Icterus has been observed, especially in the tropics; likewise, hemorrhages into the skin in the form of petechiae, as well as hemorrhages from the mucous membranes, particularly the nose.
They usually appear during the hot stage; less commonly at the beginning of the paroxysm, during the cold stage. In infections with parasites of the first group the convulsions are probably an expression of that irritability of the central motor region such as children manifest in different acute infectious diseases. In infections with parasites of the second group they may be due, as in adults, to the distribution of parasites in the internal organs, especially the brain.
Bonn's cases rarely manifested only one convulsive seizure, but usually three, four, even six or seven, within a few hours. These convulsions were always associated with fever.
There is reason to affirm, with Bohn, that the convulsions cannot always be attributed to the same cause, for at one time they may be expressions of motor irritability; again, genuine epileptic attacks, excited by the fever paroxysm.
Bronchitic and bronchopneumonic symptoms are less frequent than the gastro intestinal and nervous.
As Bohn has observed, a previously existing bronchitis or laryngitis may be rendered considerably worse by an attack of malaria . The child may suddenly present symptoms of a genuine croup or a threatening diffuse bronchitis on the addition of the fever paroxysm to a scarcely noticeable catarrh of the larynx or bronchi. The splenic tumor and the intermittency of the paroxysms will aid in the diagnosis.
In tropical regions pernicious forms are seen in children as well as in adults. The eclamptic pernicious is observed most frequently; more rarely, the pure comatose form.
Algor is not infrequent and usually proves fatal. Diaphoretic,, choleraic, typhoid, and pectoral forms have been occasionally seen and described (Benoit, Negre).
Unfortunately, but very few blood examinations have been made so far, and consequently not all the cases reported can be considered malaria .
In children over two years, and especially in those over five, the fever paroxysms are very similar to those of adults, so that nothing further will be said about them.
As an example of an infantile pernicious we introduce the following history from Negre:
In August, 1891, I was called, about 10 o'clock in the evening, to visit the child of Mrs. B., on account of convulsions and restlessness. I found a child of one and one half years, well developed, in violent convulsions, completely unconscious, the pupils fixed, dilated, irresponsive to light, the thumbs shut in the hands, the face grimacing, the abdomen drawn in, the arms and legs flexed, contracted, and twitching violently, respiration slowed, intermittent, teeth pressed together, and froth issuing from the lips.
For moments at a time the twitchings ceased, when the child appeared as if in coma, with respiration suspended and the pulse scarcely palpable. Two to three seconds later true convulsions of the muscles• would begin again.
This condition continued about half an hour. Ten minutes after my arrival the convulsions ceased and gave way to coma. The mother said that the child was healthy from birth, and that neither she nor her husband had had the fever. About 7 o'clock in the evening thechild had refused nourishment, and had fallen into a deep sleep, during which the paroxysm came on suddenly. The woman and her child had not left the district in which they lived for some days, and, as a result of this, I refused to make the diagnosis malaria eclarnptica, because this region is one of the most healthy in the city. Nevertheless, on account of the gravity of the case and the high temperature (rectum, 40.5°), I gave an injection into the buttock of 0.25 quinin mur. and ether, and at the same time ordered an aperient clyster and sinapisms to different parts of the body. An hour later the temperature had sunk to 38° and consciousness had returned.
The following morning I administered another injection of 0.25 quinin mur. The paroxysm did not occur.
A month later, in September, a new convulsive attack with fever, but milder than the first, occurred. Injection of 0.25 quinin. The paroxysm was not repeated. Since then the child has manifested no symptoms of recurrence.
Latent malaria has likewise been observed in very young children. Whether it is as frequent as Benoit assumes must remain for the present questionable. Kingsley also claims that he frequently saw latent malaria in the form of periodic headache, cardialgia, tonsillitis, laryngitis, convulsive cough, etc. Bohn has described, in a masterly way, cases of periodic torticollis, neuralgias of the trigeminal, sciatic, and hemorrhoidal nerves, as well as cardialgias, intermittent vertigos, and psychopathies. Especially interesting is his description of a frontal neuralgia in a boy one and a half years old. Hemorrhagic diarrheas of quotidian and tertian type, with little or no fever, have been likewise described by Bohn as latent malarias. Kroner observed a frontal neuralgia, quartan in type, in a seven and a half year old girl. Old people are no more spared than other classes.
The paroxysms produced by parasites of the first group differ in no way from those in younger people. Infections with parasites of the second group run a different course only inasmuch as the symptoms, especially the fever, are much less conspicuous. On this account the disease may be apparently unimportant, and manifest itself in somnolence, slight stupor, and malaise, while in reality the danger may be imminent. The termination in these cases usually occurs after a sudden short coma. This behavior is similar to that seen in other infections (pneumonia, influenza, etc.).