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       (5) For the purposes of diagnosis during an apyrexial period we must rely
chiefly upon negative signs and symptoms: the patient does not complain of
being ill; he is not incapacitated from doing his work; as a rule, he is not
emaciated; he has no fever; repeated blood examinations may yield entirely
negative results.

       (6) During a relapse of fever (pyrexial period) the temperature chart is
definite and characteristic, and we are able to make a diagnosis by inspecting
such a chart. Blood examinations are an important aid if positive results are
obtained, but we cannot place reliance upon them if negative.

       Nearly all these characters of " malarial cachexia " are very different from
those described in text-books as being present in this condition, and it therefore
behoves us to ascertain if they are applicable to a number of examples. This
we may now proceed to do.

        The following case is similar to many seen in military hospitals for native
troops :—

       AMIR KHAN, sepoy; aged 25; seen in 1901 in the regimental hospital at
Alipore near Calcutta. The patient had been admitted into hospital on the 28th
of April suffering from fever and enlargement of the spleen. On his medical
history sheet two previous admissions for " ague " were recorded. His tem-
perature chart from the 28th of April, as recorded by the hospital authorities, is
reproduced here (chart VIII). I saw the patient for the first time on July the 2nd,
that is, when he had been in hospital a little more than two months. His spleen
was enlarged nearly to the level of the umbilicus, and his liver could be felt two
fingers' breadths below the ribs. He was very anæmic, and the conjunctivæ were
very yellow, but he was not markedly emaciated. It was said that quinine had
been administered to him " off and on " since his admission, but it is doubtful
whether the drug really had been well tried. As the patient was not improving,
the medical officer had decided to send him upon sick leave.

       On inspecting the temperature chart, we see that it closely resembles those
of cases already described: it is divided into periods of pyrexia and periods of
apyrexia. The first attack shown on the chart lasted from the 28th of April
until the 10th of May and evidently was a severe one; it was followed by an
apyrexial interval of seven days' duration. The second attack lasted from the
18th until the 31st of May; it was followed by an apyrexial interval lasting only
four days. The third attack was a mild one lasting five days; it was followed by
an apyrexial interval lasting nineteen days ;—and so on. Examinations of the
peripheral blood made on the 2nd and 3rd of July did not reveal the presence of
malarial parasites or pigmented leucocytes, and with the medical officer's
permission quinine treatment was discontinued.

       Blood examinations were made again on the 10th, 12th, and 17th of July,