In spite of these defects Kelsch and Kiener are to be congratulated on their endeavor to classify cachexias, and in further researches this classification may be accepted as a basis.
The clinical symptoms of these three forms show the greatest similarity, though in form 2 the rapidly developing ascites, the result of occlusion of the portal circulation by spleen cells, may show also a great similarity with atrophic cirrhosis of the liver. Still there is usually wanting in neither form 1 nor 2 more or less developed cirrhotic changes in the liver, about which we shall say more in the sections on Complications and Sequelae and Anatomy.
[Note.-The recent discovery, by Leishman, of a new parasite in the blood obtained by splenic puncture from cases of so called "malarial cachexia and enlarged spleen," of common occurrence in India, necessitates a complete revision of the nomenclature and pathology of these cases. This parasite is also found in that large mass of cases called in India kala azar, kala dukh, or also tropical splenomegaly or cachexial fever. The parasites, which are characterized by the possession of a large and a small nucleus, resembling those of a try panosome, appear to be entirely intracellular, occurring mainly in large mononuclear and endothelial cells. Identical parasites also occur in "Delhi boil" or "tropical sore." They undoubtedly play a large part in the pathology of Indian fevers. It has been shown by Rogers that these parasites have a flagellate stage.-Ed.]
In the course of acute and chronic malaria , and even more so in the course of cachexia, complications are frequent, and while they show a certain genetic relationship to the disease, they are usually not directly dependent on it. Some of these complications occur so frequently that they seem to deserve special description. This description is, moreover, justified, since not infrequently, under the influence of the malaria or its results, the complications assume a different form from that seen under other circumstances.
These complications are in great part the result of mixed infections, though a large number, too, depend on chronic inflammatory processes due chiefly to the overloading of the organism with pigment. A smaller number are the effect of degenerative processes, and finally some are of a purely mechanic nature.
We consider it most advisable to describe these complications in connection with the systems of organs which ordinarily manifest them.
Among the organs that participate most frequently we may mention, first, the respiratory tract.