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lesson arising from this conclusion. It is well known that some medical officers
in India and in other countries are of opinion that unless provided with micro-
scopes they cannot be expected to diagnose malarial fevers accurately. To such
as hold this opinion I would commend a study of the facts of this case. The
value of microscopical methods in diagnosis, no less than that of bacteriological
ones, depends entirely upon the skill and experience of the observer, and the
prevailing notion that if one possesses a microscope and a few of the
ready-made "bacteriological tests" one can dispense almost, if not entirely,
with clinical methods, cannot be condemned too strongly. It cannot be
denied that, so far as the diseases of India are concerned, the use—perhaps
I should say more correctly the misuse—of microscopical and so-called
bacteriological methods has hindered rather than hastened the discrimination of
the various forms of fever present in this country. No better example of this
truth is needed than is afforded by the history of kala azar—a disease long
recognised by clinicians of experience to be distinct, but repeatedly pronounced
by microscopists and bacteriologists to be one or other of the diseases already
known. The consideration of an example such as this suggests to us that in
future we should pay greater attention to those accurate, yet easily carried out,
clinical methods of investigation which sometimes we are apt to regard as of
minor importance.

       2nd Case.—BAGHAN; aged 10 years. This boy was examined for the first
time on the 10th of April 1902. His parents volunteered the information that he
had suffered from fever "off and on" for about five months. He was fat and
cheerful and did not appear ill; but careful examination showed that he was very
anæmic and that his spleen was enlarged three inches below the costal margin.
His temperature on the evening of the 10th of April was 101º F., and in a film of
finger blood obtained on this day a considerable number of crescents and a few
pigmented leucocytes were found. On the 1st of May his spleen was still three
inches below the ribs; only one crescent was found in a film of blood. During
June his blood was examined on two occasions, but neither parasites nor pigment
were found. At the end of this month his spleen was only one inch below the
ribs. On the 28th of July his spleen was still one inch below the ribs, but neither
parasites nor pigment were found in a slide of finger blood. He was not
examined again until the 1st of November, when his mother said he had been
suffering from fever for about three days. The spleen was enlarged two inches
below the costal margin; no enlargement of the liver was detected. A system-
atic record of the temperature, which is reproduced here (charts III and IV),
was begun from this date. The first attack of fever shown on chart IV ended on
the 8th of November; similar attacks occurred at irregular intervals for several
months.

D