DISEASES CAUSED BY H^MOSPORIDIA 



35 



tion showing the presence of the parasites confirms this 

 diagnosis, and it is the only way in which it can be made 

 if the patient is seen during the apyrexial interval. In 

 many cases of the disease the fever is quotidian, that 

 is, a pyrexial attack occurs every day. This is the so- 

 called double tertian, and is due to the co-existence of 

 two generations of the parasite maturing on alternate 

 days. Sometimes the double character of the infection is 

 obvious clinically, as the pyrexial attacks vary in severity, 

 being alternately severe and mild (fig. u). In a double 



F" 

 105 



104 



103 



102 



iO I 



I OO 



99 



98 



97 



M E M E M E | M EMEMEMEMEME 



FIG. u. Double Tertian. 



tertian the more frequent recurrence of the pyrexia causes 

 more rapid development of anaemia and debility, and 

 the prognosis therefore is more serious. The nature of 

 the disease may be suspected from the completeness 

 of the apyrexial intervals, from the shortness of the 

 pyrexial attacks, and in some cases because the pyrexia 

 occurs in the morning, whilst in most forms of quotidian 

 intermittent fever the pyrexia is in the evening. A 

 certain diagnosis cannot be made without an examination 

 of the blood. As the name implies the prognosis, as 

 regards life, is favourable. The fever is distressing but, 

 as a rule, not dangerous. Cerebral symptoms are usually 

 delirium and such symptoms as occur in any febrile 

 condition. Rarely coma occurs, and in exceptional cases 

 may be fatal. 



