THE MALARIAL FEVERS 



The anaemia is marked, and there is fluid about the ankles and in the 

 abdominal cavity. The spleen is enormously enlarged, as is also the liver, 

 while the bone-marrow is yellow, sclerotic, or gelatinous. Parasites may be 

 found, or they may be absent. 



A special form of cachexia is that in which amyloid changes are 

 found in the kidney along with parenchymatous nephritis, associated 

 more rarely with amyloid changes in the intestine, spleen, and liver, 

 with sometimes simple ulceration of the intestine. 



4. Latent Malaria. — Plasmodium vivax and Laverania malaricB 

 can exist in the spleen of persons who show no sign of fever or malarial 

 cachexia. These parasites can go through their life-cycle in that 

 organ, and in the case of L. malarice in the liver also, but it would 

 appear that they are restrained from invading the circulation by 

 the action of some antitoxin, and therefore do not increase to such 

 numbers as to cause toxic symptoms. 



It is obvious from the above that, if the restraining influences 

 which conduce to the condition of latent malaria are removed, an 

 attack of malaria will follow, or if there has been a previous attack, a 

 relapse will take place. 



Observers have always had a difficulty in admitting that the 

 ordinary form of the parasite could be latent and cause a relapse, 

 though there appears no doubt that this can take place. Schaudinn, 

 as has already been mentioned, considers that the macrogametocjTte 

 is capable of undergoing parthenogenesis and forming merozoites, 

 thus starting a cycle of schizogony anew and causing fever. Craig 

 and other observers insist upon conjugation, causing a rejuvenes- 

 cence of the parasite and a relapse of the fever. 



Classification. — As there are three parasites — Plasmodium malaricE, 

 P. vivax, and Laverania malarice — there are therefore three clinical 

 entities — quartan malarial fever, tertian malaria] fever, and sub- 

 tertian malarial fever — due to these parasites. 



Quartan and tertian parasites go through their whole life-history 

 in the circulating blood, and though the tertian sporulating forms 

 are found in internal organs, such as the spleen, yet they do not tend 

 to accumulate in those organs or to produce special effects. On 

 the other hand, the subtertian parasite sporulates entirely, or 

 almost entirely, in the internal organs; and if one particular organ 

 is especially attacked by the parasites, there will be special clinical 

 features to that phase of the disease. This is the cause of the 

 atypical subtertian fevers, and is also the basis of those serious 

 symptoms which have for many years been alluded to as the per- 

 niciousness of this type of fever. The nature of these pernicious 

 symptoms will depend upon whether the parasite is principally 

 localized in — (i) the cerebro-spinal nervous system; (2) the gastro- 

 intestinal mucosa; (3) the pancreas; (4) the heart; (5) the lungs; 

 (6) the liver, etc. 



We will give clinical descriptions of the different quartan, tertian,^ 

 and subtertian fevers. 



