There are only a few cases which show with certainty that malaria may be transferred from an affected mother to the fetus, and it is an established fact that this transference is not only not constant, but, on the contrary, very rare.
Many older writers, like J. Frank, Stokes, Reil, and others, have insisted on the intra uterine transference of malaria , on account of observing an enlargement of the spleen or other symptoms in newborn children whose mothers had suffered from malaria during pregnancy. In some cases it was stated that every time the mother had a fever paroxysm she felt particularly lively movements on the part of the child, which could be attributed only to the participation of the fetus in the paroxysm. Still, such cases are not to be accepted as proofs of intra uterine transference without further investigation. Congenital tumors of the spleen are not necessarily of malarial origin: they may be the result of lues. The clinical symptoms of malaria in the new born are by no means so typical as in adults, and the disease should not, therefore, be diagnosticated without a blood examination. A large number of the reported cases prove nothing, inasmuch as the disease first broke out several weeks or months after birth, making the pathogenesis doubtful.
A completely convincing case was reported by Duchek. This was a premature child whose mother suffered from intermittent fever during pregnancy. The child died three hours after birth. The autopsy, done by Duchek, showed: "The skin was dark in color and exhibited here and there small ecchymoses. The pleurae were covered with small ecchymoses. A yellowish fluid was found in both pleural cavities and in the markedly distended abdominal cavity. The lower portions of the lungs were compressed; the upper, but little distended.
The liver was enlarged, and on section brownish, yellow, and smooth. The spleen was markedly enlarged, extending to 1 cm. below the umbilicus; it was 11 cm. long, 6 cm. broad, and 2 ounces in weight. Its capsule was smooth, the substance hard and friable and very dark red. The spleen and the blood of the portal vein contained considerable black pigment in the form of large, irregular flakes and granules.
A second case was observed by Bouziau. This was a new born child, twelve days old, which showed in the blood crescentic organisms.
Less convincing cases have been reported by Bureau, Playfair, Cima, Leroux, Aubinais, Taylor, Topi, and others. In none of these was the infection proved, either by the appearance of pigment or by the finding of parasites, yet in some, for instance, that of Bureau, on account of the clinical symptoms, the diagnosis was in the highest degree probable.
Opposition to intra uterine transference is not wanting. Burdel asserts that he never observed it. The investigations of Bignami, Bastianelli, Caccini, and Thayer are of more importance. Bignami twice had the opportunity of examining children of malarial mothers, born by abortion before they were viable. One case was a cachectic woman who suffered from fever paroxysms shortly before the abortion (third month); the other, a woman who a few hours after the abortion (sixth month) succumbed to a pernicious attack. In both cases the blood of the fetus was entirely free of pigment and parasites, although the blood of the mother in the second case contained an enormous number of them. A third case was a pregnant woman who died in a pernicious attack; here, too, the blood of the fetus contained no parasites.
Thayer's case was a negress who had been suffering for six months from quartan, and who, during a paroxysm, gave birth to an eleven months' old fetus. The blood of the latter, neither immediately subsequent to the birth nor later, showed parasites. The placenta exhibited parasites on the maternal, but none on the infant, side.
Bignami assumes that the nucleated blood corpuscles of the fetus are not adapted to the parasites, and that, therefore, the fetus is not attacked by malaria . Moreover, it is well known that in marked anemic patients the nucleated blood corpuscles almost never harbor parasites. Still, recalling Duchek's finding, we cannot, with Bignami, exclude entirely intra uterine infection.
Transference of malaria from the father to the child, as asserted by Felkin, is entirely without foundation and is highly improbable. Reports of the transference of malaria through the mother's or nurse's milk (Baxa, Felkin, and others) deserve as little attention, since the affected nurslings were in some instances simultaneously exposed to the miasmatic infection, and in others there was no proof that they actually suffered from malaria.