MALIGNANT TERTIAN FEVER, SO desig nated by Marchiafava and Bignami to distinguish it from tertian fever of the regularly-intermittent type, is character ized by paroxysms occurring approxi mately every forty-eight hours. These observers describe the temperature-curve as possessing the following peculiarities: A rapid rise, frequently without a chill; with slight fluctuations the temperature remains high for several hours and then, not infrequently in the middle of a par oxysm, sustains a considerable drop, but not to normal (pseudocrisis); soon after, sometimes with a slight chill, the tem perature again rises, often higher than it was at first, and after remaining there for some time finally falls to normal or below. The curve is thus divided by .1..larchiafava and Bignami into: the rise, the pseudocrisis, the preeritical elevation, and the true crisis.
In the intervals between the paroxprms the temperature is frequently' subnormal; inasmuch, however, as the paroxysms not uncommonly last thirty-six hours, or more,these intermissions are of very short duration. Although the paroxysms may occur at intervals of longer duration than forty-eight hours, it much more fro.
quer t happens that anticipation of the succeeding. paroxysms occurs, so that the periods of intermission become so short that the temperature-curve becomes al most continuous, interrupted only by slight depressions or remissions to mark the interval between the paroxysms. In this manner occur the so-called malarial remittent fevers. In consequence of marked prolongation of the paroxysms 03' decided anticipation of succeeding paroxysms, so that one paroxysm begins before the preceding one is completed, many cases show a temperature-curve that is continuous. Even in these cases, however, it is usual for the temperature to show slight fluctuations indicative of the termination and onset of the various paroxysms.
These cases of malarial remittent or continued fever pass into a condition closely resembling typhoid fever, and under the name of typlao-malaria have been the source of much confusion in their proper differentiation from typhoid fever. At the present day, and from the
foregoing description of the manner in which these cases occur, it seems un necessary to call attention to their essen tially malarial nature. These cases of Tstivo-autumnal fever may suddenly de velop pernicious symptoms at almost any period of their course. They frequently so resemble typhoid fever that the dis tinction between the two is only possible as the result of a microscopical exami nation of the blood. The patient may complain of headache and general body pains, or there may be decided delirium or mental liebetwle and somnolence. Very grave cerebral symptoms may at any time occur, such as stupor and coma; and convulsions, either general or local, may be observed. Intractable vomiting, jaundice, and profuse diarrhcea, together with a dry, coated tongue and a collec tion of sordes about the mouth complete the resemblance to enteric fever.
Of 79 cases of typhoid fever treated to -conclusion during the sixth year of the Johns Hopkins Hospital work, there were 13 that began with shaking chills. In 2 cases there v ere several severe rigors, in 3 cases there were two, while in 8 the rigor was single. Osier ( Univ. Med. Mag., Nov., '95).
In a type of autumnal fever that ap pears annually between the 10th and 15th of August in Virginia, and continues until hard frost has set in symptoms analogous to typhoid fever are often wit nessed. The temperature-curve of this prolonged remittent type and that of typhoid fever are almost identical, svhile many of the prodromal symptoms are similar. There are, however, no iliac these occur sufficiently often to make them characteristic of malaria when a nuntber are taken together. Rupert Nor ton (Amer. Jour. Med. Sciences, Feb., '98).
Typho-malarial fever is not a special type of fevers, but represents a group of hybrids between typhoid fever and ma larial fevers. Woodward (National Med. Review, May, '98).