Diseases of the muscles in the course of malaria appear to occur only exceptionally; at least, but little is said about them in the literature. Steudel mentions an infiltration of the muscles after blackwater fever. Yet the muscles may undergo serious changes, as is shown by the microscopic investigations of Vallin. He found, among 10 cases that died of pernicious forms of malaria , 3 times granular, 4 times waxy, degeneration of the skeletal muscles. In 2 of the latter the appearance was exactly that seen in typhoid fever or smallpox. In the other 3 cases the muscles were normal.
Severe myalgias (muscular rheumatism) are frequently associated with acute malaria . They are usually located in the legs, the back, and the lumbar region. Verdan observed them in Wargla (Algeria) in at least one third of the cases. For the sake of thoroughness, we call attention again to the muscular atrophies as a result of malarial neuritis.
Still less is written of the joints than of the muscles. Fayrer states that in the natives of India rheumatism seems to be a frequent complication, though, unlike ordinary rheumatism, this does not produce endocarditis. Verneuil may be correct in his conjecture that "malarial rheumatism" is rather neuralgia of the joints.
According to Heinemann, pernicious cases with excruciating pains and hemorrhages into the joints are not infrequent in Vera Cruz. The bones are frequently painful and tender in acute malaria . This may be so marked that the lightest percussion of the tibia is unbearable, and it frequently happens that malarial patients complain of nothing but this tormenting symptom. Pain in the last cervical and first dorsal vertebrae is not uncommon.
Isolated cases have been observed, associated with swelling of different lymph glands. Bodnar described 3 such cases. In one of them the malarial bubo even suppurated. Segard's observations in Madagascar are of a more recent date. He observed several cases of malarial lymphadenia. This was characterized by fever and swelling of all the superficial glands, some of which suppurated. Since quinin caused a retrogression of the swelling, Segard saw in them a localization of malaria . Unfortunately, blood examinations are wanting to give assurance.