SEQUELS 



polyfibrosis of liver, pancreas, and kidney can be met with which 

 has no malarial origin. 



The enlargement of the spleen has already been described, and 

 rupture as the result of blows or injuries is by no means unknown, 

 though not common, and requires prompt surgical attention. We 

 have only come across one case in our experience. 



Tremors are not infrequently seen in chronic malaria, though 

 more rare in acute malaria. Fine tremors, consisting of bilateral 

 fine oscillations of small amplitude, caused by the alternate action 

 of antagonistic muscles, may occur in the limbs and more rarely 

 in the head. They are most common in the upper limbs, and 

 especially in the hands. In the head there may be nystagmus or 

 the tongue may be implicated. These tremors are increased by 

 effort, fatigue, or emotion. Coarse tremors are usually exaggerations 

 of fine tremors, and are often due to emotion, such as examination 

 by the physician. Intentional tremors are produced in the hands, 

 and sometimes in the head and neck, and are due to voluntary 

 movement. They are not very uncommon in malarial infections. 



The fine tremors must be distinguished from the fine tremors 

 due to quinine, which are not very rare when the drug has been 

 given for long periods. These tremors disappear in days, weeks, 

 or months after the drug has been discontinued. 



In malarial patients coming from war zones tremors and ataxic 

 movements are not rarely seen, but these tremors are neither 

 due to malaria nor to quinine, being of hysterical origin {sens^ 

 lato), and disappear often after treatment by suggestion. 



DIAGNOSIS. 



The diagnosis of malaria may be simplicity itself, or, on the other 

 hand, it may be most difficult, as there is practically no sign or 

 symptom of disease of the human body which it cannot mimic. We 

 venture to impress upon the reader the vital necessity of making 

 a thorough and careful clinical examination, as in many cases this 

 alone may be the key to a correct diagnosis. 



The positive signs of malarial infections are: — 



1. Tertian or quartan periodicity, no matter what the symptoms 

 may be. 



2. Tertian, quartan, or subtertian parasites present in the peri- 

 pheral blood. 



3. Pigment in the leucocytes. 



4. Quinine, properly administered, producing beneficial effect 

 upon the symptoms. 



The complementary signs suggesting malarial infections are: — 



1. Spleen enlarged and hard, no matter what the symptoms may 

 be. 



2. Slightly enlarged and tender spleen in cases exhibiting syndromes 

 usually significant of another disease, if the usual tests for the causal 

 agent of the other disease are negative. 



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