ATYPICAL SUBTERTIAN FEVERS 



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II. With ' Digestive System ' Localization. 



The subtertian malarias with digestive system symptoms may be 

 classified as follows: — 



1. Pseudo-cholera type. 



2. Pseudo-dysentery type. 



3. Pseudo-appendicitis type. 



4. Pseudo-peritonitic type. 



5. Pseudo-liver abscess type. 



6. Pseudo-cholecystitis type. 



7. Pseudo-cirrhosis type. 



8. Hsemorrhagic pancreatitis type. 



9. Gastritis type. 



Pseudo-Cholera Type. — This is merely a great exacerbation of 

 the ordinary gastro-intestinal symptoms often met with in malarial 

 fever. There is vomiting, abdominal pain, and severe diarrhoea, with 

 motions typical of cholera — i.e., rice-water motions. A micro- 

 scopical examination of the dejecta may show a few leucocytes in 

 stages of degeneration. The spleen may be palpable, and an 

 examination of the blood will show subtertian parasites, while a 

 bacteriological examination shows absence of cholera and of para- 

 cholera vibros. 



During the attack the patient is pale or cyanotic, the eyes sunken, 

 the skin cold and clammy, but the temperature may be raised, and 

 hiccough, severe thirst, and painful cramps in the lower limbs, may 

 also be present. The urine is scanty or suppressed. Collapse, 

 delirium, or coma, may precede death, or the patient may be 

 sensible to the end. If the patient is to recover, the algidity 

 diminishes, the diarrhoea ceases, and after a long sleep he awakens 

 refreshed and convalescence sets in. 



Pseudo- Dysentery Type. — In this type there are two forms — viz., 

 those with typical dysenteric motions containing blood and muco- 

 pus, and the other with haemorrhagic motions without pus and 

 with little or no mucus. Fever may be high, with great distress and 

 prostration and a small rapid pulse, but at times the temperature 

 may be nearly normal. The spleen may be slightly enlarged, there 

 may be history of previous malaria, and there may or may not be 

 malarial parasites in the blood. 



Pseudo-Appendicitis Type. — The attack is sudden, with marked 

 pain in the appendicular region, sometimes vomiting, and usually 

 fever, but no rigors. The spleen and liver may not be enlarged, 

 and there may be tenderness and rigidity in the appendicular region. 

 There may or may not be subtertian parasites in the blood, but the 

 condition is cured by large doses of quinine. 



Pseudo-Liver Abscess Type. — This type is associated with fever, 

 often of an intermittent character, profuse sweating, loss of flesh, 

 spleen often not palpable, liver enlarged, with pain on pressure all 

 over the hepatic area. Malarial parasites are usually present in the 



