Clinical Manifestations and Pathology

The clinical course of the disease was extremely varied, depending on whether the malarial or typhoid elements predominated. When the malarial element was dominant, the symptoms were those of periodic fever - usually of the remittent rather than the intermittent variety. It was frequently quotidian but could be tertian, quartan, or irregularly remittent. However, the patient was more than usually depressed; there were frequent central nervous system symptoms, commonly stupor or coma, as well as gastrointestinal complaints, most commonly diarrhea. The disease was of more rapid onset than classic typhoid fever, but if the typhoid elements dominated, the disease would clinically resemble typhoid fever except for a definite periodicity, frequent hepatic tenderness, and a greater degree of splenomegaly, often with pain on palpitation. The convalescence would be more rapid than typical typhoid fever.

At postmortem there was a "greater tendency to the deposit of black pigment in the enlarged follicles" of the small bowel in typhomalarial than in typhoid fever. Furthermore, there were, in Woodward's (1863) formulation, some differences in the enlargement of the intestinal glands, the glands rising more gradually from the surrounding tissue in typhomalarial fever cases than in typhoid. By 1876, however, Woodward denied the significance of this supposed difference.

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