According to their description, also, the enlargement cannot be identified with hypertrophic cirrhosis.
Atrophy of the liver in cachectics is not infrequent. Frerichs affirms that it is not infrequently the result of occlusion of numerous liver capillaries by pigment cells. Bignami observed it once as a consequence of thrombosis of the portal vein.
The atrophic liver is small and of increased consistence. Its surface is smooth or finely granular; its capsule, thickened. The structural alterations are usually not marked and likewise not constant.
We have already spoken of the occasional occurrence of amyloid degeneration and have nothing further to add.
The bone marrow at the upper and lower extremities of long bones is red and of increased consistence. Microscopically (Bignami) the fat has disappeared and is replaced by proliferated marrow cells and new blood vessels. The large and small mononuclear myelocytes are increased, and many show signs of degeneration. In addition there are numerous nucleated red blood corpuscles of normal size (normoblasts), and a few gigantoblasts or megaloblasts. The endothelium of the vessels is swollen, and the vessel walls and the stroma are thickened. The pigment disappears from the bone marrow much sooner than from the other organs.
The inflammatory renal changes found in chronic malaria , both antemortem and postmortem, are variable. Kelsch and Kiener describe among the commonest glomerulonephritis with a tendency to secondary contraction, and a large kidney with peculiar white specks. Rem-Picci considers a chronic contracted kidney as a result of malaria doubtful. This authority frequently saw amyloid degeneration of the kidneys. It is impossible to go further into histologic details.
The lesions in the lungs produced by complicating bronchopneumonia, infarcts, lobar pneumonia, chronic indurative pneumonia, gangrene, etc., correspond in general to the same processes in the cachexia, and we will, therefore, refrain from another description.
The intestinal tract, apart from the dysentery which frequently acts as a complication, shows nothing peculiar.
The peritoneal cavity is frequently filled with transudate. Peritoneal adhesions of greater or less extent proceeding from the perisplenitis are encountered.