no longer in minute grains, as when first deposited, but in blocks and globules as large as, or even larger than, blood -corpuscles. This pigment is, of course, something quite apart from the parasite-derived hæmozoin deposited in the same organs.
Practical considerations.—— Certain clinical facts about malarial hepatic congestion and malarial hepatitis are of importance. In the first place, such conditions do not tend to terminate in suppuration; in the second, they are almost invariably associated with splenic enlargement. These are important facts to recollect when it becomes a question of the diagnosis of malarial hepatitis from abscess of the liver. Another important fact to remember is that recent malarial enlargement of the liver is usually curable, depending, as a rule, on simple congestion; whereas old-standing malarial hepatic enlargement is usually incurable, depending, as it usually does, on hypertrophy of the connective tissue and a cirrhotic condition of the organ.
Malaria a cause of nephritis.—— Changes similar to those found in the liver in the course of, and in consequence of, malarial disease occur in the kidney; in time they result in confirmed Bright's disease. Hence, probably, the frequency of Bright's disease in some highly malarious climates. In the British Guiana Medical Annual, Daniels mentions that in 926 post-mortem examinations in the hospital at Georgetown, Demerara, a highly malarial district, he found evidence of disease of the kidneys in no fewer than 228.
Cardiac degeneration.—— As a consequence of defective nutrition from prolonged anæmia and recurring fever, the muscular tissue of the heart in chronic malarials may degenerate, the ventricles dilate, and, in time, the lower extremities become œdematous. For the same reason the subjects of valvular affections of the heart, whether compensated or otherwise, must be regarded as unsuitable for residence in malarial countries.
Other sequelœ.—— These include dysenteric conditions, forms of diarrhœa, low forms of pneumonia
