II30 



THE MALARIAL FEVERS 



as aetiology, climatology, pathology, chemical pathology, and morbid 

 anatomy, and then to consider the type of fever caused by each of 

 the three parasites mentioned above — viz., the quartan fevers, the 

 tertian fevers, and the subterti an fevers — in their typical and atypical 

 acute phases. Having completed this, we have still to consider the 

 subject of chronic malaria, and we are then in a position to review 

 the complications, sequelae, diagnosis, and prognosis. Finally, the 

 important matters of treatment and prophylaxis must be discussed. 



It maybe thought that it would be better to write three separate 

 chapters detailing what is known, considering the three types of 

 fever separately; and though scientifically this would be more 

 accurate, still, clinically it would not benefit, because it is in its 

 atypical forms that malaria is mostly seen by the physician of to- 

 day, and therefore chnically it is better to treat the malarial fevers 

 together and not separately. 



It is, however, necessary to preface the account of the disease 

 with a very short note on the history, in order that the reader may 

 understand the salient features of the evolution of knowledge with 

 regard to it. 



History. — It is suggested that the references in the ' Charaka-Samhita* 

 to fevers spread by mosquitoes refer to malaria, and that this fever was 

 recognized at the time of Homer. 



In any case, Hippocrates clearly distinguished intermittent from continuous 

 fevers, while among the former he noted the tertian and quartan types, and 

 observed their frequency in summer and autumn and their occurrence near 

 stagnant water and after rains. In ii6 B.C. Varro drew attention to the 

 relationship between malaria and marshes, a fact so well realized in tlie Middle 

 Ages that illustrations are given of mosquito-nets as the only way to live near 

 these collections of water. 



We thus see that very early in the history of medicine mosquitoes were 

 associated with fever, which was also associated with stagnant water, and 

 that fevers were divided into the intermittent and the continuous. The intro- 

 duction of cinchona bark into medicine, as noted in Chapter I., made a distinc- 

 tion as to those fevers which are and those which are not curable by that drug, 

 and this was emphasized by the cure of ' Le Grand Dauphin ' in the days of 

 Louis XIV. The medicine used in this celebrated case appears to have been 

 cinchona bark soaked in Rhine wine and presumably strained, and having 

 a small quantity of tincture of opium added thereto. 



The pernicious fevers were brought into special prominence by Torti, in 

 1 71 2, in his celebrated ' Theraputice Specialis Mutinse.' 



As to the actual cause of the disease, it was believed to be minute forms of 

 animal life arising in the exhalations from decaying vegetal matters in marshes. 

 This is the miasm theory of malaria, which was fully accepted until modern 

 times, but in 1847 Meckel noticed black pigment (hsemozoin) in the organs of 

 people dying from malaria. There was much discussion as to the origin of 

 this pigment, till, in 1881, Laveran discovered the parasite of malarial fever, 

 and thus laid one of the principal foundations of modern tropical medicine. 

 Golgi in 1886 demonstrated its life-cycle in man, showing the relationship 

 between the attacks of fever and the sporulation of the parasite, as well as the 

 origin of the haemozoin. Golgi's researches firmly established the parasites 

 of quartan and tertian malaria — i.e., Plasmodium malaricB and P. vivax — 

 while Marchiafava and Bignami in 1891 demonstrated the existence of 

 Laverania malaricB and its relationship to subtertian malaria. 



During these researches the presence of the peculiar crescent bodies in cases 

 of subtertian infection became known, and caused much speculation; and it 

 was now that King, in 1883, suggested anew that mosquitoes might be the 



