ATYPICAL SUBTERTIAN FEVERS 



1. SUBTERTIAN SYNDROMES WITHOUT LOCALIZATION. 



Though it is true that one and the same case may show fever on 

 one day and not on another, still, for practical purposes, it is con- 

 venient to subdivide these subtertian syndromes into two groups, 

 according as to whether fever at the time of first examination is or 

 is not a marked feature. 



A. NoN -Localized Subtertian Syndromes without Marked 

 Fever on First Examination. 



1. Haemorrhagic non-febrile type. 



2. Ansemictype. 



3. Mental types. 



4. Algidetype. 



5. Pseudo-alcoholic type. r 



HcBmorrhagic Non-Febrile Type. — The patients are pale, very weak, 

 and languid, and complain of pains in the loins and limbs. In 

 most cases the whole body is covered with petechise, and tense 

 indurated swellings, due to large extravasations of blood, may be 

 present. The gums are often swollen, spongy, and haemorrhagic. 

 Epistaxis, haematemesis, and passage of blood per rectum may take 

 place, as well as haemoptysis and haematuria from kidney or bladder. 

 Some patients have large indurated spleens, but febrile symptoms 

 are almost constantly absent. Malarial parasites can be found in 

 the peripheral blood in some cases. Quinine is the infallible remedy. 



AncBmic Type. — The patient shows no sign of typical malaria; 

 on the contrary, he is pallid, and possesses the lemon-yellow tinge 

 of pernicious ancemia. The liver, and more rarely the spleen, is 

 enlarged. Usually there is no fever, but in some cases the tempera- 

 ture may rise to 99° or 100° F., which is common in pernicious 

 ancemia. Malarial parasites may not be found in the blood, even 

 after repeated examinations, while the usual signs of pernicious 

 ancemia — e.g., poikilocytosis, nucleated red blood-corpuscles, high 

 colour index, relative increase of small mononuclears in place of the 

 increase of the large mononuclears which one expects to see in 

 malaria, may be present. 



This type of anemia may lead the physician to suspect malignant 

 growth in elderly patients, especially if there is vomiting and pain 

 after taking food. 



Quinine acts as the diagnostic and therapeutic agent. 



LeukcBmia. — Certain authors believe that malaria can cause leukaemia, but 

 this appears to us to be more of the nature of a complication. 



Mental Types. — The patient is melancholic or apparently demented, 

 or more rarely acutely maniacal and violent, with usually a normal, 

 subnormal, or but slightly raised temperature. The spleen may 

 or may not be enlarged, but a careful examination of the blood 

 generally reveals a mononucleosis or at times a very few malarial 



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