INFECTION OF THE INTERMEDIATE HOST: VIVAX 
189 
ditions and in the same geographical local¬ 
ity to ascertain with any certainty what 
real difference actually exists. If an ac¬ 
curate study is to be made, many other 
complicating factors, such as dosage of 
sporozoites and age of sporozoites, must 
also be considered. We know, however, 
from practical experience that certain 
strains of P. vivax will produce a longer 
clinical course in paretics than other 
strains, which because of the shortness of 
the acute clinical attack are unsuitable for 
malarial therapy. 
Alleged manifestations and sequelae. The 
innumerable clinical manifestations, symp¬ 
toms and sequelae which have been ascribed 
to malaria are unflattering demonstrations 
of the imagination and credulity of the 
human mind. Fortunately for the reviewer, 
most of these conditions have been ascribed 
to infections by P. falciparum and not to 
P. vivax and were previously noted under 
malaria cachexia. 
Cause of death, case fatality. When 
death occurs from P. vivax malaria the 
anemia due to the destruction of ery¬ 
throcytes by the parasites must be regarded 
as responsible in nearly all cases. Rupture 
of the spleen must occur very seldom, in¬ 
deed, as we have never observed this in 
over 300 patients with neurosyphilis treated 
with P. vivax malaria. The many serious 
complications attending P. falciparum in¬ 
fection, due to the selective places for 
sporulation of this parasite, are not met 
with in P. vivax malaria. 
The fact that P. vivax malaria has a low 
case fatality has given it the name of “be¬ 
nign tertian.” Some information from 
hospitals where malarial therapy has been 
used indicate that the number of deaths 
range from 0 to 8 or 10 per cent. It must 
be remembered that many of the patients 
inoculated were already in poor physical 
condition and often given malaria as the 
last therapeutic resort. It is difficult to 
ascertain from hospital records if case 
fatality varies with different strains, but 
judging from the severity of the clinical 
courses produced such must be the case. 
