WHEN the malarial poison, instead of being eliminated from the system , remains to pursue its ravages, a series of constitutional effects follow, which are called the Malarial Cachexia.
The symptoms of this Cachexia vary from those which mark merely chronic disease to those which indicate remote changes in functions and tissues.
When a patient is continually exposed to the miasm which gives rise to chills and fever, he no longer displays the typical, recurrent symptoms of an intermitting fever; except, perhaps, in the height of the “season” when, a fresh supply of the poison arouses the system from its condition of non-resistance. But he is constantly suffering from a series of symptoms which indicate that depraved state of the body we call Cachexia. As this state becomes more and more fixed, nutritive changes develop and increase, and finally a condition is reached which constitutes what we may term the remote effects of Malaria.
We are to consider, then, tow conditions differing only in degree the one the ultimate effect of the other .
In the early manifestations of the Malarial Cachexia, the patient suffers from general Malaise. Clear, crisp days days are enjoyable, but every damp day, especially every warm and wet change, makes him gloomy, weary and cold.
One suffers from biliousness; another from diarrhoea; a third is tormented with Neuralgia. Still another feels tolerably well, but the onset of any disease is the occasion for an arousing of the malarial poison, greatly to his discomfort as it complicates his case and renders recovery tardy and uncertain. As the Cachexia becomes more permanent, the victim displays more constant symptoms, indicative of organic lesions. He is pale or sallow, jaundiced when the liver is diseased or its ducts obstructed, but yellow whether icteric or not. The mouth is dry, there is bitter taste and the tongue is furred. He is melancholic, suffers from tinnitus aurium, and complains of spinal irritation and even of paretic symptoms. He is always dizzy, even when not bilious.
Soon he becomes anaemic; and liver and spleen are enlarged forming what are termed “ague-cakes” a term most frequently applied to an enlarged spleen, though no less applicable to the swollen liver, too.
Still later, there develops a sort of cirrhosis of liver spleen and kidneys “Ague-cakes” are now replaced by contracted organs, congestion and haemorrhage giving place to softened pulp, fatty degeneration, amyloid changes and hypertrophy of the connective tissues. The basement membrane of the kidneys is thickened and uriniferous tubules are filled with cast off epithelium.
The heart, like muscular tissue elsewhere, becomes softened and flaccid; finally it is dilated.
Anaemia is an early and progressive symptom. Dependent at first upon defective manufacture of blood, arising from diseased spleen, etc., it soon finds other causes in the advance stage of the Malarial Cachexia; especially in imperfect digestion and in defective assimilation from intestinal catarrh and alterations in the intestinal glands.
Disintegration of red corpuscles leads to two sets of accidents; one haemorrhage, which most commonly appears as epistaxis; the other, the effects of emboli. These emboli, if they may be so- called , arise from a clogging of small vessels with pigment granules, derived from the broken down blood-cells in the spleen.
A common symptom is Dropsy. This may appear as oedema of the ankles, as Ascites, or as Anasarca, according as it arises simply from anaemia or from lesions of liver, spleen, heart or kidneys.
Finally, as still more remote effects of Malaria, we may refer to the wrinkled and half-imbecile state referred to by Watson, as, resulting from a protracted residence in miasmatic districts. Children reared in such places are dwarfed and idiotic; adults are shrivelled, stoop-shouldered and also mentally impaired.
So similar are the effects of Malaria to those of Quinine that when Cinchona has been misapplied or extravagantly employed, it seems to intensify the perniciousness of the former, and thus to aid in the permanency of a Cachexia.
T R E A T M E N T
To give in detail the treatment of the Malarial Cachexia would be to reproduce the Materia Medica. Still, there are several drugs, the pathogenesis of which so closely resemble the chronic effects of Malaria, that we may confine our studies to them.
These drugs are: Arsenicum, Carbo Veg. China, Chinin. Sul. Sulphur, Aranea Diadema and Natrum Mur.
