ination of the blood, which, if duly considered, will avert this blunder.
In hepatic abscess, although the liver is enlarged, the spleen is not necessarily so; splenic enlargement, though an occasional, is not a usual feature in liver abscess. In malarial fever if the liver be enlarged the spleen is still more so, and usually can be felt extending well beyond the costal margin. In hepatic abscess the fever occurs generally, though not invariably, in the late afternoon or evening; the patient may perspire profusely, independently of fever lysis, at any time of the day or night—— very generally whenever he chances to fall asleep. In malarial fever the paroxysm may, and generally does, occur earlier in the day; there is no marked tendency to sweating unless at the defervescence of the fever. In hepatic abscess a history of dysentery is nearly always obtainable if carefully inquired for. If fever be distinctly tertian or quartan in type it is not hepatic. In all doubtful cases the blood must be examined once or oftener, the rigor stage or early hot stage being selected for the examination, and the examination being made before administration of quinine. Apart from the presence or absence of the parasite or of pigmented leucocytes, marked increase of polymorphonuclear leucocytes would be in favour of hepatic abscess; a relative excess of mononuclear leucocytes in favour, though not conclusive, of malaria. Occasionally cases are met with in which there is a history of malarial infection and, in addition to this, a history of dysentery, and the liver and spleen are both enlarged. In such cases diagnosis may be impossible without the microscope and the aspirator.
Diagnosis of bilious remittent from yellow fever.—— In bilious remittent the icteric tinting of the skin is an earlier feature; albuminuria is not so common and generally not marked; temperature is maintained high for many days, not subsiding in three or four days as in yellow fever; the vomiting is profuse and bilious; the pulse does not become phenomenally slow as in yellow fever; in the initial
