THE MALARIAL FEVERS 



parasites, while quinine therapy effects a disappearance of the 

 symptoms. 



The violent cases may be of interest from a medico-legal point of 

 view, because the patient never has the slightest recollection of his 

 acts, and cannot be held responsible for them. 



Algide Type. — The patient is, as a rule, first seen in a condition 

 of such extreme collapse as to make the practitioner suspicious of 

 cholera. The nose is sharp, the cheeks sunken, the lips and ex- 

 tremities cyanotic, the nails livid, the pulse small, soft, and frequent, 

 becoming thready and imperceptible, the skin cold and clammy, 

 and the respiration laboured. The patient may, however, be con- 

 scious, and be able to answer questions and to complain in a weak 

 voice of severe thirst. This is a very serious and fatal form of 

 pernicious malaria, and generally kills the victim in a few hours. 



Pseudo- Alcoholic Type.- — The patient may not have been very 

 well for a few days, being capable of doing his work, but irritable and 

 complaining of not feeling fit. In order to carry on his duties he 

 may or may not take a certain amount of alcohol. Suddenly, 

 during or after a dinner or at a public performance, he tumbles off 

 his chair, and the impression at first is that he has taken too much 

 alcohol, and this may be considered to be confirmed by the odour 

 of his breath. It will, however, soon be evident that the patient 

 is seriously ill, and the diagnosis will be revised and apoplexy prob- 

 ably instituted. Finally a blood examination will generally reveal 

 a number, and sometimes a large number, of malarial parasites of 

 the subtertian type. At a post-mortem these parasites will be 

 seen to be blocking the capillaries of the cerebral cortex. 



The poorer type of native patient will be taken as a ' drunk ' to 

 the local lock-up, and in the morning the so-called drunken man 

 will be found to be seriously ill and may even be dying. Blood 

 examination generally, but not always, reveals malarial parasites. 

 Generally these are serious infections, and the prognosis is grave. 



B. Non-Localized Subtertian Syndromes with Marked Fever 

 ON First Examination. 



The non-localized subtertian syndromes with marked fever on 

 first examination may be divided into: — 



1. Subtertian hyperpyrexial fever. 



2. Subtertian syndromes resembling a specific fever. 



3. Subtertian syndromes not resembling a specific fever. 



Subtertian Hyperpyrexial Fever. 



This type of fever is characterized by very high temperatures, 

 often commencing at the onset of the illness. It may be continuous 

 or intermittent, and often attains temperatures exceeding 105° F. 

 Sometimes the temperature may reach heights which can hardly 



