204 
MALARIA 
lighter infections this may be of consider¬ 
able moment. Reports from various locali¬ 
ties assign to malaria varying degrees of 
responsibility as the etiological agent of 
abortions. Mannaberg states that: “the 
abortion does not require a fever paroxysm 
for its production. The foetus is usually 
dead before the abortion occurs.” Hehir 
(1927) notes that: “the later the infection 
occurs during pregnancy, the greater the 
liability to miscarriage.” Although the 
child of a malarious mother may survive 
birth, it frequently dies within a week. 
Congenital malaria. Marchiafava and 
Bignami (1901) were of the opinion that at 
the time of their writing, no incontrovert¬ 
ible proof had been presented in favor of 
the existence of congenital malaria and 
cited instances in which evidence had been 
searched for and not found in foetuses and 
new-born of heavily infected mothers. On 
examining peripheral (maternal) placenta 
and cord blood smears in 400 patients, 
Clark (1916) found 19 estivo-autumnal in¬ 
fections. Of these 19, all showed parasites 
(commonly segmenting and presegmenting 
forms) in the placental smears, some in 
dense numbers, whereas only 8 peripheral 
blood smears were parasite-positive. One 
cord smear revealed parasites and in this 
instance there was a history of accident of 
pregnancy in relation to the placenta. 
Blacklock and Gordon (1925) likewise 
found a much higher incidence of P. falci¬ 
parum in placenta smears than those from 
the peripheral blood. They found a posi¬ 
tive correlation between maternal infection 
and death of the child in utero, or imme¬ 
diately after birth (without infection of 
the foetus or child). It is reasonable to 
assume that there must be absorption of 
toxic substances by the; foetus and inter¬ 
ference with the foetal nutrition in the case 
of a heavily infected placenta. The con¬ 
census of opinion seems to be that infection 
of the foetus occurs only as a result of dam¬ 
age to the placenta. Diagnosis of congenital 
malaria on the basis of an enlarged spleen 
and fever in a child born of an infected 
mother is not justifiable in the absence of 
parasites from the child’s circulation. 
Malaria in children. McGown (1849) has 
the following to say on this subject: “Chil¬ 
dren under 5 years of age are less liable to 
remittent fever than those who have passed 
this age. Those between 2 and 5 years of 
age appear to be more liable to it than those 
under 2 years, but it does not appear to 
occur very frequently in the former. Those 
under 2 years of age, so far as I am aware, 
are seldom the subjects of remittent fever, 
though they are not entirely exempt from 
it. . . . It appears that a very large major¬ 
ity of the cases of congestive fever occur 
among adults, or those who have arrived 
at the age of puberty; though it is not 
exclusively confined to them; as children 
of 3 years, or 5 years and upwards, are 
sometimes the subjects of it.” Cleghorn, 
Parry and Wharton (quoted by Sternberg 
1884) supported the view of McGown. 
Sternberg (1884) felt that if the very 
young enjoyed an apparent immunity, it 
was probably due to lesser exposure. Craig 
(1909), speaking of the malarial fevers in 
general, stated that susceptibilty varied in¬ 
versely with age. 
The paroxysm is generally atypical in 
children particularly with reference to the 
cold and diaphoretic stages. These are less 
marked than in adults. Splenomegaly and 
anemia tend to develop more rapidly than 
in adults. Convulsions are not unusual and 
are mostly associated with the febrile stage. 
Pernicious symptoms are not uncommon in 
endemic areas and death is frequently due 
to the intensity of the parasitic invasion, 
often with cerebral symptoms. In those 
over 5 years the paroxysms more nearly 
resemble the adult type. One frequently 
sees in endemic areas, children who have 
experienced several infections due to P. 
falciparum, with protuberant abdomens as 
a result of chronically enlarged, “caked” 
spleens. 
Chronic malaria. Reinfections. Ca¬ 
chexia. There is a tendeney on the part of 
some writers to include reinfections when 
speaking of chronic malaria. This does not 
seem to us to be permissible in the strict 
sense of the word. James (1922) in speak¬ 
ing of indigenous inhabitants of endemic 
