onset of sweating, to disappear in an hour or two, when the
patient often sinks into a refreshing sleep. Such attacks more
commonly occur every day, every other day, or after intermissions of
two days. Rarely do attacks come on with intervals of four, five, six,
or more days. The attacks are apt to recur at the same time of day as
in the first attack. In severe cases the intervals may grow shorter,
in mild cases, longer. In the interval between the attacks the patient
usually feels well unless the disease is of exceptional severity.
There is also entire freedom from fever in the intervals except in the
grave types common to hot climates. Frequently the chill is absent,
and after a preliminary stage of dullness there is fever followed by
sweating. This variety is known as "dumb ague."

=Irregular and Severe Form--Chronic Malaria.=--This occurs in those
who have lived long in malarial regions and have suffered repeated
attacks of fever, or in those who have not received proper treatment.
It is characterized by a generally enfeebled state, the patient having
a sallow complexion, cold hands and feet, and temperature below
normal, except occasionally, when there may be slight fever. When the
condition is marked, there are breathlessness on slight exertion,
swelling of the feet and ankles, and "ague cake," that is, enlargement
of the spleen, shown by a lump felt in the abdomen extending downward
from beneath the ribs on the left side.

Among unusual forms of malaria are: periodic attacks of drowsiness
without chills, but accompanied by slight fever (100 deg. to 101 deg. F.);
periodic attacks of neuralgia, as of the face, chest, or in the form
of sciatica; periodic "sick headaches." These may take the place of
ordinary malarial attacks in malarial regions, and are cured by
ordinary malarial treatment.

=Remittent Form (unfortunately termed "bilious").=--This severe type
of malaria occurs sometimes in late summer and autumn, in temperate
climates, but is seen much more commonly in the Southern United States
and in the tropics. It begins often with lassitude, headache, loss of
appetite and pains in the limbs and back, a bad taste, and nausea for
a day or two, followed by a chill, and fever ranging from 101 deg. to 103 deg.
F., or more. The chill is not usually repeated, but the fever is
continuous, often suggesting typhoid fever. With the fever, there are
flushed face, occasional delirium, and vomiting of bile, but more
ofte