THE MALARIAL FEVERS 



First Type. — This form of anaemia comes on after attacks of 

 ordinary acute malaria, and is characterized by well-marked 

 diminution in the erythrocytes, the presence of normoblasts, diminu- 

 tion of the colour-index, and leucopenia associated with relative 

 mononuclear increase. In this type the prognosis is good. 



Second Type. — The second type is severe, and the prognosis is 

 exceedingly bad. It is characterized by great diminution in the 

 red cells, presence of poikilocytes, megalocytes, normoblasts, and 

 megaloblasts, with leucopenia and relative mononuclear increase. 



Third Type. — This is rapidly fatal, and has similar characters to 

 the second type, but is without normoblasts. 



Fourth Type. — This type is really grave chronic ansemia, resem- 

 bling the first type, but being specially characterized by the paucity 

 of the normoblasts and the marked leucopenia. 



Wassermann reaction is in our experience generally negative. 



Morbid Anatomy.— The morbid anatomy of malaria has been 

 most carefully studied in recent years by Bignami in Italy and 

 Ewing in America. It may be considered under the following 

 headings : — 



A. Acute Malaria. 



1. Lesions caused hy Plasmodium malarice. 



2. Lesions caused hy Plasmodium vivax. 



3. Lesions caused by Laverania malaricB. 



B. Chronic Malaria. 



1. Lesions caused hy Plasmodium vivax. 



2. Lesions caused by Laverania malarice. 



3. Malarial cachexia. 



4. Latent malaria. 



A. Morbid Anatomy of Acute Malaria— i. Lesions 

 Produced by Plasmodium malarice.- — Plasmodium malarice goes 

 through the entire process of schizogony in the circulating blood, 

 and hence is evenly distributed all over the body, and therefore 

 does not especially accumulate in any one organ. Marchiafava and 

 Bignami mention that they have made two autopsies, one on a 

 case of acute quartan malaria, in which the patient died of nephritis, 

 and the other in a case of the same fever, in which the patient died 

 of spinal disease. 



The visceral lesions are : Spleen enlarged, not softened nor very melanotic ; 

 liver and bone-marrow not markedly melanotic ; parasites in the spleen and i n 

 the blood, but not in the brain. 



Leishman has mentioned that he has received films from the 

 peripheral blood and spleen of a fatal case, in both of which the 

 parasites were very numerous, but he was not in a position to state 

 whether the patient died of malaria or not. If P. malarice is to 

 produce severe symptoms, it would appear necessary for it to exist 

 in very large numbers. 



