2 
MALARIA 
Quartan malaria: Quartan fever, quartan 
ague, simple intermittent fever, paroxysmal 
fever, chills and fever. 
Falciparum malaria: Tertian fever, es- 
tivo-autumnal malaria, malignant tertian 
fever, remittent fever (including bilious, 
congestive and malignant types), con¬ 
tinued malarial fever, pernicious fever, 
congestive intermittent fever, pernicious 
intermittent fever, congestive fever, con¬ 
gestive chills. 
The diagnosis of remittent fever has been 
applied to many a case of typhoid, while 
yellow fever has masqueraded as bilious 
remittent fever. 
The regularity of the recurring quartan, 
tertian and quotidian paroxysms described 
in the Hippocratic writings (Jones 1923) 
are sufficiently pathognomonic to warrant 
the identification of quartan malaria, but 
less clearly distinguish vivax from falci¬ 
parum malaria. The identity of falci¬ 
parum malaria did not clearly emerge 
from the background of other continued 
fevers until the use of cinchona became 
general. The tertian similarity of the 
paroxysms of the last two diseases makes 
their distinction on clinical grounds alone 
difficult, as is illustrated by the following 
fragmentary descriptive quotations from 
Jackson (1791): “The type was frequently 
double tertian, or quotidian; the remissions 
were indistinct; the bilious vomitings and 
purgings were often excessive, and marks 
of malignancy appeared in several in¬ 
stances. . . . the remissions were generally 
obscure, but ... the type changed fre¬ 
quently from double to single tertian; at 
the same time the intermissions became 
clear and distinct.” These words are evi¬ 
dently descriptive of falciparum malaria. 
James (1929) has pointed out that the 
word ague, now a widespread word for 
malaria particularly among the laity, was 
not always used in such a limited sense. 
Derived from febris acuta, it was origi¬ 
nally applied to any acute, and most com¬ 
monly to a continued, fever. Its signifi¬ 
cance must therefore be interpreted with 
caution. 
In addition to the foregoing, the follow¬ 
ing broader terms, viz., marsh fever, swamp 
fever, paludal fever and paludism, may be 
taken as generic references to malaria. 
Hemorrhagic malarial fever, bilious fever, 
melanuric malarial fever, or blackwater 
fever, is a condition of obscure origin, al¬ 
though generally regarded as a manifesta¬ 
tion of malaria infection. According to 
Stephens (1937), the relative frequency 
with which it is associated with infections 
produced by different species of parasites 
is proportional to the general local distri¬ 
bution of these species. 
Inferential References 
In addition to the foregoing terms there 
are many allusions in the literature of 
significance in connection with our subject. 
Principal among these is the stigma or 
repute of long-continued insalubrity at¬ 
tributed to many places. Although it is 
probable that in rural regions the presence 
of malaria alone may be safely inferred 
from such references, it is likely that in 
many urban centers the blame was also 
shared with yellow fever. Similarly the 
presence of malaria and yellow fever is 
also inferable from references to acclima¬ 
tion fever, “acclimatization” among, and 
the “seasoning” of, immigrants. The sig¬ 
nificance of those expressions is well 
brought out by the following quotation 
from Kalm (1770) speaking of “fever and 
ague” in the southern part of New Jersey: 
“Strangers who arrive here are commonly 
attacked by this sickness the first or second 
year after their arrival, and it acts more 
violently upon them than upon the natives, 
so that they sometimes die of it. But if 
they escape the first time, they have the 
advantage of not being visited again the 
next year, or perhaps ever. It is com¬ 
monly said here that strangers get the 
fever to accustom them to the climate.” 
Or by a statement from Cumming (1810) : 
“All newcomers are subject to what is 
called a seasoning, after which, though they 
may be annually attacked by this scourge 
of the climate, it rarely confines them 
longer than a few days.” 
