OTHER SEPTIC PnocEssEs may be con fused with malarial fever, such as the fever accompanying malignant endo carditis; septic processes involving the biliary passages or the genito-urinary organs, as pyelitis, pyelonephritis, or urethral fever, so called, arisin,g from gonorrlicea or the introduction of instru ments into this passage; the fever asso ciated with malignant new growths, or empyeniata in various locations. In all these instances the previous history of the case, the results of the physical ex amination and the examination of the blood will decide the diagnosis. Of these, of course, the most important is the blood-examination; the absence of leueocytosis, or actual reduction of the number of leucocytes, and the presence of parasites in malaria; the presence of leucocytosis and absence of parasites in the various forms of septiemmia.
The restivo-autumnal fevers may also be confused with tuberculosis and other septic processes particularly in those in stances where the intervals between the paroxysms are well marked. The same means of differentiation are to be in voked, however, as in the case of the regularly-intermittent fevers. When by retardation and anticipation of the par oxysms, however, the intervals between them become almost or completely erated, mstivo-autumnal fever may so re semble typhoid fever that an examina tion of the blood becomes necessary to establish the diagnosis. IIere the pres ence or absence of the parasites must alone be depended upon, as in neither disease does leueocytosis occur. Clin ically the persistence of a trace of the paroxysm, the presence of jaundice, early anmmia, herpes or urticaria, and the rela tive infrequency of Ehrlich's tion in the urine will aid in confirming a diagnosis of malaria.
Four undoubted instances in which the co-existence of malaria and typhoid has been actnally proved by microscopical blood-examinations. These at least are all that it has been possible to find on record.
Other than irregularity of fever, and occasionally chills, there is nothing in these cases of niixed infection by which to suspect their nature, and the course of the typhoid malady is not influenced; it only proves how necessary it is in all instances of typhoid fever, especially of the irregular kinds, to make blood-exami nations for malarial parasites. J. M. Da
Costa (Internat. Clinics, vol. ii, Seventh Series).
The PERNICIOUS FORMS OF MALARIA are to be separated from conditions with which they are likely to be confounded chiefly by an examination of the blood In these forms confusion may arise be tween the hmorrhagic type and yellow fever, the choleriform type and Asiatic cholera, the comatose type and insola tion, and the hwmoglobinuric type and ordinary paroxysmal hmmoglobinuria. To the observer the examination of the blood may constitute the only positive means of reaching a definite conclusion.
Chronic malarial cachexia is to be dif ferentiated from the grave anmias, leu kmmia, and pseudoleukamia by the ex amination of the blood, or, when this fails to give positive results, by the early history of the patient and the amena bility of the condition to proper remedial measures.
The administration of quinine is the therapeutic test for malaria, and is of importance if it be impossible to make a microscopical examination of the blood. Under the influence of proper doses of this drug no malarial fever will persist for more than four or five days.
_Neglect of examinations of blood has led to the gravest mistakes. A patient presented herself to a surgeon, complain ing of pain in the lower abdomen, pelvis, and back, with chills and fever. Upon examination a mild pelvic peritonitis was found. She was advised to have the tubes and ovaries removed, and submitted to the operation. The patient had a severe chill the next day, followed by a rise of temperature to 107°, and collapse. The blood was then examined and found teem ing with malarial organisms. The patient eventually recovered, but nevertheless. the operator was negligent in not exclud ing by systematic study of the case the possibility of malarial infection, before performing what proved to be an unneces sary mutilating operation. W. W. Rus sell (Johns Hopkins Hosp. Bull., Nov. and Dec., '96).