cases) showed infection in which examination of finger blood proved negative.
Delayed development.—— In some instances of malarial cachexia of early development the general growth of the body is stunted and puberty retarded. I have seen a malarial cachectic who, although 25 or 26 years of age, had the stature and sexual development of a child of 11 or 12. Abortion and sterility are common effects of malarial cachexia, which, in this as well as in other and more directways, becomes a potent agent in the repression of population.
Acquired tolerance of the malarial toxin.—— In many instances, although the state of cachexia may have attained an excessive degree, ague, or, in fact, fever of any kind, has never been a prominent symptom. It would seem that the body can become accustomed to the fever-producing toxin of the malarial parasite, much in the same way that it may become accustomed to opium and many other organic poisons. I have watched for three weeks the rhythmical development of a tertian parasite in a sailor who, although previously the subject of frequent attacks of ague, was yet quite free from fever during the period that I had him under close observation. Just as in those habituated to the use of opium a full dose of the drug, which in the unhabituated would produce profound or even fatal narcosis, acts merely as a gentle stimulant, so in those constantly exposed to, and actually infected with, malaria from infancy, the poison sometimes fails to act as a febrogene. And, to continue the comparison, just as the habitual use of opium produces a species of chronic poisoning or cachexia without narcosis, so the habitual presence of the malaria toxin may produce its peculiar cachexia without giving rise to fever. As a rule, however, particularly in the case of Europeans forced to reside in highly malarious countries, attacks of fever are of frequent occurrence in malarial cachectics.
Malarial neuroses and skin affections.—— Super-
