1116 PATHOGENIC PROTOZOA 



disease, mimicking many other infections, and that without a proper 

 examination of the blood that a correct diagnosis is frequently im- 

 possible. Pernicious malaria is often mistaken for typhoid, for 

 gastric, renal or cerebral disease, and malaria in children may end 

 fatally without presenting any of the classical symptoms. Blood 

 examinations in all febrile cases in malarious districts are therefore 

 necessary to a correct diagnosis. 



The most important sequel is marked secondary anaemia, which 

 comes on rapidly, even in cases so mild that their nature is unsus- 

 pected; in severe cases the red cell count may drop to three, two 

 or even one million red cells per cubic millimeter. The occurrence 

 of anemia, in malarious regions, should always lead one to suspect 

 this disease. It disappears rapidly under proper quinine treatment 

 but recovery can be hastened by the administration of iron and 

 arsenic. 



1. Tertian malaria is distinguished by a chill and fever occurring 

 every other day, the patient feeling quite well on fever-free days. 

 A double tertian infection occurs not infrequently, giving a daily, 

 or quotidian, chill and fever with no free day. 



2. Quartan fever, which is relatively rare, gives a chill and fever 

 every third day, with two fever-free days. In this disease also there 

 may be double or even triple infections, giving a quotidian or 

 irregular type of fever. 



3. ^Estivo-autumnal fever (subtertian, or malignant tertian) 

 shows an irregular temperature curve, the cycle varying from 

 twenty-four to forty-eight hours. By some authors this type of 

 malaria is divided into two forms, quotidian and tertian, the former 

 giving a minute ring, the latter a larger one. As multiple infections 

 are common the resulting fever curve may be irregular or continuous 

 and the chill entirely absent. In contrast to the regular intermit- 

 tency of tertian and quartan this form is often remittent, the tem- 

 perature curve never dropping to normal. 



4. Mixed infections with any two of the above fevers are often 

 found in bad malarial regions in the tropics. 



5. Latent malaria is also not infrequent, in which the patient, 

 having no symptoms of the disease, consults a physician for some 

 other reason. 



In a region where the disease is very prevalent, Bass* has shown 



* C. C. Bass, South. Med. Journ., 1919, 12, p. 460. 



