THE MALARIAL FEVERS 



when anopheline mosquitoes of undetermined species were allowed 

 to bite men in India from the 9th to the 21st of January, with the 

 result that one developed a temperature of 38-9° C. on the 5th of 

 February, but parasites were not found, and the other cases were 

 negative. 



Remarks. — The clinical description may be divided into the 

 febrile attack and the apyrexial interval. 



The Febrile Attack.- — Generally there are prodromat a before an 

 attack of quartan fever. Some few hours previously the patient 

 may complain of giddiness, weakness, malaise, headache, or even 

 nausea and vomiting. If the blood is examined during the occur- 

 rence of these symptoms, the parasites will be seen to be schizonts, 

 and the commencing formation of merozoites may also be noted. 



DAY or 



ILLNESS 



1 



2 



3 





5 



6 



7 



8 



TIME 



M 



E 



M 



E 



M 



E 



M 



E 



M 



E 



M 



£ 



M 



E 



M 



E 



104° 

 103' 

 ^ lOZ' 



































1 101° 

 /00° 



1 



5 99' 



1 H} 



































97' 

 96' 



































Fig. 619. — Temperature Chart of a Case of Simple Quartan Malarial 

 Fever »^IN the , General Hospital, Colombo. 



In a short time the definitelattack begins. It may roughly be 

 divided into three stages: (i) The cold stage; (2) the hot stage; 

 (3) the sweating stage. 



I. The Cold Stage. — The patient begins to feel cold, either in the 

 legs, arms, or back. This sensation increases until actual shivering 

 sets in. In quartan fever the rigors are well marked and charac- 

 teristic, and the patient may shiver until he shakes the bed; the 

 teeth may chatter, the lips become blue, the arms and legs cold, and 

 goose-skin may be present. If the blood is examined in this stage, 

 some of the parasites may be seen fully sporulated, or only young 

 parasites may be found. 



During this cold stage, which is the most uncomfortable of the 

 three stages, the internal temperature is rising rapidly, and the 

 internal organs must be somewhat congested during the chill; for 

 there are symptoms of intense headache, visual disturbance, 

 vomiting, and at times diarrhoea. The temperature, which rises 



