Malaria has a wide geographical distribution. No continent is entirely free from it, and certain parts of the tropics are practiciflly uninhabitable by reason of the severe types of fever which pre vail. In Africa the west coast is the worst dis trict. In Asia many portions of India, especially along the valleys of the Ganges and Indus rivers, and parts of China and Persia, are malarious. In Europe the disease prevails in Holland. North Germany, •the west coast of Italy. and the far districts of England. In North America it occurs chiefly along the lower Atlantic seacoast and in the Gulf States. The disease is always associated with warm, marshy soils, estuaries, badly drained low-lying districts, and tracts of land rich in vegetation, which offer suitable breeding places for the mosquito.
A typical attack of malaria. or paroxysm. is characterized by three well-defined stages—the cold stage is preceded by a headache, yawning, and general malaise; gradually the patient begins to shiver, and in the height of the chill shakes violently. The temperature rises to 102 or even to 105 or 106 degrees. This stage lasts from ten minutes to an hour, and is followed by the hot stage. during which the coldness of the surface
disappears and the skin becomes flushed. In from one-half to three or four hours the sweat ing stage sets in. Beads of perspiration appear on the forehead, and the whole body is bathed in a copious sweat. The fever and headache dis appear. and within an hour or two the patient sinks into a refreshing sleep and the paroxysm is over.
hi the pernicious form of malaria which occurs in the tropics and is always associated with the zestivo-autumnal parasite, the attack is sudden and violent. with intense cerebral disturbance, either delirium or coma. This form is generally fatal. The only remedy which can be relied on in this disease is quinine, which may be regarded as a specific. Large doses have sometimes to be given in the severer types of the affection. For the profound anamia following long-continued infections, iron and arsenic are given. Consult: Osier. Practice of Medicine (New York, 1901) ; Seheube. Discascs of IVarni Countries (London, 1903): in the latter book will be found a com plete list of articles on recent discoveries in malaria. See AGrE; INTERMITTENT FEVER; MASAI A.