THE MALARIAL FEVERS 



blood, and the condition yields to quinine therapy by proper means. 

 The condition is rare, and must not be mistaken for true liver abscess, 

 which is not uncommon, and the error of making the diagnosis of 

 malaria in abscess of the liver is more common than vice 

 versa. 



Pseudo-Cholecystitis Type. — There is severe pain, shooting up to 

 the right shoulder, tenderness in the region of the gall-bladder, 

 severe vomiting, and occasionally slight jaundice. The spleen may 

 or may not be enlarged, and the same is true for the liver. The blood 

 usually shows subtertian parasites, and the condition, which re- 

 sembles an attack of cholecystitis due to gall-stones, is cured by 

 quinine. 



Pseudo-Cirrhosis Type. — This is rare, and is characterized by the 

 hepatic facies and ascites. After tapping, the liver and spleen may 

 be felt to be enlarged and hard. On repeated examination sub- 

 tertian parasites may be found in the blood. Quinine very slowly 

 cures the condition. 



HcBMorrh^gic Pancreatitis Type. — The attack is sudden, with 

 violent pain in the epigastrium, followed by vomiting and collapse. 

 Tenderness and tympanites may be present in the epigastrium. 

 Blood examination reveals subtertian parasites, and quinine effects 

 a cure. 



Pseudo-Peritonitic Type. — This is characterized by fever, pinched 

 face, vomiting, pain and tenderness all over the abdomen. Malarial 

 parasites are found in the blood, and quinine cures the condition. 



Gastritis Type. — This is characterized by acute or by chronic 

 indigestion, yielding to quinine treatment: In old people, especially 

 when anaemia is present, cancer may be suspected. 



in. With ' Respiratory System ' Localization. 



It will be remembered that during the ordinary attack of any 

 malarial fever there are a few dry, rather coarse, rales to be heard 

 when the temperature begins to fall, and earher, at the beginning of 

 the attack, there are often — as first noted by Castellani^ — very 

 minute crepitations at the base, probably of pleural origin, which 

 generally disappear when the temperature has reached its highest 

 point. They both speedily disappear, but every now and then, 

 even in ordinary attacks, they are more pronounced, and the 

 patient suffers from cough or pain on taking a deep breath. 



Slight as these usually are, they nevertheless are the basis of the 

 respiratory system types of pernicious malaria, which may be 

 classified as follows: — 



1. Pseudo-bronchitic type. 



2. Pseudo-pneumonic type. 



3. Pseudo-pleuritic type. 



Pseudo-Bronchitic Type. — This subacute or chronic dry bronchitis, 

 with little or no fever, is cured by a few doses of quinine. 



