Death Due to Estivo-Autumnal Malaria

Abstract

Summary 1. The records of 100 patients who died of estivo-autumnal malaria and upon whom autopsies were performed at the Board of Health Laboratory, Gorgas Hospital, Ancon, Canal Zone, between 1925 and 1942 were reviewed. One and six-tenths per cent of all autopsies (6,214) performed during that period were on patients who died of estivo-autumnal malaria. 2. Deaths occurred in all months, although questionable peaks in May–June and December–January were present. 3. Of 39 Panamanians in the series, 34 were children 10 years or younger. 4. The duration of symptoms before hospitalization varied from four and one-half hours to twenty-one days. Twenty-three patients had symptoms of not more than one day before hospitalization and yet they died. 5. The degree of parasitization of the peripheral blood was not a wholly adequate index of the seriousness of the illness since 12 patients with light infections died within twenty-four hours of admission despite heavy treatment with quinine. 6. Some of the classical signs and symptoms of malaria such as chills, headache, vomiting, palpable liver, and spleen were absent in one third to one half of the patients. 7. The clinical and pathologic changes which have been described in shock were recorded in one third of the patients upon whom classification of the type of death was possible. 8. No correlation between cerebral malaria as noted clinically and cerebral plugging as recorded at autopsy was apparent in our material. 9. Two case reports illustrating the occurrence of shock in patients with malaria were presented. Anti-shock measures were believed to have saved the life of one patient.