unknown in the interior of the country. Apparently it is a mild disease, has no mortality, and no distinctive pathological anatomy.
'Pseudo-typhus of Deli.— Schüffher has described a fever endemic in Deli, Sumatra, which resembles very closely, if it be not identical with, Japanese river fever (see p. 315). As in the case of the latter disease, it is communicated probably by an acarus or a tick; there is an initial necrotic ulcer on the skin, followed by a typhus-like fever and eruption, and a considerable mortality.
Similar fevers have been described as occurring in the Philippines, Tonquin, and Corea. In the Corean cases no mention is made of the initial ulcer.
Endemic glandular fever.— Recently, several writers in Australia have described a peculiar form of glandular fever endemic in the Mossman district of North Queensland, and occurring among natives and whites of both sexes and all ages, and particularly in manual labourers. It is characterized by an irregular remittent fever of from three days' to three weeks' duration, non-suppurating swellings of the lymphatic glands, especially those of the axilla and groin, a macular and, occasionally, a vesicular rash, and an incubation period of from six to ten days. The mortality is very low— 1 per cent. The disease does not spread in hospital, but is transmissible to monkeys by blood inoculation.
An insect transmitter is conjectured, but nothing positive is known about the etiology of the disease.
Diagnosis of imperfectly differentiated fevers.— The diagnosis of these fevers is always a difficult matter, especially so during their early stages. Among other possibilities that of typhoid, of undulant (Mediterranean) fever, of malaria, of kala-azar, of dengue, of influenza, and of other infections has to be considered. The persistent absence from the blood of the malaria parasite and of pigmented leucocytes —if vouched for by an experienced observer— and the negative results attending administration of quinine, together with the absence of definite periodicity in
