the symptoms, of pronounced anæmia and of marked enlargement of the spleen, should be decisive against malaria. But in the present state of our knowledge it is very hard indeed, until the case is well advanced, to exclude typhoid, paratyphoid, and undulant fever. It may be that further experience of the blood -serum tests will establish their title to be regarded as absolutely pathognomonic signs. In this event the practitioner will have in his possession an invaluable aid in the diagnosis of tropical fevers. As things are at present, in cases in which there is the slightest doubt it is an excellent rule to regard all doubtful fevers as being possibly typhoid.
Treatment.— It is well at the commencement of doubtful tropical fevers to be as guarded in treatment as in diagnosis, and to eschew active purgatives, to enjoin rest in bed, to place the patient on a bland, unstimulating fluid diet, and to confine medication to some innocent fever mixture. There is no specific treatment for any of these imperfectly differentiated fevers. Each case has to be dealt with on its own merits and on general principles. Headache may be relieved by cold applications to the forehead, by an ice-cap, or, especially if temperature rises high, by sponging and, if not otherwise contraindicated, by occasional doses of phenacetin or some similar drug. If quinine, on the supposition that the case is malarial, has been freely tried, and without benefit, it must not be persisted with. As already hinted, "low fever" should be treated by change of air, and more especially, where feasible, by a sea trip.
