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MALARIAL cachexia is the term applied to a group of conditions, more or less chronic, believed to be the result of an antecedent attack of severe malarial fever, or of a succession of such attacks, or of prolonged exposure to malarial influences. Undoubtedly many of the more or less chronic morbid conditions which were formerly attributed to the malaria parasites are the outcome of infections by trypanosomes, by the Leishman body, by spirochætes, or by some as yet unidentified protozoal organisms.

Symptoms.—— The leading symptoms are those of a special kind of anæmia, characterized objectively by a peculiar earthy sallowness of skin, somewhat yellow sclerotics, enlargement of the spleen and—— in the early stages at all events—— of the liver. Usually the subject of this cachexia is liable to frequent attacks of an irregular type of fever, particularly after exposure, or fatigue, or, in fact, after any unusual physiological strain. Malarial cachexia without fever.—— It should be mentioned that fever is not a necessary antecedent or accompaniment of malarial cachexia. In highly malarious countries it is not unusual to see typical examples in which fever had never been a feature, or, at all events, had been of so mild a character as not to have seriously attracted attention, or had occurred in childhood and been forgotten.

Enlarged spleen.—— In such countries a large proportion of the population have enormously enlarged spleens. The traveller cannot fail to be struck by the number of people he sees with big bellies and spindle shanks; by their languid and depressed air;