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The diagnosis of malarial fevers.
The wrong
method.
When a patient complains of "fever we may attempt to arrive at a
correct diagnosis of his disease by one of two methods; it is scarcely neces-
sary to say that one of these methods is wrong and the other right. The
wrong method can be disposed of in a few words. It exemplifies the com-
mon observation that in India and other tropical countries most patients
who complain of "fever" express the opinion that the fever from which
they are suffering is "malarial," and that in these countries many medical
men all too frequently acquiesce in this diagnosis without taking pains to
ascertain its correctness. In such an instance the medical man, having
allowed the patient to make the diagnosis, proceeds to treat him more or
less vigorously with quinine. If, under this treatment, the fever disappears
in a few days the medical man regards the diagnosis as having been con-
firmed; he has applied what is called the "therapeutic test." If the fever
does not decline within a few days the results of having adopted a wrong
method of diagnosis become apparent, and often several weeks elapse before
a correct diagnosis is arrived at.
The right
method.
The right method of setting about the diagnosis is the following. It is
necessary to give this method in some detail, but it will readily be under-
stood that it is not possible in all cases to carry it out in its entirety. It is
seldom necessary to do so because if the principle of the method is followed
a correct diagnosis is usually made very quickly. Assistant Surgeons and
Hospital Assistants in charge of dispensaries in India have a very large
number of patients to attend to, and speedy diagnosis is important; in such
cases, of course, and in cases where the requisite apparatus has not been
provided, all the details of the method cannot be carried out; the procedure
must be modified, and accuracy of diagnosis and, therefore, efficient treatment
must be sacrificed.
The first note to be made regarding this method is that when in reply to
our question "Of what do you complain" the patient answers "fever"
we must endeavour to banish the thought of "ague" from our minds and
try instead to recall the various diseases which, not infrequently, have been
diagnosed under that heading. The list of these diseases is a long one, but