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388 fever, the apyretic interval, and the terminal fever occurring in both patients on the same days. Beyond a certain amount of headache and febrile distress there are no special symptoms, so far as I have been able to observe, nor any special complications.

Hyperpyrexial fever.— From time to time we have accounts from the West Coast of Africa, where it is not uncommon in certain parts, of a peculiar type of fever, especially prevalent during the dry season, and which doubtless was formerly regarded and treated as malarial, but which, from the absence of the malaria parasite in the blood, and the impotence of quinine in checking it, we now know cannot be malarial. From its gradual incidence and prolonged course, although it is associated with hyperpyrexia, we know that it cannot be siriasis or heat apoplexy. "What it may be is difficult to say; the probabilities seem to be in favour of its being a special form of tropical disease, associated with an animal intermediary occurring in and limited to the endemic localities.

Symptoms.— Thompstone and Bennett describe the clinical features thus: "This fever is generally ushered in by a slight rise of temperature, followed by profuse perspiration and a fall in the temperature to about 99° F. After a period of apyrexia of perhaps twenty-four hours' duration, the temperature begins again to rise, slowly at first, but when 105° is passed, with alarming rapidity, one degree in ten minutes having been frequently observed, and it may reach 107° on the second day. For fourteen or even for thirty days subsequently there is absolutely no tendency for it to fall. The skin acts either very slightly or not at all, and all antipyretic drugs fail."

In due course the tongue becomes dry and shrivelled, but the spleen and liver are not enlarged; the urine is normal and abundant, the bowels being regular or loose. The conjunctivas are injected, the pupils contracted. There is much anxiety and restlessness; but the mind is clear in most cases except when the temperature is very high. If the patient is to recover, a change for the