ii8o 



THE MALARIAL FEVERS 



V. With ' Ductless Glands ' Localization. 



The types with which we are acquainted are those concerning the 

 suprarenal capsules — viz., suprarenal haemorrhage and the pseudo- 

 Addison type, and those affecting the thyroid gland. 



Suprarenal HcBmorrhage Type. — The sign and symptoms are those 

 of acute peritonitis, but though the blood shows no malaria para- 

 sites, it equally shows no signs of polymorphonuclear leucocytosis. 

 There is no enlargement of the spleen. Quinine should be adminis- 

 tered, and the blood again and again examined for parasites. So 

 far the cases have ended fatally as far as we know. 



Pseudo-Addison Type. — There is a pigmentation of the skin 

 associated with great loss of flesh and severe asthenia, with or 

 without splenic enlargement, with or without fever, with or without 

 parasites in the blood, but benefited by quinine. 



Thyroid Type. — Intermittent and slight swelling of the thyroid 

 gland has been observed in cases of malaria. 



VL With 'Urogenital' Localization. 



Subtertian malaria with genito-urinary symptoms may be 

 classified into: — 



1. Orchitic type. 



2. Ovaritis type. 



3. Priapism type. 



4. Functional generative changes. 



5. Nephritic type. 



6. Polyuric type. 



7. Malarial haemoglobinuria. 



Orchiiic Type.- — ^Sudden severe pain in the testicles in a person 

 who may never previously have suffered from typical malarial 

 fever. The testicles become shghtly swollen and very tender. 

 There is no effusion. The temperature rises and the patient feels 

 very ill, but the symptoms may be intermittent. A blood examina- 

 tion reveals malarial parasites, and quinine cures the condition. 



Ovaritis Type. — Neuralgia of the ovaries is met with at times as a 

 malarial symptom. 



Priapism Type. — This is rare and is not influenced by the ordinary 

 drugs, but is cured by large doses of quinine. 



Functional Generative Changes. — Impotence, amenorrhoea, and 

 metrorrhagia have been assigned to malaria. 



Nephritic Type. — A type of malarial nephritis has been described. 



Polyuric Type. — After one or two days of malarial fever, due to 

 the subtertian parasites, a patient may begin and continue to pass 

 enormous quantities of urine, which may cause considerable alarm. 

 Energetic quinine therapy will stop this excessive flow. 



Malarial HcBmoglobinuria. — This will be considered in Chap- 

 ter XLL, p. 12 1 3. 



Malarial mastitis has .been recorded. Quarelli has described a case of 

 malarial chyluria. 



