The Tertian Characters of Quotidian Aestivo-Autumnal Fever

Samuel T. Darling Laboratory of Hygiene, Faculdade de Medicina e Cirurgia, Government of São Paulo, The Rockefeller Foundation, São Paulo, Brazil

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In my paper on (1) Experimental Inoculation of Malaria by Means of Anopheles Ludlowi, the opinion was expressed that Plasmodium falciparum possesses inherently both tertian (or subtertian) and quotidian tendencies, as well as its well known tendencies to cause fever of the irregularly remittent or continued type.

The opinion was based on the study of two uncomplicated experimental cases inoculated with mosquitoes reared from larvae and infected with a pure strain of Plasmodium falciparum. Quinine was withheld for a period and temperatures taken every hour.

The initial paroxysms were tertian in time, the subsequent ones quotidian. The essential tertian character of the paroxysm, however, was never lost.

It is a painful and a serious matter to withhold quinine from very ill patients. Consequently when it was seen that temperatures were rising angrily the infection was checked. The observations therefore were fonfined to periods of four and six days only, but the time was sufficient to permit the development of a febrile course which lead to the opinion expressed above.