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viously suffered from Malaria, and in which the latent malarial poison is roused into activity and considerably modifies the existing disease. We see this every day in malarial patients with surgical injuries, the fever consequent on such injuries often takes on an intermittent or remittent type and unless this is borne in mind grave errors in diagnosis if not in treatment may take place.

Complications and sequelæ.

Occasionally tetanoid spasms and epileptiform seizures have been met with, more frequently a low form of Pneumonia has occurred. In more than one case retention of the urine has been met with, and is probably due to the direct action of the poison on the nervous system.

Treatment.

In the milder cases of Remittent Fever, it is our custom to first of all open the bowels with some aperient, a modification of Livingstone's powder being preferred, viz :-Calomel grs. iv, Quinine grs. v, Pulo Rhei or Japapæ Co ad 3i.

After that has been given according to the temperature either Phenacetin or Antipyrin is prescribed, the former in mild cases in doses of iv grains-x grains administered every 4 hours, and the latter in twenty grain doses repeated hourly for the first two hours, if the temperature has not fallen by this time two further hourly doses of ten grains each are given.

As a rule antipyrin will lower the temperature. When the remission occurs Quinine is given in 5 grain doses hourly until the temperature rises to 101° F. or 102° F., after that it is useless to give it as the stomach nearly always rejects the drug.

In the severer cases where antipyrin and phenacetin prove useless, as soon as the temperature rises to 106° F., which it will do very rapidly even in the first exacerbation, ice-packing is applied, by this I mean that the patient is placed on a mackintosh sheet covered with a sheet dipped in ice-cold water, ice being packed all over his body and an ice-bag applied to his head.

It is simply marvellous to see the beneficial effect of such treatment in these severe cases. A patient who previous to it is violently delirious soon begins to calm down, and as the temperature falls he regains consciousness, his pulse becomes quieter and less rapid, and all fears of a sudden fatal termination are at an end. See notes on LOCKHEAD's case.

In an hour the temperature has been reduced by this means 10° F.

Having effected this the patient is replaced in bed and the hypodermic solution of the acid hydrobromate of Quinine is injected, the favourite sites being either the Deltoid or the muscles of the calf.

During the ice packing the patient must be carefully watched as symptoms of collapse may set in, when stimulants must be administered.

The patient generally falls into a short sleep and has some hours respite the temperature, however, frequently rises again. When the next exacerbation occurs a wet sheet applied over the body will often suffice to control the fever. See LOCKHEAD's case.

Morphia has been found very useful calming the mental anxiety, inducing sleep and probably acting as is supposed by many as an anti-periodic.

Pathological anatomy.

Congestion of the mucus membrane of the stomach.

Intestines frequently congested no ulceration, simply inflammation of mucus membrane, rosy-red appearance. Most important changes are found in the Spleen and Liver, these viscera being frequently enlarged.

It has been recorded that in Malarial fever as met with in Hongkong, the spleen is not enlarged (vide Dr. PIKE's paper).

However, the following are results of some of the post mortem examinations performed in the Government Civil Hospital:-

1. Chinaman Ho YUNG, died 31st December, 1889, cause of death Remittent Fever. Spleen

weighed 17 ounces, very soft and diffluent.

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2. Indian KOSHAL SINGH, I.P.C. 589, admitted 14th April, 1891, suffering from Remittent Fever, died 13th June, 1892. Post Mortem :-Spleen weighed 20 ounces, very soft indeed, the splenic tissue under the capsule was quite diffluent.

3. Chinaman YEUNG TSO-SHING, admitted 3rd August, 1891, suffering from Remittent Fever, died 7th August. Post Mortem :-Spleen weighed 14 ounces, soft and friable. Liver weighed 68 ounces.

4. Indian NUTTA SINGH, died 3rd August, 1890, cause of death Remittent Fever. Post

Mortem :-Spleen weighed 39 ounces, fibroid enlargement.

This enlargement of the spleen and liver is not confined to Indians and Chinese as it is also met with in the case of Europeans suffering from Malarial Fever.

We have never met with the pigmented condition of the spleen so frequently described in Medical Text Books.