INFECTION IN INTERMEDIATE HOST: FALCIPARUM 
203 
an intercurrent infection has set in, quinine 
is not as effective as under ordinary circum¬ 
stances. Naturally the prognosis is grave, 
though not always hopeless, when per¬ 
nicious symptoms have developed. Over a 
ten-year period (1922-1931) reports of the 
United Fruit Company showed that 43,535 
patients were treated for P. falciparum 
malaria in their hospitals. There were 525 
deaths, or a mortality rate of 1.2 per cent. 
The case fatality ratio was 829:1. This is 
undoubtedly a great deal lower than obtains 
under general conditions in endemic areas. 
Of all fatalities due to malaria during that 
same period, P. falciparum infections were 
responsible for 86.3 per cent. 
Malaria during pregnancy. The gravid 
female generally experiences a more severe 
infection than the non-pregnant, other 
things being equal. This is understandable, 
inasmuch as she already has an added call 
on her resources. Perhaps the gravest prob¬ 
lem she faces is that of anemia and even in 
Regarding the differential white cell 
count, James (1922) quoted Thomson as 
observing that the proportion of nono- 
nuclear elements varies inversely with the 
temperature. During the apyrexial period 
they might rise as high as 80 per cent. 
James (1922) noted that during the afebrile 
stage the polymorphonuclear forms fall 
from about 70 to 50 per cent and that the 
mononuclears rose from about 25 to 45 per 
cent. The proportion of these latter forms 
is greater than normal in active malaria, 
and monocytes containing variable amounts 
of pigments are commonly seen in blood 
smears from falciparum-infected patients. 
Prognosis. If the infections are seen 
early, and if proper treatment is instituted 
promptly and pernicious symptoms are not 
evident, the prognosis should be good. The 
appearance of intercurrent infections calls 
for a guarded prognosis. We have noted 
that in the event that very high densities 
have been attained by the parasites or that 
