TYPICAL SUBTERTIAN FEVERS 



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2. Double Subtertian Fever. 



This is a quotidian fever, caused by two broods of Laverania 

 malaricB. The cold stage is less marked than in a quotidian fever, 

 due to quartan or tertian parasites. The temperature rises rapidly, 

 the fastigium is very short, and the fall is to below normal. There 

 is nothing particular to remark about the warm or sweating stages, 

 which resemble those of the simple subtertian fever. The whole 

 attack only lasts six, eight, or twelve hours. 



3. Irregular Subtertian Fevers. 



When several broods of Laverania malarice exist together in the 

 blood, it is obvious that, instead of sporulation taking place regu- 

 larly every day or every other day, it will be irregular, and hence 

 the attacks will run into one another and produce an irregular 

 type of fever, which is commonly met with on the West Coast of 

 Africa. 



4. Remittent Subtertian Fevers. 



Remittent fevers arise by prolongation of ordinary attacks, or by 

 anticipation or subintrance, so that two attacks become continuous, 

 the onset of the second attack beginning before the first one is con- 

 cluded. Duplication may also lead to a remittent fever. 



Febrile Attack. — These fevers may be mild or grave, and may be- 

 come pernicious. The symptomatology is briefly as follows : After one 

 or two days of prodromal lassitude, pains, and sensations of chilliness, 

 etc., fever comes on without any cold stage. The skin becomes hot 

 and dry, and often turns yellowish, and headache, with pains in the 

 different parts of the body, is a source of trouble to the patient. 



The tongue is coated; thirst is sometimes intense, and may be 

 associated with vomiting and purging, together with pains in the 

 region of the liver, spleen, and stomach. The toxins affect the 

 brain, causing sleeplessness, restlessness, and delirium. The liver 

 and spleen are both enlarged and tender, and at times there is 

 slight cardiac dilatation on the right side. The temperature is 

 characterized by high fever with remissions. 



Interval. — The time of the remission is by no means certain. It 

 may take place in the morning and the rise in the evening. Under 

 treatment the parasites rapidly disappear from the peripheral 

 circulation, but last longer in the viscera, so keeping up the fever. 



Course, — Mild attacks get well under the week, but without 

 treatment they would soon become the more serious or grave type 

 of fever, which is part of the atypical group of subtertian fevers 

 which are dealt with in the next section. Three variations may be 

 mentioned here. The first resembles typhoid in its clinical features ; 

 the second is distinguished by the bilious vomiting and diarrhoea, 

 with marked enlargement of the liver and jaundice, which is often 

 called bilious remittent fever; and the third shows a tendency to 

 haemorrhages, local gangrene, haemoglobinuria, and great weakness, 

 sometimes called ' adynamic remittent fever.' 



