A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.
- Date:
- 1887
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
117/1022 (page 85)
![[The pernicious form occurs in isolated cases wherever the ordinary variety of the disease prevails, but is much more common in the Southern and Western States, and there varies in frequency in different years. Periodicity in the attack is not always observed. The pernicious character is not always manifested in the first attack, one or more mild paroxysms being often precedent. In this country the algid form of pernicious periodic fever is often called “ congestive chills,” and this form is more common than the comatose or another form not mentioned by the author—the haemorrhagic. In the latter the blood escapes from the kidneys, and less constantly from the mucous membrane. During the late civil war the mortality in the white soldiers of the United States army from pernicious malarial fever was 23'91 per cent.] 3. Remittent and Continuous Forms of Malarial Fever.—These are generally severe, and are seen, like the preceding, only in the worst haunts of malaria. The proof that they have the same aetiology as intermittent fever lies in the fact that they are sometimes developed out of the milder forms ; but it is to be noticed that many types of disease which physicians in the tropics describe as malarial affections have not yet been proved to our satisfaction to have an actual identity of origin with the common intermittent fever. The symptoms of this variety are likewise those of a severe constitutional infection. Gastro-intestinal symptoms may pre- dominate ; or there may be such grave nervous symptoms as coma, delirium, and convulsions ; or there may be jaundice, haematuria, and even a general haemor- rhagic diathesis ; or various local disorders may exist, such as pneumonia, nephri- tis, and hepatic and splenic abscesses. The fever is high, but without any sort of regular intermissions, maintaining for one or two weeks a remittent or a tolerably continuous type. Milder forms may end in recovery after eight to fourteen days, but often death ensues at this time, or even earlier. [The remittent form apparently shows a greater intensity of the poison or a greater susceptibility of the individual. In the United States army, from 18G1 to 1866, its mortality was twelve times as great as that from the intermittent form.] In all severe varieties of malarial disease, including the pernicious intermit- tent, the remittent, and the continued fevers, there is one very constant and remarkable symptom. It is also observed in the malarial cachexia, of which we shall speak below. This symptom is an abnormal and abundant formation of pigment matter. During life the pigment can be readily demonstrated in the patient’s blood—i. e., “melansemia” exists. We find minute rounded granules or flakes, either free or in the interior of white blood-globules. After death the pig- ment is found in the greatest abundance in the spleen. This organ is enlarged, resistant, and of a dark grayish-brown color. The matter lies in part along the blood-vessels, in part within the cells. Pigment is also found in the liver, the lymph-glands, the marrow of bones, the kidneys, lungs, brain, and other organs. As to the process of its formation we have no accurate knowledge. Marchiafava and Celli teach that the transformation of haemoglobin into melanin takes place within the red blood-globules themselves, and, it is affirmed, under the influence of micro-organisms which have penetrated into the interior of the globules. Some authors ascribe great clinical importance to the formation of pigment. They refer the grave cerebral disturbances, as well as other symptoms, to the occlusion of minute cerebral vessels by emboli of pigment matter. 4. Chronic Malarial Cachexia.—This occurs in the true malarial regions, and affects not only people who have had frequent attacks of pronounced intermittent or remittent fever, but also those who have never had acute attacks. The condi- tion is chronic. It may exhibit a genuine intermittent character. The patient usually has a decidedly yellowish, malarial complexion, and almost always the spleen is evidently enlarged. There are no regular febrile attacks, but merely](https://iiif.wellcomecollection.org/image/b21981565_0117.jp2/full/800%2C/0/default.jpg)
