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THE MALARIAL FEVERS 



PERNICIOUS MALARIA. 



When any of the above-mentioned syndromes caused by the 

 suhtertian parasite become serious, and threaten to endanger the 

 life of the patient, they are called ' pernicious malaria,' which is 

 therefore commonly caused by Laverania malarice. 



More rarely pernicious malaria may be due to the quartan or 

 tertian parasites being present in enormous numbers in the blood, 

 when the syndrome usually produced is without localization and 

 most frequently of the comatose type. 



CHRONIC MALARIA. 



Chronic malaria may result from infection by any of the three 

 malarial parasites, but is usually caused by Laverania malarice, the 

 subtertian parasite. 



The symptoms of chronic malaria are repeated attacks of slight 

 fever, which may pass unnoticed; enlargement of spleen and liver; 

 and pigmentation of the skin and mucosae. This pigmentation is 

 particularly to be noted in the tongue in dark races, while in white 

 races Gerhardt's urobilin icterus may be seen in the skin. Other 

 symptoms are oedema about the feet, associated with ansemia, 

 which may be marked; the presence of malarial parasites in the 

 peripheral blood during an attack of fever; and often palpitation 

 and dizziness, bronchitis and digestive troubles, and a general 

 disinclination for exertion and work. The urine shows an increase 

 of urea and urobilin. If this state of affairs is allowed to continue, 

 it may pass into malarial cachexia with enormous enlargement of 

 the spleen, which is firm to the touch and not tender or painful, 

 associated with a profound secondary anaemia, and great reduction 

 of red cells and haemoglobin, with increase of mononuclear leuco- 

 cytes. In boys and girls the onset of puberty may be arrested 

 (malarial infantilism) . 



In malarial cachexia the apyrexial intervals are long, during 

 which search may in vain be made for the parasite in the peripheral 

 blood, but it is usually found during the febrile attacks, which 

 may be quite mild. This is a condition, however, in which blood 

 examination does not help the diagnosis as it does in other forms 

 of malaria, and the clinical symptoms require to be studied, for 

 .the disease resembles kala-azar, while it may also be mistaken for 

 ankylostomiasis. 



Chronic malaria, of course, is due to insufficient treatment of the 

 acute disease by quinine. 



MALARIAL RELAPSES. 



The cure of an attack of malaria, unfortunately, does not end 

 the disease, for relapses are the rule and not the exception; in fact, 

 using an expression of Mannaberg's, ' Malaria is one of those infec- 

 tious diseases in which a relapse may be considered as an essential 



