COMATOSE FORM. — In this form the earliest manifestation may be suddenly oncoming coma; unconsciousness is pro found and respiration stertorous and ir regular, so that in many instances a : niblathe to apoplexy is pro- Idutt.d More freqm ntly, however, coma tl, t• t ensue until after the occurrence f -nu or more paroxysms uncomplicated Lerebral symptoms, or associated, it-Laps, only with slight delirium and s.,innolotee. Then, with deepening stu pt. r or increasing delirium, coma super \ e nes. ln other instances coma inter tit:ts, beginning with the elevation of t onperature associated with the parox ysm. and ceasing with its decline, and this play repeat itself several times. In by far the greatest number of cases, how ev(r. coma continues, at times with occa sional periods of slight improvement, and may thus last for three or four days until either death or recovery terminates the CaSC.
In the comatose form of malarial fever the temperature-curve conforms to no particular type. The face is usually deeply congested, or may be pale if the pernicious symptoms occur in a person suffering from the anmmia incident to previous malarial infections. The pupils may be dilated or contracted and -usually react to light; occasionally they are un equal. The pulse may show increased frequency, or may be slow, and is usu- , ally of high tension, although it may be weak and compressible, especially toward the end of the paroxysm. The respira
tion may be increased or decreased in fre quency and stertorous, and is frequently irrec.mlar, conforming to the Cheyne Stokes type. The skin is hot and dry, and toward the end of the paroxysm may be bathed in profuse perspiration. Occasionally petechim are observed, and slight jaundice is not uncommon. Cer tain muscles may be the seat of local spasms, as evidenced by the occurrenee of trismus or deviation of the eyeballs. Involuntary evacuation of fces and urine occurs, although urinary retention is frequent. With the decline of the fever, coma, with the associated symp toms, disappears, and recovery may result from what is apparently the most pro found infection. A second paroxysm rapidly follows the first unless energetic treatment be instituted, and this gen erally proves fatal. In other cases of this type of pernicions malarial fever delir ium of a wild maniacal character raay occur, and hallucinations and delusions are not infrequently seen. In still other cases convulsions of a tetanic character (perniciosa cornatosa tetanica) are to be observed, and paralyses, hemiplegic or localized, are not uncommon.