THE MALARIAL FEVERS 



COMPLICATIONS. 



Many other diseases may occur in the human body at the same 

 time as an attack of malaria ; but of all, the most important are 

 typhoid, dysentery, pneumonia, and nephritis. 



Typhoid as a complication is, of course, due to the Bacillus 

 typhosus occurring in a person who is also infected by malarial 

 parasites, and in that sense, therefore, the old term ' typho-malaria ' 

 is correct. 



Dysentery may be a complication due to the Loeschia histolytica 

 or to the dysenteric bacilli, but it may also be directly caused by 

 the malarial parasite alone (p. 1177). 



As to whether there is or is not a malarial pneumonia is a vexed 

 question; personally, we are of the opinion that a severe subtertian 

 fever may produce symptoms resembling a pneumonia, but that 

 true lobar pneumonia, when present in a malarial subject, is due to 

 the pneumococcus, and is therefore a complication. 



Nephritis may be found in tertian and subtertian fevers, being 

 directly due to the irritation of the kidney by the malarial toxins. 



SEQUELAE. 



Many so-called sequelae have already been described under 

 Atypical Subtertian Fevers (see p. 1168). The possible sequelae of 

 malaria are very numerous, and maybe classified into those belong- 

 ing to the nervous system and sense organs, the blood, the liver, 

 and the spleen. 



The subtertian parasite may leave severe traces of its action upon 

 the brain after pernicious attacks, and, indeed, the mind may never 

 regain its old condition. Apart from the milder alterations of 

 disposition and character, actual insanity in the form of mania or 

 melancholia may result. 



Neuritis in some form is sometimes of malarial origin, but it is 

 quite possible that alcoholic and arsenical poisoning, and, indeed, 

 beri-beri, may have been confused with it. We have seen cases of 

 polyneuritis of malarial origin, but the condition is rare. Neuralgias 

 have already been mentioned, and are probably in some cases due to 

 the direct influence of the malarial toxins. Tinnitus aurium, vertigo, 

 deafness, anosmia, and loss of taste, are said in some cases to be 

 malarial in origin. 



Severe and long-continued ancBWiia may result as a consequence 

 of malaria caused by the subtertian, and much more rarely by the 

 other parasites. The classification and characters of these anaemias 

 have already been given in the section on Pathology, to which 

 reference should be made (pp. 1144 and 1151). 



Cirrhosis of the liver of malarial origin is, in our experience, much 

 less frequent than admitted by many writers. Cirrhosis of the liver 

 is common in the tropics, and in certain cases is due to alcohol; but 

 one of the writers has pointed out that, at all events in Ceylon, a 



