ii6o 



THE MALARIAL FEVERS 



Double Quartan Fever. 



In this form there is an attack of fever on two successive days, 

 and an apyrexial interval of twenty-four hours. 



Typically the two attacks should be equal in severity, but often 

 that is not so, for one attack is less severe than the other. As already 

 stated, this may be due to two groups of parasites, inoculated on 

 separate days. But sometimes quartana simplex may become 

 quartana duplex, and this is explained by the fact that there may 

 be a double infection, but that while there are many of one brood 

 of parasites, and hence fever, the other brood may be so few at first 

 that they require time to develop to such numbers as are necessary 

 for the production of fever. Consequently quartana duplex may 

 at first show itself by a very slight rise in the temperature on the 

 second day, which increases gradually till equal to that produced 

 by the stronger infection. 



Triple Quartan Fever. 



This is a quotidian or daily fever produced by three broods of 

 quartan parasites coming to maturity on three successive days, 

 and can only be diagnosed by an examination of the blood. The 

 three attacks may be similar, and may begin at the same hour, 

 or they may vary in severity and begin at different times. In 

 quartana triplex sometimes an attack may be ' subintrant ' — that 

 is to say, the cold stage of one attack may begin before the sweating 

 stage of the other attack is finished; but this is not common, and 

 usually there is a distinct interval of normal or subnormal tempera- 

 ture. 



A simple or a double quartan may become a triple quartan in 

 the manner described above for the origin of a double from a simple 

 fever. On the other hand, it may start as quartana triplex, and 

 become a duplex, and finally a simplex. This may be due to the 

 weakening of certain groups of parasites. Sometimes a triplex may 

 directly become a simplex from the linking together of two other 

 groups of parasites at the same time. 



Irregular Subcontinuous Quartan Fevers. 



Quartan parasites are believed not to cause continuous fever, 

 but very rarely they may cause subcontinuous or remittent fever. 

 Such a condition is due to the presence in the blood of parasites of 

 all ages, which, therefore, are continually sporulating and dis- 

 turbing the metabolism, thereby producing the remittent type of 



Mixed Infections. 



Mixed infections may occur with either of the other two parasites 

 — viz., P. vivax or L. malarice — and an intermittent irregular fever 

 be produced, only to be diagnosed by the microscope. 



Chronic Quartan Malaria. 



See Chronic Malaria, p. 1 1 82. 



