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386 one of the most fatal of the fevers there. Remittent is a misnomer, for the symptoms are even less remitting than those of typhoid. The temperature runs high, touching 104° or 105° F. for a long part of its course. It begins not unlike simple continued fever. By some it is considered a variety of typhoid, notwithstanding the absence of many of the symptoms of that disease. Hepatic enlargement and congestion are early and constant conditions; but the spleen, as a rule, is not distinctly enlarged. " Bilious diarrhœoea, in no respect resembling the diarrhœa of typhoid, is also a very frequent symptom. Quinine often given in large and repeated doses in these cases is not only not useful, but so obviously adds to the distress of the patient, without in any way producing an improvement in the progress of the symptoms, that it is very soon abandoned. Meanwhile, the temperature continuing persistently high, marked head symptoms, especially delirium of a muttering and irritable kind, come on, and the patient may even, and often does, pass into a condition of coma from which he can hardly be roused. This condition of persistent high temperature without marked remission, a distinctly enlarged and congested liver, bilious diarrhœa, congestion of the back of both lungs; and a low, muttering delirium, is generally reached by the eighteenth to the twenty-fourth day. If coma supervenes, the patient frequently dies about this period. In more favourable cases, where the symptoms are less severe, they may continue for a week or two longer. In such the average duration of the case is six weeks." (Crombie.) Crombie, although he had seen this fever in Europeans, regarded it as being essentially a disease of natives. It is seldom met with after the age of 30, but is frequent enough in childhood.

Double continued fever.— In South China I encountered, both in Amoy and in Hong Kong, a peculiar type of fever, apparently of very little gravity as affecting life, but sufficiently distressing while it lasted. Thorpe has recorded a case occur ring in Wei-hai-wei. The disease is characterized