TYPHOID FEVER. The relations be tween typhoid fever and malaria are the same as between malaria and other in fective processes. From our present knowledge of malarial fever and the aid in diagnosis afforded by the microscope we know that there is no distinct clin ical type of the disease to which the term typho-malaria may be properly ap plied. The elass of cases, the continued forms of mstivo-autumnal fevers, which have been the source of so much con fusion respecting the two infections, have already been referred to. The examina tion of the blood in these cases and the action of quinine afford means of diag nosis as easy of application as they are decisive in results. An acute malarial infection or the lighting up of an old one may occur in the course of typhoid infection, and the symptoms of the latter 'td as to indicate the ' . , .
,: .1 t; t mplication, but the h.E. h. t lte their course in .. r .1., 1 t ther and their 1.1S ' I (...; lit t giNe rise to a new 1.01 e't cal entity.
.IS e titer than typhoid fever, .` t7 t ruotiNe fevers, acute then ,- L the 11.,(, bear the same rela 0, I ,rarLa.
NI 11 kl. CACIIEX1A.A.S t f !leg eeted eases of malarial r. u.Lialiv of the xstivo-autuinnal r the result of inadequate !re .1 ti t by quinine, a series of relapses r eventually give rise to such .tilt of the general health as to ,4'.I111 a chronic cachexia. This is the frequently met with sequel to mala r ;. vet- and first manifests itself as an 1, \shich, if the cause be not re :" 1. lolly develop to the gravest pro The patient's appearance be e n. d.stinctive. and, with the evidences i.f pr-f,und antrmia, the skin presents a w or muddy color; the mucous rants are all but colorless, while extreme exhaustion, breathlessness p.ri-n the idightest exertion, headache, end ,uhentaneous cecleina indicate the ..-r-tily of the ehang.es that have occurred thr Hood. Digestive disturbances are and the tongue is frequently a:J(1. Great enlarg,ement of the spleen, pronounced that may be en -hntercd. occurs in this condition,
r1P to thP popular term of "ague rni-P.- Neuralgia, especially of the 4..pra(rbital and intercostal nerves, is a n incident and the occurrence of ecrt:go upon any sudden change of posi te.n may interfere with the patient's lo . .r.rtirn. In advanced cases dropsical P.'u,-:onq into the serous cavities a 1T1 y Tal-e place. while marked emaciation, ex diarrhrpa, anorexia, and pro found asthenia render the patient par ticularly susceptible in intercurrent in fections.
Chronic malarial cachexia may pursue throughout an afebrile course or it may be punctuated by irregularly-recurring paroxysms of mild pyrexia; in still other instances an irregular, subfebrile tem perature may exist for a long period. While any variety of malarial infection may be followed by cachexia, it usually occurs as a sequel to the xstivo-ati tunmal. The blood-examination rnay be negative. in Tstivo-autumnal infections, however, crescents and ovoid bodies are nearly always found, while in other in fections pigmented leucocytes and a few parasites are usually to be seen.
This sequel has already been referred to as arising from the fail ure to pursue treatment sufficiently to destroy all the parasites at the period of sporulation, so that the parasites thus escaping continue to pass through suc cessive cycles of development until a group is produced of sufficient size to cause the toxic manifestations consti tuting a paroxysm. There are other in stances, however, in which the relapse takes place a long time after the termina tion of the original paroxysm, and such instances have been ascribed to the per sistence of some form of the parasite within some of the internal organs.
AN.XMIA.In addition to the changes in the blood indicative of secondary anremia of a grave type, in certain in stances the alterations characteristic of progressive pernicious amemia occur; the termination of such cases is, of course, a fatal one.