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Studies of Malaria in Panama

V. Pernicious Malaria¹

1. The material studied included 331 attacks of pernicious malaria.

2. Three pathological subdivisions of pernicious malaria are suggested to replace the numerous old subdivisions based on predominant symptoms or complications erroneously attributed to malaria. The subdivisions or groups are as follows: (1) hyperinfection; (2) cerebral thrombosis, and (3) erythrolytic hemoglobinuria.

3. Three clinical criteria are proposed for recognizing the pathological groups: (1) degree of infection—6 per cent or more of the red blood corpuscles infected; (2) cerebral symptoms—coma or stupor, and (3) hemoglobinuria—trace to "blackwater."

4. A statistical study of the three groups is given, and treatment discussed.

5. The causes of death and the parasites of pernicious malaria are discussed.

¹ Read at the nineteenth annual meeting of the American Society of Tropical Medicine, San Francisco, Calif., June 25, 26, 1923.