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leukæmia, kala azar, and malarial cachexia), and (2) those in which the
spleen may be not at all or only slightly enlarged (the remainder of the
diseases in the list). Let us deal first with the second class, which is the
largest. There are in this class ten diseases, but some of them, such as heat
stroke, dengue fever, cerebro-spinal fever, and typhoid fever, are not very
frequently met with among natives of India, and the diagnosis of others such
as small-pox can seldom be difficult, so that without doubt at this stage of
our diagnostic procedure it is justifiable to think first of malarial fever and to
see if by questioning the patient we can confirm this diagnosis. If we are
convinced from the answers of the patient that the fever from which he
suffers show definitely a Quartan or Tertian periodicity we may regard our
provisional diagnosis of malarial fever as being confirmed, and we are justified
in commencing suitable treatment at once. If, however, the patient's
answers show that his fever is of a continuous type or presents a Quotidian
periodicity or if it began only a short time before he has sought our advice
the difficulties of diagnosis may be very great. We will suppose that our
patient is being examined on the second day of his illness, that his temper-
ature is 102° F., that his spleen is not at all or only very slightly enlarged,
and that we have been able to find no other signs which will aid us mate-
rially in our diagnosis. In such a case the correct course to pursue is as
follows: (1) the patient should be admitted into hospital; (2) he should
be given a milk diet; (3) his temperature should be taken every four hours;
(4) two specimens of his blood should be taken-one on a slide for the exami-
nation for malaria and other parasites, the other in a blood capsule for the
serum reaction tests with cultures of the Malta fever and typhoid fever bacilli
(see pages 10 and 21); (5) if thought desirable a diaphoretic mixture, not
containing quinine, and a mild purgative may be prescribed, but this is the only
medicinal treatment permissible. On no account should quinine be given.
Our course of procedure is now an expectant one; we must wait and watch
for positive symptoms and signs which will afford a clue to the correct diagnosis.
As soon as possible we shall examine carefully the specimens of blood taken. If
it happens that we find the parasites of malaria or of relapsing fever or of
filarial fever in the blood film our task of diagnosis is ended, and we can proceed
at once to treat the patient appropriately. But such a fortunate event by
no means always happens, and it may be several days or a week or even more