230 
M AT. ART A 
fections the condition rapidly disappears 
on treatment with antimalarial drugs. 
This often occurs also in chronic quartan 
infections, but some cases have gone on 
to fatal terminations despite antimalarial 
treatment (Fabry, Guillerm and Ragiot 
1937). In some of the quartan cases, par¬ 
ticularly in older adults but also in some 
children, a chronic glomerular nephritis 
manifested by nitrogen retention has been 
seen, and in the young eases at least this 
condition seems to be a late result of the 
malarial infection (Giglioli 1932). In 
some overwhelming cases of P. falciparum 
malaria the general kidney function is pro¬ 
foundly affected and the patient may die 
with a picture of uremia. Acidosis is not 
a prominent symptom in malaria. The 
carbon dioxide combining power of the 
blood may be temporarily lowered during 
the febrile stage but is usually normal at 
other times. 
In blackwater fever, kidney function is, 
of course, profoundly disturbed by the 
products of hemolysis which the kidneys 
are called upon to excrete. The formation 
of methemoglobin and its precipitation in 
the kidney tubules is apparently the most 
important element in the development of 
anuria and uremia which characterizes the 
clinical picture. 
Summary 
The physiological pathology of malaria 
involves primarily the blood and circula¬ 
tion, with secondary effects on many organs 
of the body. The blood euglobulin is in¬ 
creased, cholesterol, lecithin and glucose 
rise during the chill but are usually slightly 
decreased at other times, potassium is 
greatly increased by the rupture of ery¬ 
throcytes, erythropoiesis is stimulated and 
the reticuloendothelial system is activated 
and possibly partly blocked. A non-spe¬ 
cific positive serological test for syphilis 
is obtained. The circulation is disturbed 
by the blockage of capillaries and probably 
by toxic products-of the infection. Tissue 
respiration and nutrition are affected. 
The liver and kidneys suffer from the 
heavy demand upon their excretory func¬ 
tions. The adrenal glands show cortical 
depletion possibly due to postassium poi¬ 
soning. The heart shows toxic changes and 
is further embarrassed by the blood 
changes and by the effects on other organs. 
The brain is also involved in toxic and 
circulatory changes. In short, there . are 
few infectious diseases of man which, in 
their severe manifestations, produce func¬ 
tional changes in more organs and systems 
of the body than malaria. 
