Irregular or masked forms are more frequent in young children and are more apt to be misinterpreted.
The child may have no paroxysm at all and the fever may be very irregular in type, simulating many diseases. Headache is very frequent and may be associated with vertigo and drowsiness. Pain in various parts of the body is not uncommon.
Holt called attention to acute pulmonary congestion which may accompany the paroxysm of malaria. This may give rise to obscure symptoms. The onset is acute with vomiting and prostration, high fever, cough, rapid respiration and often slight. cyanosis. Feeble respiration is heard over one or both lungs occasionally with moist vales. These symptoms may disappear in the course of a few hours to return with the next paroxysm. If quinine is given they may entirely disappear.
Chronic Forms of Malaria; Malarial Cachexia. These cases are often mistaken for anemia and the real cause overlooked.
The child is pale and sallow arid the spleen is enlarged. There may be a slight irregular fever. There may be slight oedema of the lower extremities, general muscular weakness, coated tongue and loss of appe tite. There is liable to be indigestion with attacks of vomiting. There is a tendency to hrumorrhage and the urine may contain blood. The only positive evidence of malaria in such cases is the presence of the malarial organisms in the blood.
positive diagnosis is made by an examination of the blood. It requires, however, considerable practice to become expert in the diagnosis of malaria from blood slides. Both stained and fresh specimens should he examined. The best time to take a specimen of the blood is a few hours before the paroxysm, before quinine has been admin istered. If malaria is suspected repeated examination of the blood should be made. The therapeutic test with quinine may be made in cases where a blood examination is not feasible. A fever that reacts promptly to quinine is probably malaria and one that does not is due to sonic other cause.
The periodicity in the symptoms is suggestive of malaria as is an enlargement of the spleen. The spleen is enlarged in a child when it can be felt below the border of the ribs. Malaria must be differentiated from typhoid, tuberculosis, septicremia, broncho-pneumonia and certain forms of nephritis.
The recurring chills and fever in pyelitis are often attributed to malaria. Conditions accompanied by an enlarged spleen such as amemia, syphilis and rickets may be mistaken for malaria.
With the modern methods of diagnosis no physician should fall into the error of regarding all vague and indefinite symptoms as malarial.
is rarely fatal in young children, but it may lower the child's resistance so that he is more liable to succumb to some acute disease.
Treatment : consists in malarious districts in destroying mosquitoes and in protecting children from their bites. Drainage of marsh lands and the use of crude oil on the breeding places are efficient. The windows, doors, porch and the baby's crib should be well protected with screens and mosquito netting. Ointments contain ing pennyroyal, turpentine, etc., may be used on exposed portions of the body.
general treatment is symptomatic along general lines. An initial purge with calomel is indicated. During the chill, stimulants or a cold bath may be required and in the hot stage, ice to the head and frequent sponging.
The specific drug is quinine. This should be given early and con tinued until a cure is effected. The bisulphate in solution is preferable in young infants. Relatively larger doses are required for infants and young children than for adults. An infant one year old will require from 10 to 15 grains of the bisulphate in twenty-four hours and even larger doses may be given without producing cerebral symptoms.
When the quinine can not be tolerated by the stomach it can be given in solution per rectum through a catheter. Suppositories of quinine are sometimes used. The hypodermic injection of the hydro bromatc or bimuriate of quinine is advocated by some but it should only be employed in serious attacks, on account of its producing local irrita tion and abscesses.
In children over a year old the taste must be disguised. Euquinine and tannate of quinine are almost tasteless. There are several tions of quinine combined with chocolate on the market. An aqueous solution of the bisulphate can be mixed with the syrup of red sarsaparilla, etc. Capsules or wafers containing the sulphate of quinine can be given to older children.
In young children it is best to give the quinine in frequent small doses. The quinine should be given for at least a week after the last symptom of malaria.
In chronic cases iron and arsenic in some form should be given.