MORBID ANATOMY 



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2. Lesions Produced by Plasmodium vivax.—li is rare for 

 death to ensue as the result of an infection with P. vivax. Still, this 

 does occur at times when there is a heavy infection. Ewing has 

 described a case Of tertian infection causing coma, hsemoglobinuria, 

 and either causing or associated with catarrhal colitis. 



The principal features are the pigmentation of the bone-marrow, liver, and 

 spleen, which last is also enlarged. The blood and spleen show large numbers 

 of P. vivax. The kidneys and colon are inflamed, and the endothelial cells 

 of the brain are swollen and contain pigment. 



3. Lesions Produced by Laverania malaricB.— We haye aXvedidy 

 insisted several times upon the fact that L. malaricB differs 

 from the other malarial parasites in sporulating in the organs, 

 generally in the spleen, but at times choosing one organ and at other 

 times another. The organ in which it sporulates ir large numbers 

 suffers most, and produces symptoms which give the characters of 

 that particular type of malarial fever. 



Thus the parasite may attack principally the brain, the intestine, 

 the heart, or the pancreas, producing marked signs of disease therein. 

 Therefore the conditions of the organs vary with the localization of 

 the parasite. 



MacYoscopical Examination. — In general the body is pale, with a yellowish 

 tinge, which may be noted superficially in white races, but which may only 

 be observed in the subcutaneous tissues in native races. The heart may be 

 small or dilated, the muscle flabby and pale or brownish, and ecchymoses may 

 be present in both the epicardium and endocardium. The lungs may be 

 normal, anaemic, or hypersemic and congested. Haemozoin is not easily 

 detected in the lungs, because of the usual pigmentation. As first described 

 by Laveran, a sclerosis of the lungs is not infrequently met with. 



The liver is generally enlarged, and varies from a dark brown to a slate 

 colour. It is soft and congested, and the outlines of the lobules are usually 

 indistinct. The gall-bladder is full of dark-coloured bile. 



The spleen is enlarged, with a tense capsule, but its consistency is usually 

 much less than normal, and at times it may be almost diffluent in very 

 acute cases. We have, however, seen it quite firm in a recent infection. 

 Its colour varies from a deep brown to black. 



The stomach and intestines may show but little change, except in the choleraic 

 forms, in which their mucosa may be intensely congested and dark red in 

 colour, except where the Peyer's patches and the solitary glands stand out 

 clearly. The intestine is darker red in certain places, giving it a mottled 

 appearance, and the contents may be blood-stained fluid with flakes of mucus. 

 In fact, the appearance post mortem and the history, if death takes place 

 rapidly, so much resemble those of cholera that in regions where that disease 

 is prevalent mistakes may arise, though, indeed, the dark pigmentation 

 should enable errors to be avoided. We have not infrequently met with 

 dark pigmentation of the small and large bowels in cases of pernicious cerebral 

 malaria, and in general infection without cerebral symptoms. This pig- 

 mentation is due to haemozoin, as can be easily proved by microscopical 

 examination. 



The lymphatic glands may be swollen, while the pancreas is usually normal, 

 but it may be very rarely swollen and haemorrhagic — i.e., in a condition of 

 haemorrhagic pancreatitis. We have seen it quite brown, and pigmented with 

 capillaries choked with infected corpuscle debris, pigment, etc. 



The suprarenal capsules may be congested. The kidneys are more or less 

 normal, but sometimes they are congested, with punctiform haemorrhages in 

 the pelvis and cloudy swelling in the parenchyma, or brownish. The serous 

 membranes, pleura, and peritoneum, show as a rule nothing remarkable, 



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