68 REVIEW — TKOPICAL MEDICINE, ETC. 



Fevers- Mention has been made of the Acute Tuberculous Fever described by Roberts and 



cnniinucd Bhandarkar.' This is described as 



a continued fever of a remittent or intermittent type, lasting from a week to four weeks or more, and 

 due to an acute invasion of the tubercle bacillus which during the febrile period and for a long time afterwards is 

 found to l)e excreted in the urine. The main symptoms seem to be furred, but not " typhoid," tongue, skin dry 

 aud hot. no sweats, urine highly-coloured without albumen, and, specially characteristic, pain and tenderness 

 in the epigastrium. The mind is clear, forming a marked contrast to the typhoid mental state. The liver 

 is often enlarged, the spleen not so, aud the bowels are usually constipated. 



Recovery may take place or the patient may drift into a tuberculous career, commencing with an indefinite 

 kind of illness characterised by dyspepsia, fever relapses, depression and malaise. Some cases dcvelo]! obvious 

 tuberculosis. The diagnosis from liver abscess is very difficult, but is accomplished by finding tubercle bacilli in 

 the urine by the following technique : — 



Centrifuge, wash the deposit once or twice in distilled water before fixation and use egg aDiumen in the 

 fixing process! Stain by the Ziehl-carbol-fuchsine process with a final metliylene blue (lightly done) as a counter 

 stain. Other acid-fast bacilli have to be eliminated by the procedure recommended by Coles. 



Tests on guinea pigs which have been made were not completed at the time of publication. 



These observations, which are very interesting, require confirmation, but, if this bo 

 forthcoming, a most valuable addition will have been made to our knowledge of obscure 

 fevers, at least in India. Tuberculosis is far from being uncommon in the Sudan, and it 

 will be well to keep on the look-out for cases answering to this description. 



Rogers' book, already frequently quoted, is at the present time the standard work on 

 tropical fevers, at least so far as India is concerned. The two chapters therein which bear 

 especially on the subject under discussion are those respectively entitled " Unclassified Long 

 Fevers " and " Unclassified Short Fevers." As regards the former, the author mentions 

 Crombie's old classification and shows that his " remittent fever" is really typhoid, which 

 was supposed to be uncommon amongst natives, while kala-azar accounts for another type. 

 He then discusses certain doubtful, irregular, long fevers, dwelling principally on their 

 incidence, and concludes that though they " may possibly belong to some one or more still 

 undifferentiated tropical diseases, yet they present no features incompatible with their being 

 either paratyphnids, including the class recently described by Castellani, or early cases of 

 sporadic kala-azar, but they require further study and following up for long periods before 

 their exact nature can be finally decided. Special reference is made to a Low Fever of 

 European immigrants occurring in the damp, hot provinces of India, benefited markedly 

 by change of climate or removal to a place with a dry soil, and due in all probability either 

 to an enfeeblement of the heat-regulating mechanism or possibly to some undiscovered 

 protozoal parasite. In the latter connection, he considers a leucocytozoon, but no parasites 

 of this kind have been found in these cases. He also notes that a fever resembling kala- 

 azar, but without the Leishman-Donovan bodies, has been described in the Philippines. 



Mention is also made of undetermined fevers in China, such as the Double Continued 

 Fever described by Manson and a similar form found by Rousseau amongst sailors at 

 Hankow. 



As regards the " Unclassified Short Fevers," we are now, thanks to Rogers' own work, 

 on surer ground. He has described as a distinct entity, what he calls Seven Days' Fever, a 

 condition which Sandwith believes exists in Egypt and which very probably occurs also in 

 the Sudan : — 



The onset is sudden, in many oases rigor or chillness being present. Repeated rigors may occur resembling 

 those of malaria. Rarely the onset is gradual. 



There is a flushed face, reddened conjunctivae, often a listless, typhoid-like expression, while abdominal 

 symptoms and even a few rose spots may suggest enteric fever. 



Pain in the back and limbs is common, but the joints arc rarely affected, thus distinguishing the attack from 

 dengue. Headache is common, severe and often frontal in site. The tongue is furred on the dorsum and has raw, 

 red edges. It is like the tongue seen in influenza or dengue. 



Sickness may occur, but the bowels are usually regular. Abdominal pain and distention are not infi-equent. 

 Slight enlargement of the liver was found in 5 per cent, of cases, and of the spleen in only 7 per cent. Respiratory 

 symptoms are absent. The pulse is like that in typhoid and p;iratyphoid, and is therefore somewhat characteristic. 



Rashes may occur but are not common. The typical temperature curve is of a saddle-back shape, the remission 

 being slight, moderate or deep. Sometimes there is complete remission to normal before the terminal rise. There 

 is also a type of case showing a continued typhoid-like curve and, as there is usually a terminal rise, cases coming 

 late under observation are apt to be confusing. 



' Roberts, J. R., and Bhandarkar, R. S. P. R. (February 15th, 1908), " Preliminary Note on the Existeuco 

 of an Acute Tuberculous Fever in India which has been coirfuscd with Continuous and Remittent Fevers." 

 British Medical Journal, p. 377. 



