96 DISEASES DUE TO PROTOZOA 



in the late summer and late autumn, and hence is called " aestivo- 

 autumnal " fever. 



It has been noted that crescents can rarely be found in the African 

 subtertian fevers, but when these patients get to Europe the parasites 

 can more frequently be found (Manson). 



The fevers produced by the subtertian parasite are very irregular, 

 the rigor is less marked, the pyrexial stage more prolonged, while 

 vomiting, body pains, intestinal disturbances and depression are more 

 marked. Relapses are much more frequent. There may be a false 

 crisis preceding the true one. There is a rapid destruction of 

 corpuscles, followed by a marked cachexia. Grave symptoms may 

 arise at any time. 



Double Subtertian Fever. 



This is caused by two broods of the Laverania malarise parasite, 

 and has symptoms in common with the preceding form. 



Irregular Subtertian Fever. 



This is caused by several broods of L. malarise sporulating at 

 different times, causing an irregular fever. It is common on the West 

 Coast of Africa. 



Remittent Subtertian Fever. 



An ordinary attack may be prolonged or two attacks may be con- 

 tinuous, the second commencing before the first has concluded. 



These may be serious at any time or may become pernicious. 



There may be sleeplessness, restlessness or delirium. 



The liver and spleen are enlarged and tender. 



There is slight dilatation of the right side of the heart. 



Unless drastically treated the fever may resemble — 



(i) Typhoid fever in its clinical manifestations, with low delirium, 

 prostration, dry tongue, liver and spleen much enlarged, and 

 melan^mia; 



(2) Bilious fever, with vomiting, diarrhoea, constipation, jaundice, 

 due probably to the absorption of modified haemoglobin, e.g., haema- 

 phein ; the liver is much enlarged. There is much blood destruction, 

 much bile formation, and sometimes coma and death. 



(3) Adynamic fever, with tendency to haemorrhages, local gangrene, 

 hasmoglobinuria, great weakness, nervous depression, muscular and 

 cardiac debility, profound and rapid blood deterioration, icterus, 

 leucocytosis and melanagmia. 



The hasmoglobinuria must be differentiated from blackwater fever 

 proper. The former complicates a subtertian attack. 



It has been shown that L. malaria produces an haemolysin in such 

 quantities that it cannot be kept in check by the anti-h^molysin, which 

 results in dissolved blood being excreted by the kidneys. Jaundice is 

 more rare in this condition than in ordinary blackwater fever. 



