Ii66 



THE MALARIAL FEVERS 



infection. Prodromal symptoms resembling those of tertian fevers 

 may exist before an attack. 



Febrile Attack— The cold stage may be entirely absent, but it 

 often occurs, and is sometimes severe. Sometimes the attack begins 

 with the warm stage, in which the symptoms are very severe pains 

 in the limbs, back, and head, with gastro-intestinal disturbance in 

 the form of vomiting, diarrhoea, and coated tongue. The skin is 

 often flushed and dry and sometimes icteric, while the eyes are 

 injected. The sweating stage is never absent, and may be marked. 

 The spleen is usually tender, as well as the liver. The four-hourly 

 temperature chart is most characteristic, for the invasion takes place 

 with a rapid rise to 104° F. to 105° F., after which the temperature 

 remains high, oscillating about 1° F. The oscillation which imme- 

 diately precedes the crisis is larger than the others, and is called 





f 





P M 



A M 



P 



M A 



M 



P 







P M 



A M 



P M 1 





1 MOUJ> 



2 



6 



10 



2l6ilO 



2 



6 



10 



2i 6 



10 2 C 



:\0 



-i— 



2 16 



10 2 



:_ _ 



6 



10 



2 6 



— 1 



10 



2 6 10 



2 



6 lOl 



HOUR 



104 

 103 

































^— 



=r 









— t — ! 



- 40 





















































































- 39 



102 









































101 







































100 

























— 













38 



99 







1 















f 













i ^ 





at. 





- 37 



08 

 07 

































F 



r 







- 36 













































L 











































Fig. 622. — Chart of a Case of Subtertian Malarial Fever, 

 The curve is most typical on the second day, before quinine was administered . 



the pseudo-crisis. After this the temperature rises to its highest 

 point (precritical elevation), and then suddenly falls (crisis) below 

 normal, where it remains, as a rule, until the next attack. It may, 

 however, rise from subnormal to normal, and just prior to the next 

 attack show a distinct depression. This typical temperature may, 

 however, be greatly masked by an absence of the sudden rise at 

 the invasion, or of the precritical elevation, or by an exaggeration 

 of the pseudo-crisis, making the single attack appear double. 



Lastly, the whole attack may be shorter than usual, and resemble, 

 as regards the temperature, a simple tertian fever. 



The duration of the attack in subtertian fever is about twenty- 

 four hours or more. 



The Interval —The interval will be twenty-four, ten, or even eight 

 hours in duration, varying, of course, with the length of the attack. 



