Remembering that only such persons are affected as have suffered repeatedly from malaria and have lived for some time in tropical malarial regions, we are forced to attribute the destruction of the red blood corpuscles to factors resident in the individual, possibly in the blood making organs, acting in association with climatic conditions. The predisposition to this disease produces no characteristics which we can yet recognize, for it is not even limited to anemic individuals.
As an example of a mild case, we take the following from O'Neill:
Jacques Reneau, aged thirty four, marine, has lived three years on the African coast and eleven months in Rio-Nunez. After his arrival in Boke he had an attack of intermittent fever. The day before admission to the hospital, he had a fever paroxysm, for which he took 0.80 quinin with ipecac.
January 10, 1868: 10 a. m. : He entered the hospital with a chill which lasted half an hour. He stated that he had had bilious vomiting and bloody urine. Face pale, scleras slightly yellowish, pulse hard, tension high-114. Temperature in the axilla, 40.5°.
Prescribed 1.5 calomel to be taken within ten minutes, infus. flor. aurant. and an emollient cataplasm to the abdomen.
4 p. m. : During the clay three times bilious vomiting and three bile stained stools. Urine large in quantity, of port wine color. Pain in the lumbar region and epigastrium. Headache in the top of the head. Intense thirst. Pulse dicrotic ("vibrant")-113. Temperature in the axilla, 41.2°. Ordered iced lemonade.
8 p. m. : For the last three quarters of an hour sweating. Urine yellowish, cloudy, still containing some albumin. Temperature in the axilla, 38.5°; pulse, 85. Ordered lemonade, 2 gm. quinin sulph. in solution to be taken within two hours; dilute wine; cold bouillon.
January 11: 7 a. m.: During the last hour a new paroxysm. Saffron colored icterus. Urine very frothy; port wine color. The chill was slight and lasted only a few minutes. At the time of the visit the temperature was 40.9°; pulse, 112. Nausea and bilious vomiting, girdle pains. Prescribed iced lemonade and an ice bag to the epigastrium.
4 p. m. : Skin somewhat moist; pulse, 102; temperature, 39.4°. Prescribed quinin sulph., 1.0; syrup, diacodii, syrup, aurant., aa 30.0, to be taken in the evening. Iced drinks.
9 p.m.: Complete apyrexia. Urine yellowish, cloudy. Quinin and drinks were well borne.
Prescribed diluted wine, broth.
January 12: 7 a. m.: Passed a pretty good night, complains only of weakness and vertigo. Prescribed quinin sulph., 1.20 in 24 pills; chocolate, bouillon, Bordeaux wine.
January 13: 7 a.m.: Apyrexia; patient desires to eat.
Prescribed quinin sulph., 1.0 in 20 pills. " Regime reparateur."
Boisson reports a rapidly fatal case with coma:
D., aged twenty three. From the Thirtieth Artillery Squadron. No hereditary complaint. At the age of twelve, typhoid fever; after his arrival in Madagascar, sunstroke, which kept him in the hospital for five days in a very severe condition. Remittent malaria for the first time toward the end of June; later, numerous intermittent attacks at irregular intervals, during which the fever was combatted with quinin. On September 27 he was sent to a sanatorium, where he remained a month, in order to recuperate.
On admission to the Hospital Desgenettes (Lyons), December 7, he was weak and anemic, though he had lost no flesh. The liver was scarcely enlarged; the spleen extended beyond the border of the ribs about 3 cm. Neither sugar nor albumin in urine. The digestive, circulatory, and nervous systems showed nothing pathologic.
During the month of December, he had, on the sixteenth and on the nineteenth, fever paroxysms of moderate severity lasting about six hours each.
December 26: Patient complained of headache and diarrhea. On December 28 he was in an excitable condition and very restless at night. During the afternoon of December 30 he had a fever paroxysm that began with a violent chill. Temperature at 2 o'clock, 41.8°. The skin rapidly became yellow. At 6 o'clock temperature, 41.7°. The scant urine was intensely red from hemoglobin, but contained no erythrocytes. At 9 o'clock in the evening, coma. Extremely little urine, stained very dark by hemoglobin, containing considerable albumin, granular casts, but no trace of bile pigment.
The coma persisted through the night, and the next morning (December 31), at 7 o'clock, the patient died.
The autopsy showed only the signs of malarial infection.
The following is a severe case, terminating in recovery, taken from Albert Plehn:
M., carpenter, very robust. For the last ten months (since November, 1894) has had, in Kamerun, very many severe fever paroxysms which were treated in the ordinary way with 1.0 to 1.5 gm. quinin after every fall of temperature.
In June, 1895, choleraic attack, with algor and severe collapse. Since then a paroxysm about every fourteen days-one on September 23, 1895.
September 23: 7 a.m.: Temperature normal; general condition good; was given 1.5 quinin.
10 a. m. : Chill, high fever, black red urine.
4 p. m. : Urine of normal color and free from albumin, after which it continued so.
September 28: He rose from bed.
September 30: Discharged. Hemoglobin, 78 per cent. October 7: Came again to the hospital after a fever paroxysm. Temperature, 38.5°.
October 8: 7 a. m.: General condition good; temperature normal, 1.0 quinin. At 12 noon, chill; temperature, 39.3°; excruciating cardialgia; bilious vomiting. At 3 p. m. : 200 c.c. dark red urine; sp. gr., 1020; passed in drops, accompanied by intense burning in the urethra. Boiling with acetic acid coagulated the urine almost solidly. In the thick sediment numerous finely granular casts and kidney epithelium, but no blood or pus. Morphin, hot poultices. In the evening, condition improved. Temperature, 38°; 160 c.c. urine, with the same characteristics as at 3 p. m.
October 9: During the night, no sleep.
4 a. m. : Violent chill, high fever, renewed oppression, vomiting. Urine like yesterday, 750 c.c.; sp.gr., 1012.