Two monographs on malaria and the parasites of malarial fevers / I. Marchiafava and Bignami, II. Mannaberg.

  • New Sydenham Society
Date:
1894
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Licence: Public Domain Mark

Credit: Two monographs on malaria and the parasites of malarial fevers / I. Marchiafava and Bignami, II. Mannaberg. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    set fortli in these cases, which through their clinical course, and through the regular succession of the parasitic forms in the blood, may be considered the simplest. It may, however, happen that we meet with a similar curve also in the common tertian, although under special conditions, and only by way of exception. Thus there has come under our notice a double spring tertian, in which the two paroxysms, instead of following each other, as is the general rule, at an interval of about twenty-four hours, more or less, were so approximated to each other that they were incompletely conjoined; in this way a curve was formed similar to that of a prolonged attack, with two very high eleva- tions of temperature, each of them I'epresenting a tertian parox- ysm. But in this case the form of prolonged attack resulted from the blending of two paroxysms, and corresponded to the coming to maturity of two generations of parasites which were produced within a few hours of each other ; while the curve of the summer tertian, on the contrary, represents a single attack, and corresponds to the coming to maturity of a single generation of parasites, as we have determined.^ So that we may affirm that the curve we have described is a typical one for the .summer tertian [3]. When the paroxysm is developed according to the type de- scribed, with the different elevations in temperature as set down, the case is often a severe one : an aggravation of the clinical symptoms usually coincides with the beginning of the paroxysm and the pre-critical elevation ; but, for the most part, the distress, agitation, and depression of the patient, as well as the clouding over of the sensorium, are at their maximum during the latter, and they have only an incomplete cessation during the following brief intermission. The same curve may, however, take place also in mild infections, where there is the same prolonged parox- ysm, the same pre-critical elevation, &c. This form, then, of the thermic curve is connected with the development of the parasite, not necessarily with the fact of the infection taking a serious turn, although in the majority of cases there is the tendency to a progressive aggravation. In the typical attack the initial and the pre-critical elevations may be alike in intensity ; but in other cases, while the initial elevation reaches the ordinary degree of fever temperaturd as found in these diseases {i.e. 104°—104-9°), the pre-critical elevation may touch hyperpyretic temperatures (e. ^. io67°, and even 107-6° F., in the axilla). When the pre-critical elevation is as high as this, it may be preceded by a sensation of cold or even 1 See preliminary note, 'Rif. Med.,' No. 217, 1891.