=Other Clinical Types.=—(1) _The Malignant Form._—In such cases instead of the insidious onset we have the characteristics of a severe acute infection with high temperature from the beginning, ranging from 103° to 105°F. Such cases may show vomiting and early diarrhoea. This is followed by a typhoid state with cardiac manifestations in the way of irregularity of the pulse. An ordinary type of case may assume this malignant form and such cases may develop a broncho-pneumonia. (2) _The Intermittent Form of Hughes._—Here we have a type of case similar to the typical one but less severe. It is a subacute form which from time to time shows an intermitting fever. These cases may fail to show evidence of serious illness and the patient may continue his work although noting a progressive deterioration of health. Some very mild cases which only rarely show slight fever of a few days’ duration have been reported as _ambulatory_ cases. (3) _The Disease in Infants._—Di Cristina and Maggiore have described various forms of the disease as observed in infants in Palermo. They note a hyperpyrexial type and an undulant type. A type with anaemia and marked cachexia is very severe. Another form shows cyanosis, irregular pulse and irregular respiration with marked sweats. Again the symptoms may be those of a cerebro-spinal meningitis. =Sequelae and Complications.=—It should be borne in mind that while not serious from a standpoint of mortality this disease is to be dreaded by reason of the possibility of invalidism. The neuralgic pains, insomnia and mental depression render patients liable to the morphine habit. In pregnant women there is a tendency to abortion. In rare cases we may have intestinal haemorrhages with asthenic manifestations. Bassett-Smith has reported a case with extensive purpura. The same author in paramelitensis cases has noted the susceptibility to secondary streptococcal infections. SYMPTOMS IN DETAIL _Temperature Chart._—Except in the malignant form of the disease, when the temperature may be rather continuous, the fever course is a step-like ascent with daily remissions for about ten days and then a similar descent. Following an evening rise of temperature night sweats may be noted. It is the wave-like succession of such courses of fever, separated by afebrile intervals, that suggests the name undulant fever. _Circulatory System._—The disease shows rather a toxic effect on the heart as shown by palpitation and irregularity and rapidity of pulse rate. In the beginning of the fever, however, the pulse rate is not very fast. Anaemia is a rather marked feature. _Respiratory System._—A slight bronchitis with cough tends to suggest phthisis in those cases which show rather marked night sweats.