160 MALARIA 



places, and it is not uncommon to hear of a person having a 

 " touch of malaria " when in reality he has only indigestion, a 

 cold or a light case of la Grippe.- It is largely due to this fact 

 that malaria is looked upon in non-malarial districts as of such 

 small consequence. 



The early stages of all tA'pes of malaria are similar except that 

 the quartan type produces the intermittent fevers on every third, 

 instead of every second, da}'. During the inculiation period of 

 the disease there is a feeling of ennui with headache and perhaps 

 slight fever. After about a week, when the parasites have mul- 

 tiplied to 150,000,000 or more, the regular intermittent fevers 

 set in. Each attack begins with a shivering chill, sometimes 

 accompanied by convulsions, so severe that the teeth chatter 

 and goose-flesh stands out all over the body. Yet the tempera- 

 ture will be found to be several degrees above normal, and still 

 going up. In the wake of the chill comes a burning and weak- 

 ening fever, with violent headache and vomiting and a tempera- 

 ture from six to eight degrees above normal. The fever stage in 

 turn is followed by a period of sweating, so profuse that the 

 clothes or bedding may become wringing wet. The sweating 

 gradually subsides, the temperature drops rapidly, often below 

 normal, and the patient, after from six to ten hours in the case 

 of benign infections and about 20 hours in malignant infections, 

 rests fairly easy until the next attack. The fact that the attacks 

 most commonly occur between midnight and noon, instead of in 

 the evening, is often useful in distinguishing malaria from other 

 intermittent fevers. 



In the case of " benign " (tertian and quartan) infections 

 after these agues have recurred for about ten days or two weeks, 

 the symptoms gradually subside and the patient experiences a 

 rally. From this point either he may recover completely (even if 

 untreated) or he may suffer a relapse with all the old symptoms of 

 regular agues. Then comes another rally and a second relapse, 

 this continuing for months or years, aided, perhaps, by constant 

 reinfections. During all this time general symptoms of emaci- 

 ation, sallowness, anemia and enlarged spleen constantly in- 

 crease at a diminishing rate with each elapse, and decrease at 

 a similarly diminishing rate with each rally, so that eventually a 

 fairly constant state of spleen-enlargement, emaciation, anemia, 

 sallowness and general run-down condition is arrived at — the 



