The clinical diagnosis of vivax malaria in this country is often not difficult. The patient, in many instances, can suggest the correct diagnosis at the onset of an attack, and this can easily be confirmed by the demonstration of malarial parasites in one or more examinations of blood smears. There is a history of residence in an endemic area and, except for the first attack, there have been previous similar attacks. The symptoms of a "paroxysm" (acute attack) as a rule are quite characteristic, consisting of chilliness followed by a chill of varying severity and high fever of short duration followed by sweating, headache, backache, generalized aching and malaise, weakness, abdominal pain and tenderness and frequently nausea and vomiting. Vague muscular and joint pains, malaise, headache, backache and slight fever may precede the acute attack by several days.
Without treatment, paroxysms recur daily or every other day for a varying