ALTITUDE influences the development of malaria to the extent that with in creasing elevations a corresponding de crease in the prevalence and intensity of the infection occurs. and. even in mala rious districts, those residing in the upper stories of dwellings are less liable to the disease than those whose living quarters are nearer the ground. While increasing elevation has the effect men tioned, it must be borne in mind that malaria may prevail wherever heat, moisture, and decaying vegetable detritus are to be found associated, and the in crease in altitude simply diminishes the chances for the association of these con ditions.
malaria is a wide spread disease. In America the region of its prevalence is gradually becoming more and more restricted, and in many sections, notably the New England States and upper Atlantic sea-coast, where for merly it prevailed extensively, it has now ceased to occur except in the mildest forms. In the Southern States, particu larly along the gulf and the Mississippi River, the disease is almost constantly present, while it is still to be met with in certain regions about the Great Lakes. In Europe, although the disease is still to be found in parts of France, Germany, and even England, its chief seats of ac tivity are to be found in certain regions of Italy and in Southern Russia. Trop ical and subtropical regions, however, where the telluric and other conditions already mentioned as favorable to its genesis exist, are the parts of the world where malaria is to be particularly en countered and where it more or less con stantly prevails.
The same type of malarial fevers found in the Philippines as are found in other tropical countries, namely: the testivo-auturnnal, the tertian, and the quartan. There was this important dif ference from other tropical countries, however, which explains in part the comparative mildness of the Philippine malarial fevers: The predominating type of malarial fevers reported in other tropical countries is the wstivo autumnal.
In the Philippines a much larger per centage of the malarial fevers appears to be due to the tertian parasites than has been reported by investigation in the other tropical countries. In 223
cases of malarial fever in which the parasites were Iound in the blood, in cases observed in the First Reserve Hos pital, Manila, P. I., there occurred the testivo-autumnal parasites in 166, the tertian in 33, the quartan in 1"3,nd the tertian and aestivo-autumnal Ambined in 3.
Taking the pure infections (220 cases) alone, the tertian parasite occurred in 53 out of 220 or 24 per cent., the quartan in less than one-half of 1 per cent., and the stivo-autumnal in 75 per cent. J. J. Curry (Boston Med. and Surg. Jour., May 9, 1901).
has no direct influence upon the susceptibility to malaria. Those in the active periods of life contract the disease more frequently because they are more exposed to the predisposing causes, while the very young and the aged, only be cause they are less likely to be exposed, enjoy an apparent immunity. Excep tions to this statement will presently be noted.
Case of congenital malaria when child was 10 weeks old. Physical examination showed the patient to be much emaciated, pale and weak. Convulsions occurred daily since birth. 'When child was 11 weeks old, blood was examined and plas modium malariaz found in abundance. The child was given 1 grain of quinine by the rectum in enema twice daily, and the convulsions ceased from this time, but muscular rigidity, sleeplessness, colic, constipation, and restlessness persisted.
Since patient did not improve nor gain in weight after a month's treatment with quinine, child MIS taken to a non-ma larial place, \\ here it began to improve immediately. The plastnodia were prob ably conveyed directly by means of the fcetal circulation, although there is a pos sibility of infection by the mother's milk.
-• V.1.1 A \ And . ki 2 ' - orincioit, malarial .. 1 1%1 ,111111fallt . 1111 111(1111• I .11.M 111:.; 111'1111'1'y, Ilikaller • \ t e itne lime the child •ri it. -.• tid ;mot it.. cold, it.
it #11.1 pinched. mill linger-nail, • ," V.11 111 1.1I it 111111.1.:1(111.1.. 103.5'„ and