ENLARGED SPLEENS AND MALARIA 179 
In younger persons the pigmented organs are much heavier than the 
unpigmented organs ; so that at these ages the spleens which show pigmentary- 
evidence of malaria are also enlarged. 
In British Central Africa post-mortem examinations were not obtainable, but 
clinical observations were made. Amongst the native adults I did not see a single 
case of enlarged spleen, though several hundred examinations were made ; but I was 
informed by others that the condition, though rare, did occur. 
In native children, however, enlarged spleen was common. The variation in 
the age incidence was marked, and differed also in different districts according to the 
liability to malarial infection as determined by the length of residence requisite for 
infection of susceptible newcomers. In districts represented in the first vertical 
column of Table III, a few of the newly-arrived Europeans escape ' fever ' for a year 
or more ; in those represented in the second column infection is usual in a month, 
and few persons escape much longer ; whilst in those represented in the third column 
an exposure for a fortnight or so results in the infection of nearly 25 per cent, of the 
Europeans exposed. 
Table III 
Enlarged Spleens in Percentages 
Highlands 
3,000 feet or more 
Lake Level 
1,500 feet odd 
Lower Shir^ 
300 feet or less 
Aged two years and under 
i 8-4 
18-8 
+8-i 
Two to four years - - - 
315 
+ 5'i 
57-1 
Fifteen years and under - - 
26-2 
1 1-5 
'37 
The total number of these children was eight hundred and fifty. Of these 
five hundred and thirty-five were fifteen and under ; one hundred and twenty-four 
were two to four years old ; and one hundred and ninety-one were under two years. 
The ages in only a portion of the cases could be determined with certainty, in the 
others it had to be estimated from the development. 
Attacks of 'fever' are common in cachectic or persons with enlarged spleens. 
In these attacks it is exceptional to find malaria parasites ; pigment is usually absent 
from the organs in fatal cases, and the action of quinine is uncertain. 
Persons with chronic enlarged spleens, with or without cachectic, are peculiarly 
liable to certain diseases, particularly lobar pneumonia. 
