QUARTAN FEVERS 



1159 



before the chill begins, varies at first from 100-4° to 102-2° F., 

 but generally rises rapidly to its maximum — about 104° or 105° F. 



The cold stage does not last long, fifteen to thirty minutes being 

 the average time, but it may be longer or shorter, and may be 

 irregular, being preceded by a transient sensation of heat. 



2. The Hot Stage. — Gradually the shivering ceases, and the patient 

 begins to feel warmer and more comfortable, though sensations of 

 cold and heat may succeed one another. By degrees the sensation 

 of heat increases, until the patient becomes burning hot, and as in 

 the cold stage he desired to wrap himself up with coverings, now 

 he desires to throw these off. The skin feels hot and dry, the 

 pulse and respirations increase, the conjunctivae become injected. 

 Vomiting and diarrhoea may take place, and an erythematous rash 

 sometimes appears. The temperature reaches its maximum, and 

 soon declines. 



This stage may last about three to four or more hours. 



3. The Sweating Stage. — Towards the end of the hot stage the 

 forehead is noticed to be damp, and presently the sweat begins 

 to appear profusely, and great relief is felt by the patient. As the 

 sweating increases, the temperature falls rapidly and the pulse-rate 

 declines. As the temperature approaches normal the patient may 

 fall into a sleep, from which he will wake feeling much better, and 

 with a normal or subnormal temperature. The total duration of 

 the attack may be about eight to ten hours. 



The Interval. — After awaking from his sleep the patient feels 

 quite well, though weak, and generally goes about his ordinary work 

 during the two days of this interval. But signs are not wanting 

 that everything is not well; for the temperature is often subnormal 

 and the pulse slow, while in the blood the developing parasites 

 may be traced, and leucopenia with relative mononuclear increase 

 noted. At the end of seventy-two hours the apyrexial interval will 

 end in an attack of fever, as described above. 



The Course of the Fever. — Quartan, rightly or wrongly, is believed 

 to have a great tendency to relapse, to go on for months, and even, 

 it is said, for years, if not treated. The parasites rarely appear 

 to multiply to any great extent in the blood, and hence pernicious 

 symptoms are usually absent. If left to itself, the fever is supposed 

 to gradually die out, but to recur at times. Spontaneous cure is, 

 however, rare. 



Irregularities. — Prolongation of the attack has been noticed. 

 Marchiafava and Bignami state that it may very exceptionally last 

 for more than twenty-four hours, in which case the temperature 

 shows two chief undulations — one near the beginning and the other 

 near the end of the attack — separated by a marked remission. 



Children. — Children may show neither cold nor sweatmg stages. 

 Very often convulsions take the place of the cold stage, but these 

 may be so slight as not to be noticed. On the other hand, they 

 may be very severe. 



