The symptoms on the part of the skin that ordinarily accompany the paroxysms, like herpes and urticaria, have been previously described. We may mention, as a rarer occurrence, a rubeola like eruption, without conjunctivitis or subsequent scaling of the skin, observed by Segard. He also reports cases of intense urticaria with marked, erysipelas like swelling of the face, hands, and feet. Doer ing mentions a case followed by urticaria and a pemphigus like condition. Numerous cases of petechiae, simulating the picture of morbus maculosus Werlhofii, have been observed epidemically. Steudel reported furunculosis as frequent after blackwater fever.

More or less marked pigmentation of the skin is often observed in malaria . Moscato described a case in a four year old boy with chronic malaria. The pigmentation was chocolate colored and occurred on the lower extremities, the seat, the scrotum, the penis, and the forearm. The pigment was even found in the vessel walls and in the rete mucosum. He designated the condition as partial postmalarial melanoderma.

Gangrene

In discussing malarial cachexia, as well as the complications on the part of the digestive, respiratory, and urogenital tract, we repeatedly mentioned that gangrene not rarely developed in the course of these conditions. The literature on this subject has been critically sifted by Petit and Verneuil. They divide gangrene into associated and idiopathic.

The associated gangrene appears in connection with wounds and operations on malarial patients. Comeano,. for instance, observed that shot wounds in malarial patients showed a tendency to become gangrenous. Fontan saw gangrene in a case of osteotomy of the ulna. Yet the cases in which wounds healed without complication are in the very great majority (MacNamara, Roth, and others), and the former cases may readily be looked upon as coincidences.

Idiopathic gangrene, however, manifests in a considerable number of published cases unmistakable relations to malaria (see also Raynaud's disease). Apart from the gangrene of the internal organs, it usually affects the most distal parts, like the nose, ears, fingers, and toes. The gangrene is usually dry. It is observed in the course of acute affections and in cachectics, with or without fever.

A severe case of dry gangrene of the nose, cheeks, and ears, after a malarial infection lasting four weeks, has been described by Fischer, and a similar one by Blaise and Sarda. According to Schtchastny, such cases are not infrequent in the Caucasus.

Moty observed in a cachectic a moist gangrene that spread over the whole of the left rump and eventually produced death; again, an interesting case of disseminated gangrene of the skin in an old cachectic. Echeverria saw disseminated gangrene in the course of continued malaria .

Laveran and Rogee each saw a case of dry gangrene as a sequel of endarteritis obliterans, in persons who showed malaria in their history. Whether there was a connection between the two affections cannot at present be said.