Capillary thrombosis may be the cause of necrotic foci scattered throughout the structure of the spleen. The spleen in all cases does not present marked mela nosis, and in many cases is relatively free from both pigment and parasites.
The Liver.—In most cases the liver is somewhat enlarged and, from the large number of parasites and pigment COD tained within its capillaries, is of a dark slate-colored hue, often almost black.
t pillarieS Of the I +rttl‘, f the portal vein, and •,,. 1,c,,atie loin aro found to be , w th pigmented parasites. In r:,- f the portal vein may be lar:c st macrophages, which o, • ,r.g atcd in the spleen and which, ,.t • vv., of their large size, obstruct tr•v f the vessels. The hepatic dr, and often contain pig :•:. ,,nd at times fragments of red l-c. 11 vs, lc s may be observed within '1,- -1 'File capillary endothelial cells .1,Irce,imitly show the presence of ; as an evidence of their phago action. and as they are often con , !era' !y swelled the capillary lumen be ,...11,cs correspondingly limited. In the p-.r;i-crtal connective ti.ssne a small-cell difcration is not infrequently to be ob s.,rved, which may be the starting-point fr ,m which occurs the hepatic cirrhosis times noted as a sequel to malarial f. ction (Ma nnal lerg).
[Barker (Johns Ilopkins IIosp. Re rts, vol. v. '95) describes the occurrence cf F attcred foci of local necrosis of the liver tissue, depending, probably, upon capillary thrombosis brought about by various forms of leueocytes. They are %cry similar, however, to analogous cbangcs occurring in other acute infee Cl-us diseases, in which their occurrence is ascribed to the action of circulating t( xins. JAmEs C. WILSON and Tnomns G. A,nToN.1 The Ever in most cases shows a varying d_;rec of hypermmia, -which accounts, to a , tqta:n extent, for the enlargeinent of t1.1;:s rgan. To the hyper[einia, also, as ti- the large amount of pigment (l'er in the organ, is to be ascribed :P" r r,-tse in weight.
7 e idn eys.— The macroscopical 1"..11,;$ "0 apparent in the liver and si:ec .re not often to be observed in P ' Nevertheless, at times, r- • f pi_men:ation can be detected within the cortex or along the course of the vessels in the pyramids. Microscop
ically, pigmentation to a considerable ex tent may be observed, especially in the gloinerrili, the pigment being contained within large leueocytes, which may pro duce a narrowing of the calibre of the vessels; at times the endothelium of the gloineruli may be pigmented. Degenera tion and clesquamation of the epithelium of the capsules of Bowman constitute one of the most serious lesions, while in the tubules may be found, here and there, areas of necrotic epithelium.
limmoglobinuric, or black-water, fever the changes in the kidneys are most marked. They are usually increased in size, of somewhat lessened consistence, and of varying color, being frequently pale and an2emic in appearance; less fre quently they are a darkened color. Upon the surface of the organ, especially when it is pale, are to be observed scattered brownish spots due to pigment-deposits which crowd the epithelium and lumina of the uriniferous tubules. Kiener and Kelsch (Arch. de Phys. Norm. et Path., '92) have also described the appearance of intratubular hmorrhages within the pyramids, as a result of which this por tion of the renal structure assumes a deep-red color. Microscopically the renal epithelium is found to contain pigment; and pigment-rodlets, or fine-yellow gran ules, or dark, amorphous masses, are ob served to fill the lumina of the urinifer ous tubules. Usually some of the tubes are filled with blood-corpuscles, and sometimes the evidences of a beginning nephritis are fonnd.
Malarial fever should be given a promi nent position in the etiology of chronic as Well as of acute nephritis. In all cases of malarial fever the urine should be closely watched. A blood-examination should be made in all cases of nephritis occurring in those who have visited or lived in a. ma larial district as it often happens that the severe grade of nephritis resulting may mask entirely the clinical picture of ma larial fever. Lamed (Johns Hopkins Hosp. Bull., July, '99).