Il62 



THE MALARIAL FEVERS 



If treated in this stage, the fever may never develop, but if neglected, 

 it will appear in the course of a few days. 



After a feeling of illness, giddiness, nausea, or vomiting, with 

 perhaps a slight rise of temperature, the patient suddenly becomes 

 very cold and shivers, and his symptoms resemble in detail those 

 already described for quartan malarial fever, except that they may 

 not be so severe. In about ten to thirty minutes the warm stage 

 begins. 



As the chills diminish, sensations of warmth appear; at first 

 pleasurable, they soon become intense, and the patient feels burning 

 hot. The skin is hot, flushed, and dry; the conjunctivae injected; 

 the pulse full, quick, and often dicrotic, and the pains in the head, 

 back, and limbs increase. A slight cough may be noted; vomiting 

 is common, and sometimes diarrhoea occurs. Very often the white 



Fig. 620. — Temperature Chart of a Case of Simple Tertian Malarial 

 Fever, showing the Effect of Intramuscular Injections of 

 I Gramme of Quinine Bihydrochloride. 



skin shows a sallow or slightly yellowish tinge, which is also present 

 in native races, but can only be seen in the conjunctivae. The 

 heart-sounds are usually normal, but sometimes a soft systolic 

 raurmur can be heard. In the lungs, at times, sonorous and sibilant 

 rales occur. The spleen is enlarged and tender, which is charac- 

 teristic, and a soft murmur over the splenic area, like a uterine 

 souffle, is said to be sometimes heard. Skin eruptions have been 

 described; the commonest in our experience is erythematous or 

 urticarial. Herpes may occur on the lips. 



The temperature begins to rise before the chill, and continues to 

 ascend during the cold stage, reaching a maximum in the hot stage, 

 which may be anything, from 102° to 108° F., but is generally 

 about 104° or 105° F. The warm stage may last four or five hours, 

 when it passes into the 'sweating stage. 



The mouth becomes moist, and sweat gradually comes out all 



