'upper • 11 Policlinic°, II. 5, f. 4. 1902).
Prognosis.—The prognosis of malaria influenced by a number of conditions the most important of which is the variety of parasite to which infection may 1.e due. Thus, the prognosis of or dinary quartan and tertian fevers when pri.perly treated is almost always favor although even these milder forms infeeti. n, if treatment be neglected or 1,1,.!1'ci..ntly carried out, play be followed ea I ex.a or ameinia of severe grade.
- turtaly mentioned, however, the tend the,,e infections is toward spon taneo,is recovery. _Estivo-autumnal in f. • ti. ns, n the other hand, show this t( a much less degree, and if '0.ft tr- ti.Pmselves are much more likely n into one of the grave post .? WrL! •-onditions, or to develop per .1-z manifestations; nevertheless the rozni=i= if ordinary mstivo-autumnal f. wl-o-n properly treated, is favor able. although it must be borne in mind that in this infection greater activity of treatment is demanded.
111 the pernicious fevers the prognosis is always grave and can never be consid ered as favorable until that period of time has passed during which the occur rence of a second paroxysm is likely. These cases, of course, call for the great est activity in treatment, and upon the efficiency with which this is carried out the prognosis largely depends.
The g,rave amemias occurring as se (-plebe of malaria are events which should cause the deepest concern regarding ulti mate recovery; their course is only too apt to show progressive tendencies. The prognosis of chronic malarial cachexia depends largely upon the patient's abil ity and willingness to take advantage of changed climatic conditions.
Malaria is a disease that rarely kills in the large towns of the Atlantic sea-board. William Osler (Internat. Bled. Mag., Jan., '96).
Five thousand and forty-four cases of malaria collected from the records of five hospitals in Philadelphia and it is found that there has been a decline in the num ber of cases during the last half-century and more especially during the last twenty-five years. J. M. Anders (Univ. Bled. Mag., May, '97).
Malarial infection in Cuba is extremely severe, and attacks all of the population.
It continues for an indefinite time, ag gravates all associated disorders, and one attack predisposes to another. The victim of paludism has his powers of resistance lowered, and, while the im mediate mortality is comparatively small, yet to it must be added a large number of deaths which are to he attributed to malarial cachexia and intercurrent com plications. J. M. Espada (Jour. de Hy giene, June 22, '09).
Treatment.—In cinchona and its de rivatives, more particularly quinine, we pos-sess a remedy against malaria that tnay be regarded as a true specific. That quinine owes its efficacy in malaria to the destructive influence which it exerts upon the parasite is now agreed to by all observers. The changes in the para site resulting from its administration have been given close study by Laveran, Golgi, Romanowsky, Marchiafava, Big nami, Mannaberg, and others. The ac tion is most marked upon the young ex tracorpuscular bodies and very slight upon the parasite during the corpuscular phase of its existence. This is true not only of the parasites of the regularly in termittent group of fevers, but is also true of the parasite of Tstivo-autumnal fever. It follows, therefore, that the ad ministration of quinine a few hours be fore an expected paroxysm will not pre vent its occurrence, because at the time of its administration the parasites being within the corpuscles are in that phase of their cycle of existence during which they are the least susceptible to the ac tion of the drug. Segmentation is not prevented, therefore, and the paroxysm occurs, but the resulting free young seg ments are destroyed and their further evolution cut short, so that the next suc ceeding paroxysm is averted.
After the administration of quinine the active movements of the amceboid parasite, particularly of the tertian vari ety, are observed to lessen, while the pig ment tends to clump and the parasite becomes more highly refractive. At the same time the parasites are much dimin ished in number and present the evi dences of degeneration, hydropic and fragmented forms prevailing.