CLINICAL TYPES.—Mannaberg divides the malarial fevers into two main groups: (1) the fevers clue to infection with the ordinary tertian and quartan parasites of Golgi; (2) tbe fevers due to infection with the mstivo-autumnal or crescent forming parasite.
Under these two main groups, which may also be termed, respectively, the regularly intermittent fevers and the more irregular, often continued or sub continued, fevers, may be differentiated three separate types of fever: 1. Tertiau fever, single and double infections. 2. Quartan fever, single, double, and triple infections; both types comprising the first group of fevers. 3. The second group of fevers, the mstivo-autumnal.
Tertian fever is of common occurrence in almost all malarial districts. The quartan type, while the common fever in a few malarial regions, such as certain parts of Sicily, is in most regions, where other varieties of infection are common, of rare occurrence. The following table is given by Mannaberg to illustrate the infrequent occurrence of this type in dif ferent parts of the world:— zlistivo-autuninal form of severe grade predominates in tropical and subtropical regions, and as these regions are departed from appears only in the late summer and autumn months; while the less se vere forms, tertian and (ruffian fevers, occur earlier in the season.
Terttin Fever. – SIN.;1.1: INFEcTioN, •. , I \ tunmt rrEN Ft-NEIL—In s f r the infection is. with a ..,•. t p of tertian parasites. each t% it . inhir of whidi is in approxi , same stage of development; !hot Jinentation of all, with which .1.. i.oroxIsin a,,.sociated, takes place at .1. :Ile same time. As already stated, t...-• neassary for the completion of , of de\ elopment of the tertian about forty-eight hours, some t in— .1 little more. sometimes a little less, ti :atter more commonly than the for mer.
TI1F l'ArtoxYs3t.—The paroxysm may I e Tviolud into three stages: the chill, au fever. and the sweating stage.
Po. Cl/in.—Unpleasant feelings, ill d. f.t.id sensations of discomfort, usually prL...le the chill, and in an individual who has ever experienced a malarial out break are peculiarly significant of what is al.--ut to follow. Even at this time s..inc elevation of the temperature may be noted. Occasionally the onset is ab rupt and without premonitory manifesta t•on=. Gradually the chill develops fri•in chilly sensations up and clown the back early in the paroxysm until the fully developed rigor is attained. There is then chattering of the teeth and general shaking of the body, often so violent as t ) Atake the bed upon which the patient is lying. While the surface of the body i= cold, and the skin, owing. to the erec
tion of the hair-follicles, presents the con dition of goose-fiesli, the internal tem ' eraturo, a= determined in the rectum, is li;gh, often 103° or 106°. The skin is pal often bluish in color, and visual dis tur!.ances, headache, dizziness, nausea, and vomit-ng are common. The pulse is tense, small, and accelerated. The quan tity of ur-ne is increased. The duration of ti.e i= variable, usually from ten minutes to half an hour, or an hour, or even longer.
The Ferer.—The febrile, or hot, stage gradually supervenes upon the stage of chill, until by repeated flushes of heat the stage of chill is completely superseded, and the patient throws off the additional bed clothing which a short while before was so gratefully accepted. The skin be comes hot, dry, and reddened, and a sense of burning heat is complained of; the eonjunctivce are suffused; the pulse rapid, full. and bounding; intense head ache, dizziness, and noises in the ears are often complained of; thirst, restlessnes.s, and occasionally, delirium occur, or the patient may be drowsy and somnolent. Constipation is generally present; epis taxis, diarrhcea, and vomiting are among the less frequently occurring symptoms. Cutaneous manifestations are of common occurrence, more particularly herpes of the lips and nose, while erythema and urticaria are soinetimes seen. In most cases the splenic tumor may readily be detected. The duration of this stage is usually four or five hours, and the tem perature now attains its greatest eleva tion.
The Sweating Stage.—With the initia tion of this stage the patient experiences great relief. At first perspiration is no ticed to occur about the forehead and npon the face, but shortly spreads over the whole body, usually becoming most profuse. The temperature rapidly falls, so that in two or three hours it has reached a subnormal point, where it gen erally remains for some time. Great re lief from the distressing symptoms of the preceding stages is experienced, the pulse rapidly lessens in frequency, and the pa tient sinks into a refreshing sleep.
The Intermission.—The intermission continues until the young parasites de.
rived from the segmentation that has caused the first paroxysm have, in their turn passed through their cycle of de velopment until the stage of segmenta tion is attained, and with it occurs the second paroxysm. The time thus occu pied is forty-eight hours, longer or shorter, resulting in anticipation or re tardation of the paroxysm. During the intermission the temperature remains subnormal for some hours and the pa tient experiences great relief.