added to the febrile attacks, and to the associated anæmia, we may meet in cachectics with a variety of functional troubles. One characteristic of most of these functional troubles is the periodicity they generally observe. Thus we may have quotidian, tertian, or quartan neuralgias, gastralgias, vomiting, diarrhœa, headaches, attacks of palpitation, of sneezing, and so forth. Besides these, skin eruptions—— such as herpes, erythema nodosum, patches of lichen planus, eczema, urticaria, possibly synovitis—— exhibiting a periodic liability to exacerbations and an amenability to quinine, have been noted in malarial conditions.
Peripheral neuritis.—— I frequently see cases of well-marked peripheral neuritis, especially in patients from the West Coast of Africa, whose symptoms have been attributed to malaria. The degree of paresis varies from total inability to stand to weakness merely. There can be no question about the antecedent malaria, but whether the neuritis in every instance be the direct result of this infection it is hard to say. I have seen a well-marked multiple peripheral neuritis, in which there was slight fever with abundant subtertian parasites, promptly subside on the administration of quinine. In this case the neuritis began with violent cramps in the legs. Loss of memory, partial or complete, appears to be a common accompaniment of this condition.
Herpetic eruptions are very common in malarial attacks. According to Powell, in Assam the appearance of a patch of herpes somewhere about the body, usually the lips, is regarded as an infallible sign that the attack of fever is over for the time being.
Hœmorrhages.—— In high degrees of cachexia, hæmorrhages of various kinds are apt to occur; in such conditions epistaxis, hæmoptysis, hæmatemesis, melaena, retinal hæmorrhages, purpura, occasionally hæmaturia or hæmoglobinuria are not infrequent. In such patients trifling operations——tooth extraction, for example—— may prove a dangerous matter. I have seen in malarial cachectics hæmorrhages from the latter cause which were very difficult to control.
