30 TROPICAL MEDICINE AND HYGIENE 



The disease has a depressing mental effect and may 

 lead to actual insanity, which as a rule terminates when 

 effective anti-malarial treatment is undertaken. 



Quartan Malaria. Clinically, this form closely re- 

 sembles benign tertian, but differs from it in that in a 

 simple infection the pyrexial attacks occur with an interval 

 of two days between them (fig. 12). The character of 

 each attack is similar to that of benign tertian in that the 

 onset is sudden, the stages of fever marked and the total 

 duration a few hours only. Quartan malaria is less 

 widely distributed than benign tertian, but also occurs 

 throughout the Tropics, and in subtropical and even tem- 

 perate climates. In some districts cases are as numerous 



FIG. 12. Quartan Fever. 



as those of benign tertian, or even more so. As a rule 

 in such countries quartan will be commoner amongst the 

 poorer classes and tertian amongst the well-to-do, but no 

 race or class is exempt. The reason for the irregular 

 distribution of quartan is not known. Double and triple 

 infections of quartan malaria occur, due to two or three 

 generations of the parasite being present in the same 

 patient, and reaching maturity at intervals of twenty-four 

 hours. With three generations the fever would be 

 quotidian, with two generations there would be fever 

 on two days and then a day free from fever, followed 

 again by two days with fever and so on (fig. 13). The 

 effects of quartan malaria are very similar to those of 

 benign tertian, but it is more dangerous to life, especially 

 in cases of disturbed cardiac action, such as in beri-beri. 



