DOUBLE TERTIAN FEVER 



over the body, and soon a most profuse perspiration may take place, 

 and the pulse, respirations, and temperature may fall to normal in 

 about four hours, when the patient, as in quartan fever, goes off into 

 a sleep. The attack lasts about ten to twelve hours, and generally 

 begins in the morning, but may take place at any time of the day. 



Apyrexial Intervzl, — This lasts about thirty-six hours, during 

 which the temperature is often subnormal. In the interval the 

 patient may feel well, but his blood will show developing para- 

 sites, reduced erythrocytes, and a leucopenia with a mononuclear 

 increase. 



Peculiarities. — As in quartan, so in tertian fever, children may 

 have neither chill nor sweating stage, but may, on the other hand, 

 show convulsions. 



Double Tertian Fever. 



When parasites mature on two separate days, fever is produced 

 every day, which is therefore quotidian in type, and is called a double 

 tertian (tertiana duplex). The attacks are similar to those described 

 above, but usually are shorter, and, of course, the apyrexial in- 

 terval is shorter. As a rule, the attacks begin at the same hour 

 each day, but sometimes one attack is later than the other. Very 

 often one attack is not so severe as the other, but if left to itself 

 without treatment, it may become similar to the more severe attack. 













P.M 







A.M. 





P. M. 



A.M. 





PM. 











P.M 









Hour 



a 



e 



10 



2 





10 



Z 



6 



10 



2 



6 



(0 



2 



6 



10 



2 



6 



10 



2 



6 



10 



z 



6 



10 



2 



6 



(0 



Hour 



104° 

 _ 105" 

 102° 



























































r- 40° 



B 



-i9' |, 



i| 101' 

 a 100° 



1 



•C 98' 



























































o 



-38°| 

 B 

 o, 



-37' 1 



37' 



























































-36° 



Fig. 621, — Chart of a Case of Double Tertian Malarial Fever in the 

 General Hospital, Colombo. 



(Note postponement of attack in third and fourth days.) 



Double tertians may arise by a simple tertian anticipating. If this 

 is continued after the double tertian is developed, or if one of the 

 attacks of a double tertian anticipates, in course of time it will join 

 in with the originally previous attack, so that a person who is in 

 the sweating stage of one attack may suddenly start the cold stage 

 of the other. 



Clinical Course. — Left to itself , tertian malaria tends to a spon- 

 taneous cure after a series of attacks, but relapses may occur. 

 Groups of more severe attacks alternate irregularly with groups of 



