n a drowsy state. After twelve to forty-eight hours the fever
abates, but the temperature does not usually fall below 100 deg. F., and
the patient feels better, but not entirely well, as in the ordinary
form of malaria, where the fever disappears entirely between the
attacks. After an interval varying from three to thirty-six hours the
temperature rises again and the more severe symptoms reappear, and so
the disease continues, there never being complete freedom from fever,
the temperature sometimes rising as high as 105 deg. or 106 deg. F. In some
cases there are nosebleed, cracked tongue, and brownish deposit on the
teeth, and a delirious or stupid state, as in typhoid fever, but the
distention of the belly, diarrhea, and rose spots are absent. The skin
and whites of the eyes often take on the yellowish hue of jaundice.
This fever has been called typhomalarial fever, under the supposition
that it was a hybrid of the two. This is not the case, although it is
possible that the two diseases may occur in the same individual at the
same time. This, indeed, frequently happened as stated, in our
soldiers coming from the West Indies during the Spanish-American
War--but is an extremely uncommon event in the United States.

=Pernicious Malaria.=--This is a very grave form of the disease. It
rarely is seen in temperate regions, but often occurs in the tropics
and subtropics. It may follow an ordinary attack of chills and fever,
or come on very suddenly. After a chill the hot stage appears, and the
patient falls into a deep stupor or unconscious state, with flushed
face, noisy breathing, and high fever (104 deg. to 105 deg. F.). Wild delirium
or convulsions afflict the patient in some cases. The attack may last
for six to twenty-four hours, from which the patient may recover, only
to suffer another like seizure, or he may die in the first. In another
form of this pernicious malaria the symptoms resemble true cholera,
and is peculiar to the tropics. In this there are violent vomiting,
watery diarrhea, cramps in the legs, cold hands and feet, and
collapse. Sometimes the attack begins with a chill, but fever, if any,
is slight, although the patient complains of great thirst and inward
heat. The pulse is feeble and the breathing shallow, but the intellect
remains clear.

Death often occurs in this, as in the former type of pernicious
malaria, yet vigorous treatment with quinine, iron, and nitre will
frequently prove curative in eithe