II50 



THE MALARIAL FEVERS 



As every sporulation causes the destruction of red cells, anaemia 

 is one of the marked features of malaria. This destruction takes 

 place at each paroxysm, and though in quartan and tertian fever it 

 may be slight, in subtertian fever it is apt to be considerable. 



After a certain number of attacks of fever the loss becomes much 

 less than in the earlier seizures. 



When the fever is intermittent, regeneration takes place quickly, 

 so that before the next paroxysm the normal number of erythrocytes 

 may be nearly reached; but even in quartan and tertian fevers, if 

 long-continued, anaemia will result. 



The histological changes in the unaffected corpuscles are pallor 

 and poikilocytosis, with demi-lune and crescentic forms, and in 

 severe cases megaloblasts, with polychromatophilia and basic 

 granular degeneration, together with normoblasts, may be noted. 

 The tonicity of the corpuscles is increased after a number of attacks, 

 according to Viola. In the blood of malarial 

 cachectics the brothers Sergent have described 

 basophile formations having the shape of a 

 figure 8, with a double contour, and Brumpt 

 and others have described basophile rings with 

 a single contour. Laveran considers these 

 appearances to be due to artefacts. 



Leucocytes.— The leucocytes are at first 

 increased during the paroxysm, and then 

 markedly diminished, so that a leucopenia is 



Blood characteristic of the simple malarial fevers. 



Film showing The normal ratio of white to red corpuscles 

 Partial Decolor- is I to 500 or 600. From observations of 

 izATioN OF AN Stephcus and Christophers this may be i to 90, 

 TcI"tIoZ 200, I to 290, or I to 300 during the rigor 



OF Laverania ma- leucocytosis), becommg i to 764 (i.e., 



laricB. (X 1,000.) leucopenia) when the rigor is completed, and 

 (After Norman.) when the temperature falls altering to i to 968. 



Billet has shown that if curves are made of 

 the leucocytic count and the temperature in simple tertian and 

 quartan fevers, the two curves follow one another in their rises 

 and falls. In pernicious malaria there may be leucocytosis. 



Another important matter is the relative increase of the large 

 mononuclear leucocytes, and this is better marked during the 

 leucopenia of apyrexia than during the leucocytosis of the attack, 

 for Thompson finds that it is usually low during the rigor and the 

 febrile stage, but with the decrease of the fever it may become as 

 high as 90 per cent, of the total leucocytes. This mononucleosis 

 is observed for a long time after an attack of fever, even when 

 quinine therapy is persisted in continuously. 



The following are some examples of the differential count accord- 

 ing to various observers: — 