When practicable, the patient should be removed to another and more healthy district. If he is taken to a mountaineous country, it must be dry and free from stagnant pools and dense woods. Remaining out of doors after sunset and leaving the house at or before sunrise should be strictly interdicted. Such invalids are very susceptible to exhalations from the ground and also to the dampness of nightfall. If the patient is taken to the sea- side, care must be used to see that the locality is well-drained. Sandy soil soaked with either the offal of the kitchen or that of water-closets is particularly objectionable to malarial patients, and will hinder their recovery if it does not increase their recovery if it does not increase their maladies.
When acute paroxysms now and then develop, select one of the following : Lachesis, Sulphur, Carbo Veg.
If the spleen is affected; Arsenic, Carbo Veg., Aranea, Sulphuric Acid., Sulphur, Ceanothus (the last one if its pain is present.).
If the liver is diseased, with or without duodenal catarrh: China, Arsenic (Duodenitis), Lachesis, Sepia, Polyporous Officinal, Sulphur, Calcarea, Carb.
Dropsy calls for: Arsenic, China, Ferrum, Sulphur, Apis, Apocynum Can., Helleborus (when Arsenic fails), Digitalis (circulation weak, pulse thready with every little exertion).
Chronic Neuralgia; chinin. Mur., Arsenicum Cedron (left Supra- orbital), Chinin. Arsenicum, Chinin. Arsenicum, China., Chinin. Sulph (spinal irritation).
For protracted debility, sallow complexion but no dropsy Sulphur, Arsenicum, Chinin, Arsenicum, Carbo Veg., Ferrum, Chelone, Alstonia.
Hysterical symptoms require, probably, Tarantula (Jousset). As several of the mineral acids cause a sort of liver cachexia, they should be considered in severe cases.
To remove the Cachexia, it may be necessary to institute a careful and exhaustive analysis of the case under consideration, for the initial chill on. In this manner we sometimes find a meaning for existing symptoms, otherwise apparently insignificant.
A skilful physical may often trace indications for a remedy, which, though originally indicated, was awkwardly applied or utterly forgotten, but which still suits the main features of the case. And again, it may be that the early paroxysms were suppressed by crude drugs and no remedy can be found for the disconnected malady of existing symptoms. Under such circumstance, Ipecacuanha 30 should be prescribed to prepare the way for a more profoundly acting medicine. Quite frequently, too heredity and various acquired dyscrasiae step in to complicate and perplex, and must be considered in prescribing.
When the patient suffers in damp places or in wet weather, Aranea, Nat. Sul., and Rhus may be studied. When the spleen is the seat of sharp pains, we can thank Dr. Burnett for an efficient remedy in Ceanothus. When the liver is affected and the patient is annoyed with sick headaches, yellow tongues, nausea, dull dragging pains in the liver through to the back, etc. Polyporous Officinalis is required. If, however, the patient is a child, or a well-marked “lime-subject,” Calcarea Carb. acts rapidly for enlarged liver with a feeling of fullness to bursting in the right hypochondrium, worse from stretching, or which is equivalent, from bending over to the left.
A case of Morbus Brightii of malarial origin was cured chiefly with Sulphur 30 and 2c.. The urine was albuminous and contained casts; the patient was sallow, emaciated and dropsical. Sulphur was chosen because of hunger in the fore-noon, burning of the feet, restless sleep and a tendency to relapse after apparently well-indicated drugs. The urine was examined every two weeks, at first by Dr. Tyson and later by Dr.E.Seguin.
A young lady who contracted chills and fever in St. Louis in 1880, was not cured despite Homoeopathic and Allopathic treatment. In the fall of 1882, after conducting a kindergarten for three months, she was so prostrated that she was obliged to take to her bed. Chills came regularly accompanied by jerking of the head backwards, opisthotonos and general tremors. Cicuta 2c. was the only remedy that helped. For the remaining spinal exhaustion and general muscular weakness, remedies were wholly ineffective. Galvanism and massage were relieving. After the disease assumed the nervous from, a persistent vomiting (which , by the way, nothing but grain doses of Quinine would stop, showing their origin), ceased. It has not yet returned.
An elderly lady, living in a marshy region in Maryland was so prostrated by Malaria and Quininism that the became bed- ridden. Her extreme weakness, together with such symptoms as flatulency, inability to take the simplest food without burning in the stomach or vomiting cold feet and legs, led to the selection of Carbo Veg. In four or five months, she was able to go about the house, and is now well.