Page:Tropical Diseases.djvu/115

iv] portion to the severity of the febrile attacks; that, although the loss of corpuscles following first attacks is usually very marked, this loss is rapidly made good; that, although in relapses the loss of corpuscles is less than in first attacks, the tendency to reparation is also less. Morbid anatomy: Macroscopic.—— If the body of a patient who has died in the course of an acute attack of malarial disease be dissected, certain appearances are generally found. In the first place, and invariably, the spleen is enlarged often very much enlarged; its surface is dark—— black sometimes—— what is called pigmented. On section, the gland tissue is also found to be dark. Generally the parenchyma of the organ is so much softened as to be almost diffluent, so that the tarry pulp can sometimes be washed away by quite a gentle stream of water. The liver, too, is softened, congested; enlarged, and pigmented. The vessels of the pia mater and brain cortex are full, and the grey matter may present a peculiar leaden hue. The marrow of the spongy bones, such as the sternum and the bodies of the vertebræ, is also dark and congested; and a similar state of pigmentation and perhaps congestion may be discovered in the lungs, alimentary canal, and kidneys. Microscopic: Malarial pigmentation.—— The pigmentation referred to is pathognomonic of malaria. On submitting malarial blood from any part of the body to microscopical examination, it will be found to contain grains of hæmozoin. Particularly is this the case with blood from the organs just mentioned; microscopic sections (Plate II., Figs. 2, 3, 4) will show more or less thickly distributed in the blood, and within the cells of the endothelium of the arterioles and capillaries, minute grains, or actual blocks, of the same intensely black substance. For the most part the hæmozoin grains are enclosed in leucocyte-like bodies which are either clinging to the walls or lying loose in the lumen of the vessels. Here and there the pigmented bodies may be so aggregated together that they form veritable thrombi and occlude the vessels. It is possible that many of