34 



TROPICAL MEDICINE AND HYGIENE 



below normal, when, beyond a certain amount of debility, 

 or sometimes a mild form of collapse, the patient will feel 

 well and be able to resume his occupation. 



The next day, and till forty-eight hours after the 

 occurrence of the rigor, the patient remains to all 

 appearances in normal health. At the end of this period 

 there is another similar pyrexial attack, and on each 

 alternate day, in an untreated case, these attacks of pyrexia 

 recur. Even without active treatment, sooner or later 

 the paroxysms diminish in severity, and gradually dis- 

 appear altogether, and the temperature may remain 



103 

 (02 

 tOl 



too 



99 

 96 

 97 



C M E M IE M E MJE M E M E M E |M E M E M E MEM E 



FIG. io. Simple Benign Tertian. 



normal or subnormal for two or three weeks, when 

 another series of febrile paroxysms on alternate days 

 will occur. These attacks of tertian fever alternating 

 with apyrexial intervals may continue for two or three 

 years. During the whole time the patient is suffering 

 from infection with parasites of malaria, and visceral 

 changes, especially enlargement of the spleen, are likely 

 to occur, as well as anaemia and general debility. Death 

 is unusual even if treatment be neglected, and a fatal 

 result is usually due to concomitant disease. 



In a simple benign tertian the character of the pyrexial 

 paroxysms and the regular periodicity of their recurrence 

 enable diagnosis to be made readily. Blood examina- 



