The endemic diseases of the southern states . race than in the negro. While negro children are notinfrequently the subjects of malarial cachexia, it is much rarerin the adult negro. Of adults, males are more commonlycachectic than females; among children the proportion is abouteven. The condition rarely develops in persons of the betterclass, but is seen in those living under improper hygienic con-ditions and who neglect the treatment of acute malaria. Cases of cachexia developing without outbreaks of malariahave been reported, but are subject to question. Infectionswith the estivo-autumnal pa
The endemic diseases of the southern states . race than in the negro. While negro children are notinfrequently the subjects of malarial cachexia, it is much rarerin the adult negro. Of adults, males are more commonlycachectic than females; among children the proportion is abouteven. The condition rarely develops in persons of the betterclass, but is seen in those living under improper hygienic con-ditions and who neglect the treatment of acute malaria. Cases of cachexia developing without outbreaks of malariahave been reported, but are subject to question. Infectionswith the estivo-autumnal parasites are followed by cachexiamuch more frequently than tertian and quartan infections. The cachectic usually presents a singular appearance. Theemaciated limbs are in marked contrast to the big belly, andthe features are aged beyond the years. The most pronouncedphenomena are the anemia and the enlarged spleen. The redblood-cells may be reduced to seven or eight hundred thousandper cubic millimeter. The leucocytes are generally normal in. 128 ENDEMIC DISEASES OF THE SOUTHERN STATES number or a little below. Numerous differential counts haveshown a relative increase of the large mononuclear red cells may show basophile degeneration, polychromato-philia, poikilocytosis and nuclei, but none of these changes areby any means constant. According to my experience parasitesare rarely found in the peripheral blood. The spleen oftenextends to the umbilicus and to the crest of the ilium, sometimesbeyond. It is usually hard and the anterior border presentsa sharp edge. Pain and tenderness on pressure are not alwaysfelt. Occasionally a bruit is to be detected over the splenicarea. The pulse is small, compressible, and may be of the heart and hemorrhages, especialty epistaxis,ma} occur. An anemic murmur over the precordia is oftenheard. Myocarditis and dilatation are not infrequent. Thebreath is short, sometimes amounting to actual dyspnea. Acough is com
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