ATYPICAL SUBTERTIAN FEVERS 



1179 



Pseudo-Pneumonic Type.' — This is of ten of the nature of a 

 broncho-pneumonia, and is accompanied with blood expectoration, 

 in the red corpuscles of which parasites may be seen, dyspnoea, and 

 cough. The symptoms are better in the remission of the fever, and 

 worse during the attack. The blood is full of parasites. In many 

 cases broncho-pneumonia in malarial patients is not due directly 

 to the malarial parasites, but is a complication due to the pneumo- 

 coccus. 



Pseudo-Pleuritic Type. — Intermittent pleuritic pernicious fever 

 has been described, with sharp pricking pain, dry cough, and 

 friction sounds, which improve in the remission, and become worse 

 again in the attack. 



Pleurisy of malarial origin is without effusion. 



TV. With ' Circulatory System ' Localization. 



Atypical subtertian malaria with circulatory system symptoms 

 may be classified into: — 



1. Pseudo-anginal type. 



2. Endarteritis type. 



3. Intermittent claudication type. 



4. Erythromelalgia type. 



Pseudo- Anginal Type. — The right heart has been noticed to be 

 enlarged in attacks of malarial fever, and sometimes these symptoms 

 become marked, with severe pain in the cardiac region of an anginal 

 nature, sometimes accompanied by vomiting of blood, a development 

 of the algide condition mentioned above, and death. 



Sometimes the anginal syndrome is very marked, but the con- 

 dition is amenable to treatment by quinine. 



Pseudo -Endarteritis Type. — A superficial artery may swell, become 

 hard and knotty to the touch, and extremely painful. There is 

 no fever, and the blood examination may be negative, but the 

 condition yields to quinine. 



At other times dry gangrene may be the only sign of an endar- 

 teritis of a deeper and more important vessel. Search should be 

 . made for malarial parasites, and if there is any reason to suspect 

 malaria as a possibility, quinine should be administered. 



Intermittent Claudication Type. — From time to time the patient 

 is unable to put his foot to the ground, because he feels pain in the 

 calf of the leg and there may be an absence of pulse in the dorsalis 

 pedis artery or in the posterior tibial. Quinine cures the condition. 



Erythromelalgia Type. — The hands, and at times the feet as well, 

 become flushed, and the patient complains of pain and tingling 

 in the fingers and at times the toes also. Quinine is the correct 

 treatment. 



Heart Block. — This may be due to malarial parasites. 



Raver Forms.— Certain authors admit endocarditis as being of malarial 

 origin. 



