Diseases in Which the Temperature Chart Is of Prime Importance In Diagnosis
Benign Tertian and Quartan Malaria.—The presence of a fever of tertian or quartan periodicity is absolutely characteristic of malaria. In rare cases however of meningococcus sepsis, without cerebral localization, we may have a tertian or even quartan periodicity. Such cases are apt to show petechial spots and blood cultures give the diagnosis. There is also a polynuclear leukocytosis. As the result of the introduction by infected mosquitoes, on successive days, of two generations of malarial parasites in benign tertian or of three generations in quartan malaria, a quotidian periodicity may obtain.
Such a type of fever is observed in tuberculosis, liver abscess and various pyogenic infections. The rise of temperature in benign tertian and quartan malaria takes place in about one-half the cases somewhat early in the day, while the daily rise in tuberculosis, septic conditions and liver abscess, is more apt to occur in the evening, the evening rise being almost the rule in such diseases. Hectic fevers generally show a less distinct cycle of chill, hot stage and sweating than do the benign malarial paroxysms. At the same time the enlarged spleen, presence of parasites in the peripheral circulation and response to quinine are diagnostic points in malaria which must always be thought of. When quinine administration has caused the parasites to be temporarily absent from the blood the increase of large mononuclears is very suggestive.
Dengue.—In this disease the extremely sudden onset with a fever rising rapidly to 104°F. or more and remaining elevated for three or five days, to fall by crisis to normal and, after an apyrexial period of one or two days, to be succeeded by a second febrile accession, gives a fever chart which is quite characteristic—the saddle-back chart.
The typical dengue eruption does not appear until towards the end of the primary fever or about the commencement of the secondary one. Intense postorbital soreness is a striking feature in dengue. The comparative slowness of the pulse may be noted in dengue as well as in yellow fever. Leucopenia and polymorphonuclear percentage reduction are rather characteristic.
Relapsing Fevers.—These fevers, when there are three or more relapses, can perhaps be more easily diagnosed from the temperature chart alone than is the case with any other disease, excepting malarial fevers showing tertian or quartan periodicity. With an abrupt rise of temperature, which remains elevated for from three to seven days and drops by crisis to normal, to be followed by approximately a week of normal temperature, with two or three repetitions of the fever and apyretic intervals we have an extremely characteristic temperature chart.
Unlike malaria and yellow fever the onset is apt to be towards evening rather than in the morning hours.
The spleen is apt to be enlarged during the pyrexia and less so when the temperature is normal. The spirochaetes are to be searched for while fever is present as they disappear from the peripheral circulation during the apyretic intervals. In tick fever numerous relapses are frequent in the European and less common in the native.
Malignant Tertian Malaria.—While benign malarial infections are more common in temperate climates malignant tertian is the one which usually prevails in the tropics.