CHAPTER V. 

 SUBTERTIAN MALARIAL FEVER. 



MALIGNANT TERTIAN, subtertian, restive-autumnal, and 

 tropical malaria are some of the names applied to the re- 

 maining forms of malaria, viz., those due to infection by 

 parasites, which pass the later part of their asexual stage 

 in the visceral capillaries (Plasmodium falciparum). 

 Young forms and gametocytes are found in the peri- 

 pheral blood. The gametocytes are the sausage-shaped 

 bodies known as " crescents." It is not certain whether 

 there is more than one species of these parasites. The 

 geographical distribution of this is more limited than of 

 other forms of malaria. It is the commonest form in 

 the Tropics, and was called by Koch tropical fever. In 

 temperate regions it is not found as far north as benign 

 tertian, and in the south of Europe it occurs later in the 

 year than other forms of malaria, i.e. r in the summer and 

 early autumn, and was, therefore, called by the Italians 

 aestivo-autumnal. 



Clinically it has a less regular and definite course than 

 the other forms, and the stages of the pyrexial attack are 

 ill-defined, and last longer, whilst the periodicity is 

 uncertain. 



There is a liability to sudden onset of pernicious 

 symptoms, often fatal, even in cases apparently not very 

 severe. Hence the name malignant tertian. Sometimes 

 before the fever there are aching pains in the back and 

 legs; as in other forms of malaria these myalgic pains 

 may become worse with the onset of the fever, or, in 

 other cases, disappear. 



The pyrexia presents few diagnostic characters. The 



