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rare), malarial cachexia, and kala azar. Splenic leukmia, of course, is very
easily differentiated by a microscopical examination of the peripheral blood-
every field is crowded with leucocytes-but the differential diagnosis between
malarial cachexia and kala azar is not always easy, and as a rule we must admit
the patient into hospital if we wish to make the diagnosis accurately.
The chief differences between these two diseases may be tabulated thus:-
Malarial cachexia.
Kala azar.
There are definite pyrexial and apyrexial
periods; the pyrexial periods are of short
duration, and if a careful record of the
temperature is taken every four hours
chart presents definitely the characters of
a malarial chart. Quinine stops the
fever.
Fever is present for long periods; it is
sometimes intermittent, but it presents
great irregularity. Quinine does not stop
the fever.
Progressive emaciation is absent, and
between the pyrexial attacks the patient
is able to do his work.
Great weakness and progressive emaciation
are always present.
The spleen is greatly enlarged; the liver
slightly or not at all enlarged.
The spleen and liver are greatly enlarged.
In order to confirm the diagnosis it may be necessary in a few cases to
puncture the liver or the spleen by the method already described.
The diagnosis of the pernicious attacks of malaria is sufficiently dealt with
in the descriptions on pages 61 to 63. In such cases it is seldom possible to
save the patient's life unless we are able to make an immediate examination
of the blood because until this is done the diagnosis is often obscure and the
treatment incorrect.