PROGNOSIS 



PROGNOSIS. 



Quoad vitam the prognosis is usually good if an appropriate 

 quinine therapy is carried out, but it must be remembered that per- 

 nicious cases tend to a high mortality, notwithstanding all treat- 

 ment, and even in the usual benign cases the cure is very often 

 merely clinical and not complete, as is also seen in other protozoal 

 diseases such as syphilis, yaws, and amoebiasis. 



There are two further points to be considered under this head- 

 ing, and they are:— 



1. The probability of recovery. 



2. The probability of a cure. 



1. Probability of Recovery. — This depends upon:— 

 [a] The type of fever. 



ih) The condition of the patient with regard to race, age, sex, 

 physical fitness, the presence or absence of other diseases, idiosyn- 

 crasy to quinine, and the duration of the symptoms. 



(c) The nature of the country in which the patient is living. 



The Type of Fever. — -Quartan and tertian infections, especially 

 in the simple type, give the best prognosis, but quotidian infections 

 and fevers due to the subtertian parasite should be viewed as more 

 dangerous, while pernicious malaria must be regarded as extremely 

 dangerous. 



Race. — -The mortality among natives of bad malarial regions is 

 usually low, while that among Europeans is high. The death-rate 

 in a native race which has comparatively recently been subjected 

 to increased danger of malarial infections is sometimes truly 

 appalling. 



Sex. — -There is a better prognosis for males than for females, and 

 there is a distinctly worse prognosis for an attack taking place during 

 pregnancy. 



Age. — -Children often have more severe attacks than adults, but 

 can usually stand quinine well, which rather balances this disad- 

 vantage. 



Physical Fitness. — -Persons debilitated by long residence in 

 tropical countries or from existence upon poor food are not in a 

 condition to resist severe malarial infections, and therefore the prog- 

 nosis is rendered more serious. 



Complications. — The presence of complications in any form — 

 typhoid fever, etc. — naturally makes the outlook more serious. 



Quinine. — -Idiosyncrasy to quinine of an anaphylactic nature 

 is most serious, but can be combated by commencing with very 

 small doses, and slowly and steadily working upwards. 



Duration of the Symptoms.— If the symptoms persist in the 

 face of quinine therapy the prognosis is serious. 



2. Probability of a Cure. — The probability of a cure — that is to 

 say, of a so-called bacteriological sterilization of a patient with 

 regard to the malarial parasites — is a very doubtful matter, as the 



