IC MALARIAL CACIIEXIA.
n r it s rathulogical changes are to be rvLd in the org.ans of those who have 1 -7.1; ,ubjetts of lon_ce-continued z:•,1 L;ith malaria; the most note f these changes occur in the 1;N-cr. and bone-marrow.
Sp.'ren.—Notable enlargement of :Lc sr•14 on always occurs, and thickening f •::p-ule is u=ually to be found. This •',:..I7en•ng. as a rule, is not evenly dis t-i'. but is apt to show as scattered .t infrequently these islets, or 11'.f arr, cartilaginous in character, ? - 7ionally ossification of the cap -.Ile p'acP. The consistence of the . :s much increased and its r 11-'1 lly well defined. Tts color..s.,ally rel. but not infrequently it a grayi,h-brown or slaty color. The , 1- Hare shows marked prominence of 7 -rat eci ke, which corresponds to the el,z-rce inrrease of the connective ? l tl.C,ckening of the sheaths of the vessels. The veins are dilated to such an extent as to simulate angiomata, and the Malpighian bodies arc but slightly apparent.
The microscopical changes are signifi cant. Shortly after the termination of the actual infection a cessation of the acute hyperemia occurs and necrotic areas develop in the pulp, while some of the follicles also become necrotic and fibrous.. In addition, extensive regener ative changes take place, originating largely from the follicles, which become markedly hyperplastie; hyperplasia of the elements of the pulp is also to be ob served. The arrangement of the pigment becomes changed; it gathers in small clumps in the pulp and becomes con centrated in the sheaths of the vessels and the connective tissue of the septa. The macrophages, which in the acute tumor are the carriers of the pigment. disappear, probably as the result of de generation, and the pigment in the chronic tumor becomes extracellular (Mannaberg). Subsequently the pig ment disappears completely. While ab sorption of the areas of necrosis takes. place, dilatation of the vessels and hyper trophy of the septa become more marked and the splenic pulp becomes so com pressed as to entirely disappear. The final result of these changes is that the function of the spleen is entirely de stroyed and the recognition of its histo logical elements becomes impossible.
The Liven—The liver is increased in volume and weight, at times very greatly; its surface is smooth and its consistence increased; thickening of the capsule is. of frequent occurrence. The cut surface is found to vary somewhat in accordance with the duration of the infection. In general, the lobules are slightly promi nent and quite distinct, while the appear ance of the surface is finely granular.
The changes to be observed by micro scopical examination are thus summa rized by Mannaberg from the researches of Bignami. Shortly after the termina tion of the acute infection it will be no ticed that the parasites have disappeared from the capillaries. the endovascular macrophages are no longer to be seen, and the pigment is entirely collected in the endothelium and in Kupffer's cells. A decided atrophy occurs in those parts of the liver-lobules in which necrosis has taken place and the vessels become di lated. The lobule is further freed from pigment, which is carried by the mono nuclear and polymorphonuclear leuco cytes to its periphery. At the same time the beginning of regenerative changes becomes apparent in the liver-cells.
The next stage is that which, in conse quence of the atrophic and regenerative processes, leads, on the one hand, to the development of psendo-angiomata and lymphatic cysts, and, on the other, to the formation of abnormally-large lob ules. The pigment is carried out of the vessels by the leueocytes and deposited in the perivascular lymph-spaces, while the perilobular connective tissue becomes hyperplastic.
The final result is a large, dense liver, of a reddish color, which upon section shows the finely-g,ranular lob-riles to be surrounded by trabecuhe of connective tissue. The vessels are dilated and the organ is congested, while pigmentation is no longer to be seen. Kelsch and Kiener assert that a few months after the termination of the acute infection pigment is no longer to be found, and Bignami has observed that it has, in large part, disappeared in from three to four months.