DIAGNOSIS— TREA TMENT 



1313 



Differential Disi^nosls,— Malaria can be diagnosed b}^ the discovery 

 of the malarial parasite in the blood. 



Typhoid is indicated by the positive results of hsemo-cultures and 

 by the fever having started gradually. Widal's reaction is not of 

 much help during the first week. Typhus can be separated by the 

 absence of spirochaetes, by a negative Lowenthal's reaction, and 

 by the presence of its characteristic rash. Yellow fever can be 

 diagnosed by its black vomit, though at first the differentiation 

 may be impossible without a microscopical examination of the 

 blood. Dengue fever is characterized by its slow pulse and, of 

 course, by the absence of spiroch^etes. Weil's disease m.ay be dis- 

 tinguished by the more marked jaundice and by the different 

 nature of the spirochaetes, which are seldom found by the simple 

 microscopical examination of the blood. 



Prognosis. — ^The prognosis is usually favourable. Marked jaun- 

 dice is a bad sign, while pregnant women generally abort. The 

 mortality appears to vary considerably, being, according to Mur- 

 chison, only 4 per cent, in the United Kingdom; while, according 

 to Sandwith, it is 14*4 per cent, in Egypt, which is nearly the same 

 percentage as that reached in Russia. The causes of death are 

 toxaemia in the first attack, and collapse in the first intermission, 

 but it may be caused by one of the above-mentioned compli- 

 cations. 



Treatment. — This may be discussed under the following 

 headings: — 



1. Specific Treatment. 



2. Symptomatic Treatment. 



Specific Treatment. — Salvarsan or neosalvarsan or their sub- 

 stitutes may be administered either by intramuscular injection or, 

 better, intravenously. This is a specific treatment, most effica- 

 cious, but care should be taken not to inject a large dose, as 

 certain patients, especially, it seems, those suffering from Asiatic 

 relapsing fever, stand the drug badly, cases of death having been 

 recorded, even after a medium dose, such as 7 J grains (0*5 gramme). 

 According to Mouzels, an intravenous injection of 4 or 5 grains 

 (03 gramme) does not give rise to any unpleasant symptom, and 

 is generally sufficient to make the spirochaetes disappear from the 

 blood and cure the attack. If, however, another attack of fever 

 develops, a second injection of the same dose may be given. 



Symptomatic Treatm^ent. — Pains in the head and muscles may be 

 relieved by small doses (2 to 3 grains) of salicylates, aspirin, antipyrin, 

 or by quinine. If these pains are very severe, opium or a hypo- 

 dermic injection of morphia may be necessary. Epigastric pain 

 may be relieved by fomentations sprinkled with tincture of opium, 

 while vomiting should be treated with ice, champagne, and bismuth 

 mixtures, though occasionally morphia or codeine may be required. 

 E^erv^escing ammonium carbonate mixtures are often grateful. 



A dry, troublesome cough may be relieved by codeine or small 



83 



