The bilious remittent of Zanzibar is preceded by general languor and listlessness, with lassitude of limbs and heaviness of head, with chills and dull pains in the body and extremities, and with a frigid sensation creeping up the spine. Then comes a mild cold fit, succeeded by flushed face, full veins, an extensive thirst, dry, burning heat of skin, a splitting headache, and nausea, and by unusual restlessness, or by remarkable torpor and drowsiness. The patient is unable to stand; the pulse is generally full and frequent, sometimes thready, small, and quick; the bowels are constipated, and the tongue is furred and discoloured; appetite is wholly wanting. During my first attack, I ate nothing for seven days; and despite the perpetual craving thirst, no liquid will remain upon the stomach. Throughout the day extreme weakness causes anxiety and depression; the nights are worse, for restlessness is aggravated by want of sleep. Delirium is common in the nervous-bilious temperament. These symptoms are sometimes present several days before the attack, which is in fact their exacerbation. A slight but distinctly marked remission often occurs after the 4th or 5th hour—in my own case they recurred regularly between 2 and 3 A.M. and P.M.—followed by a corresponding reaction. When an unfavourable phase sets in, all the evils are aggravated; great anxiety, restlessness, and delirium wear out the patient; the mind wanders, the body loses all power, the ejecta become offensive; the pulse is almost imperceptible; the skin changes its dry heat for a clammy cold; the respiration grows loaded, the evacuations pass involuntarily; and after perhaps a short apparent improvement, stupor, insensibility, and sinking usher in death. On the other hand, if the fever intends yielding to treatment, it presents after the 7th day marked signs of abatement; the tongue is clearer, pain leaves the head and eyes, the face is no longer flushed; nausea ceases after profuse emesis of bile, and a faint appetite returns.