198 
MALARIA 
Fig. 3. No. 1164 (P. falciparum) : Fever of inter¬ 
mittent-remittent type. Two adjacent paroxysms 
pairing off to produce remittency. No. 1199 (P. 
falciparum) : Course commenced as tertian, became 
quotidian, then remittent (temperature remained 
over 37.2° C for 64 hours). Fatal termination. 
Occasionally at the onset of a falciparum 
infection, the temperature presents a remit¬ 
tent type of curve (Fig. 1, No. 258). It is 
probable that in this case sporulation was 
almost continuous. Later, a variable degree 
of regimentation of sporulation usually ap¬ 
pears but it is very seldom as orderly as one 
usually sees in P. vivax infections. 
We have occasionaly seen pure tertian 
Fig. 4. No. IS 10 (P. falciparum): One cycle 
shows higher temperature peaks and broader bases 
than other. No. 1189 (P. falciparum) : An exam¬ 
ple of continuous remittent fever. Uncontrollable 
by quinine. Fatal termination. 
courses (Fig. 2, Nos. 1150 and 1111) in P. 
falciparum infections and recognize that 
the schizogonous cycle of the parasite is 
primarily of 48 hours duration. We have 
observed also the presence of two cycles, re¬ 
sulting in quotidian paroxysms. Pure ter¬ 
tian or quotidian courses, in our experience, 
have been uncommon (the hypothesis that 
daily paroxysms were’induced by a subspe¬ 
cies, P. falciparum quotidiannum (Craig 
1909), is not generally accepted). Their 
occurrence is probably dependent, at least 
in part, on immunological factors which we 
do not as yet understand. Courses that are 
tertian throughout do suggest some degree 
Fig. 5. No. 1S05 (P. falciparum) : Course com¬ 
menced as quotidian, became tertian and, regaining 
lost cycle, terminated as quotidian. No. 1158 (P. 
falciparum): Brief course commencing as tertian. 
Original cycle disappears (3rd, 5th and 7th days) 
as new one appears (4th, 6th and 8th days). 
of immunity on the part of the patient. 
The paroxysms in falciparum malaria, even 
when in simple quotidian arrangement, 
commonly have a broader base than do 
those due to P. vivax. Frequently, there¬ 
fore, two closely adjacent paroxysms may 
partly merge and show an intermission in 
which the temperature does not fall to nor¬ 
mal, creating a remittent curve (Fig. 3, No. 
1164). This may occur over a period of 
days, the paroxyms pairing off to produce 
a series of remittent curves, between each 
of which pairs the temperature drops to 
normal. In such cases the interval between 
