THE MALARIAL FEVERS 



Hemiplegic Type. — The patient may be suddenly taken ill with 

 fever, and develop a typical hemiplegic attack. 



Monoplegic Type. — This simulates a cerebral haemorrhage, but 

 is associated with high fever, and in both it and the two preceding 

 subtertian parasites can be found in the blood. 



Myelitic Type. — This simulates a transverse myelitis. 



Ataxic Type. — The symptoms are slow and scanning speech, great 

 muscular weakness, exaggeration of tendon reflexes, ataxia, together 

 with vomiting. Subtertian parasites are found in the blood. At 

 flrst there is no fever, but this may develop later. Such patients 

 generally recover on quinine treatment, or, indeed, they do so 

 spontaneously. 



Disseminated Sclerotic Type. — There is scanning speech, inten- 

 tional tremor, nystagmus, spastic gait, and increased reflexes, all of 

 which yield to quinine therapy. 



Bulbar Type. — A fever with bulbar symptoms — that is to say, 

 difficulty of speech and deglutition, with facial paralysis, or with 

 a weakening of the muscles of the face and also frequently of the 

 legs. This appears to be by no means rare, and yields to quinine 

 therapy if taken in time. Malarial parasites are often absent from 

 the blood, and the spleen need not be enlarged. 



Cerebellar Type. — The symptoms of this type are ataxia, the 

 patient walking like a drunken man and complaining of severe 

 headache and almost complete loss of vision. Vomiting is frequent ; 

 often there is no fever, and the spleen and liver are not enlarged. 

 The blood may show parasites, and quinine therapy cures the con- 

 dition, which may be suspected to be cerebellar tumour or abscess, 

 according to the absence or presence of fever. 



Cerebral Type. — This type resembles a cerebral abscess to such a 

 marked degree that an operation may be considered to be necessary, 

 when a blood examination reveals the subtertian parasites and 

 quinine cures the condition. 



If there is no fever cerebral tumour may be suspected, but the 

 blood examination reveals the true condition. 



Polyneuritic Type. — This type closely simulates ' wet beri-beri,' 

 because the patient is oedematous, with the characteristic gait 

 and loss of knee-jerks. There is neither fever nor enlargement of 

 the liver or spleen, but the blood contains subtertian parasites, and 

 the condition is cured by quinine therapy. 



Polyneuritis without oedema is also known. 



Korsakoff -like Type. — This resembles the preceding in that the 

 patient shows polyneuritis, but in addition he suffers from mental 

 symptoms, among which the most important is the loss of memory 

 for recent events, all of which disappear under the influence of 

 treatment by quinine. Subtertian parasites may or may not be 

 present in the blood, and the liver and spleen may not be enlarged. 



Aphasic Type. — In this type motor aphasia develops with or 

 without other paralyses. 



