some time, a bright 

 purple colour develops (Plehn's reaction). If some of the urine is 

 made alkaline with potash and then boiled, a purple colour, due to 

 haemochromogen, is produced (Stephens and Christophers' reaction). 

 The urine resists decomposition for some time. 



The presence of urobilin can be detected by acidulating with a 

 little acetic acid, extracting with amyl alcohol, and examining with 

 a spectroscope, when a broad band to the red side of F will be 

 seen. Bile pigments are seldom present, and may be recognized 

 by Gmelin's or Marechal's reactions. There is a considerable 

 amount of albumen present in the form of serum albumen, serum 

 globulin, and nucleo-albumen. Phosphates are said to be diminished. 

 The hsemosozic value is higher than that of the red corpuslces of 

 the blood. 



Symptomatology. — ^Usually the patient has resided six months or 

 longer in one of the regions mentioned above, and naturally has had 

 attacks of malarial fever, and has taken quinine. 



Prodromata. — ^Prodromata may be almost entirely absent, but 

 usually the patient complains of lassitude, pains all over the body, 

 loss of appetite, restlessness at night, and an entire lack of energy 

 during the day, and a yellowish tinge may be noted in the con- 

 junctivae or skin for a day or so. 



Attack. — ^Suddenly the patient feels chilly, and shivering fits may 

 occur, accompanied by headache, severe pains in the back and 

 legs, and an intense feeling of weakness and nausea, which, as a 

 rule, quickly ends in retching and then vomiting, first of food, and 

 then of green bile. The tongue is coated with a dirty-yellowish fur, 

 and there is much thirst and constipation, the faeces at first being 

 dark-coloured, and often scybalous. 



The liver and spleen are enlarged and tender; the skin is hot and 

 dry, and if not already tinged yellow, rapidly becomes so, deepening 

 in tint as time goes on. It is said that itching is sometimes felt, 

 but we have never noted this. The conjunctivae are tinged yellow. 



