their sallow, dry, rough, unhealthy-looking skins. In many malarial cachectics the skin pigmentation is remarkably dark; patches of almost black pigmentation are also sometimes discoverable on the tongue and palate.*[1] It is said that in some intensely malarial places children are occasionally born with enlarged spleens, as if the malarial poison had already affected them in utero. I cannot personally vouch for this, but I have often seen very young children with bellies enormously protuberant from distended spleen. According to Scheube, De Freytag and Van der Elst observed in 1873 and 1878 in Atchin that all the children born were affected at the time of birth with malarial cachexia, and that most of them died in a few months. Bein and Kohlstock found malaria parasites in the blood of the four-months-old child of a malarial mother, born some time after the arrival of the latter in a non-malarial district. Bignami failed to find malarial parasites, malarial pigmentation, or other sign of paludism in the fœtus of a woman who died of a pernicious malarial attack an observation which has been repeated and confirmed by other pathologists. Although unusual, more recent observations have shown that infection of the fœtus in utero through the maternal circulation does occasionally occur, presumably through rupture of the placental attachments.
Clark's observations on placental blood films in subtertian malaria suggest that the malaria parasite does not enter the fœtal circulation unless through an accidental rupture of placental vessels during pregnancy. Films made from the maternal face of the placenta showed parasites in 19 cases, whereas films made from blood from the umbilical cord of the same cases showed parasites in one instance only, and in this case there was a history of accident during the pregnancy. Clark found that the maternal placental blood was much richer in parasites than finger blood from the same cases, and in a considerable proportion of instances (11 in his 19
- ↑ * Observations in India tend to show that this condition, melanoglossia, is racial and not pathological.
