Notes on the etiology of relapse in malarial infections / W.M. James.

  • James, W. M.
Date:
1913
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Licence: Public Domain Mark

Credit: Notes on the etiology of relapse in malarial infections / W.M. James. Source: Wellcome Collection.

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    known symptoms of chronic malaria—anemia, enlargement of the spleen and liver, edema, palpitation, and dropsy. Now, the symptoms of this second group are not brought about solely by the effects of four or five febrile attacks, unless these are prolonged and of unusual severity. For many persons who, by reason of reinfection or relapse have had a similar number of febrile attacks, when these have been treated promptly and energetically, show no further disturbance than that associated with the attacks themselves. The other symptoms often develop in the apyretic intervals between the febrile manifestations, even when the latter are mild, and are due to an additional factor. This factor, even before the hypothesis that the asexual cycle persists between febrile relapses was advocated, Mannaberg looked on as “‘an obstinate persistence of the virus”; and Marchiafava and Bignami defined chronic malaria: ‘“‘When the infection of the organism continues for months and even years.” It is clear from a study of their work that these authorities recognized a persistence of the infection, but at that time they did not correlate this persistence with that which occasions relapses after long apyretic intervals. But the variation in intensity of malarial infection is one of degree only, and such infection continuing over a long period of time does not of necessity always produce pyrexia, or even other symptoms. In the medical service of Ancon Hospital, Dr. W. E. Deeks years ago recognized post-malarial symptoms such as anemia, neuritis, cephalgia, and minor complaints occurring at more or less frequent intervals after the primary infection, or between relapses, when pyrexia was absent. And he found that such cases often do not improve on quinine by mouth, but clear up rapidly after two or three hypodermic injections of quinine. There is also a group of cases similar to these, but further advanced, in which the anemia is more profound, and gastro- intestinal disturbances and other signs of toxemia are more appar- ent. These cases also may resist quinine by the mouth, during apyretic intervals, yet the condition yields rapidly to hypodermic or intravenous administration. Similar cases are not uncommon,
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