CLINICAL DIAGNOSIS IN MALARIAL FEVER 



37 



It persists for a longer time, and often yields less readily 

 to quinine. 



Clinical Diagnosis. The single and double infections 

 are easy to diagnose because of the peculiar periodicity. 

 In a triple infection the quotidian periodicity may not 

 only be confused with double tertian, but with any 

 diseases in which quotidian fever occurs. Prognosis is 

 good in uncomplicated cases if well treated. 



In some cases the parasites are scanty, but even in small 

 numbers may give rise to occasional attacks of fever or, 

 without any pyrexia, to malaise. It is perhaps more 

 frequently overlooked than any other form of malaria. 



F 

 104 



103 



102 



IO I 



I OO 



99 



98 



97 



M Eltt C M E 



FIG. 13. Double Quartan. 



Pathology. The malaria parasites of both the benign 

 tertian and quartan fevers circulate freely in the blood 

 throughout the body. When the parasites are full-grown 

 they have a tendency to remain in the splenic sinuses, 

 probably because the red corpuscles containing such 

 parasites are so altered as to adhere to the walls of the 

 smaller vessels. This tendency is more marked in benign 

 tertian than in quartan, but in both numerous full-grown 

 forms will also be present in the peripheral blood. 



The rigor follows shortly after sporulation. For some 

 unknown reason, with both species of parasites, the 

 stages of growth are completed either all about the same 

 time, or at periods differing by twenty-four hours from 



