Page:Tropical Diseases.djvu/105

III] covery is the rule, a considerable proportion of such attacks prove fatal.

Adynamic remittent.—— The same writers class by themselves a set of cases they call "adynamic remittent "; cases which are characterized by fatuousness, restlessness, nervous depression, intense muscular and cardiac debility, profound and rapid blood deterioration, icterus, leucocytosis, melanæmia, liability to syncope, occasionally hæmoglobinuria, liability to hæmorrhages, and a marked tendency to local gangrene. Tuberculosis, syphilis, renal disease, or alcoholism will often be found as factors in determining the two latter types of fever.

Many writers have drawn attention to what are called pernicious attacks or pernicious symptoms —— the French neatly designate them "accès pernicieux " ——a series of phenomena, the possibility of the appearance of which, not only in the course of remittents, but in the course of what is seemingly only an ordinary paroxysm of intermittent fever, should never be lost sight of by the practitioner in tropical climates. These " accès pernicieux " may supervene in apparently mild cases and carry off the patient with horrifying suddenness—— as suddenly as an attack of malignant cholera. The wary practitioner is always on the look-out for them, and is always prepared with measures to meet them promptly when they threaten.

Pernicious attacks are roughly classified into cerebral and algide. The cerebral are divisible into hyperpyrexial, comatose, convulsive, paretic, and so forth; the algide into syncopal, choleriform, dysenteric, hæmorrhagic, etc.

Hyperpyrexial.—— There can be little doubt that many of the cases of sudden death from hyperpyrexia and coma, usually credited to what has been called "ardent fever" or " heat apoplexy," are really malarial. If careful inquiry be made into the