the remittent may merge into an intermittent which, in the course of weeks or months, subsides for a time, to recur every now and again at longer or shorter intervals. These recurrences may take place at fairly definite intervals; " long-interval fevers " the Italians have named them. Kelsch and Kiener allowed certain remittents in Europeans to run their course unchecked by quinine; they found that in ten or twelve days the fever gradually expended itself. Under favourable hygienic conditions the parasite and the associated fever frequently disappear together spontaneously. Occasionally the fever forms of the parasite may be present in the blood for days on end without causing acute clinical symptoms.
REMITTENT TYPES
Bilious remittent.—— One type of fever, known as bilious remittent, has long been recognized on account of the bilious vomiting, gastric distress, sometimes bilious diarrhœ, sometimes constipation, which accompany the recurring exacerbations. It is further distinguished by the pronounced icteric or, rather, reddish - yellow or saffron tint of skin and scleræ; a tint derived, probably, not from absorption of bile as in obstructive jaundice, but from modified hæmoglobin (hæmaphein) free in the blood or deposited in the derma and sclerotica. These bilious remittents are very common in the more highly malarious districts of Africa, America, the West Indies, India, and, in fact, in all malarious tropical countries. They are not specially nor directly dangerous in themselves, but they result usually in profound anaemia, and are often but the prelude to chronic malarial saturation, bad health, and invaliding.
Typhoid remittent.—— A modification of the bilious remittent what Kelsch and Kiener call " typhoid remittent " is very much more grave as affecting life than the simple bilious remittent. In the typhoid remittent, typhoid symptoms such as low delirium, prostration, dry tongue, swelling of spleen and liver, subsultus tendinum, marked melanæmia are superadded to the usual symptoms. Though re-
