Fevers in tup: Sudan 



PUELIMINARY NoTE 

 BY 



The Directou 



No subject is of greater importance in the Sudan than that which gives tliis paper 

 its title. In some respects, also, there is no subject about which there is more to be 

 learned. It is true that in the case of a certain number of febrile disorders in the Sudan 

 we are on sure ground as, for example, enteric fever, the paratyphoid fevers, malaria, 

 spirochietosis, Malta fever, the febrile dysenteries, the fever due to hepatitis, cerebro- 

 spinal fever, diphtheria, influenza and pneumonia. In such cases we know the cause 

 and can treat the condition with more or less chance of success. What is better, we can 

 very often prevent such diseases occurring or check their spread. A second class exists 

 where we know either the cause or the method of infection and can do something towards Classes of 

 preventing them, but where, so far, treatment is of little avail. As examples may be -pronics 

 mentioned trypanosoma fever, kala-azar, phlebotomus fever, dengue, measles, variola 

 and varicella. Finally, there comes a group where it is often difficult to make a diagnosis, 

 where the condition may be trivial or of great gravity, where the explanation, when 

 obtained, may be simple in the extreme but where such explanation can only be secured 

 by careful clinical and laboratory work and by following out the synoptic methods so 

 ably set forth by Sutherland' of Lahore. In this class come the ptomaine poisonings, the 

 obscure tubercular processes, especially general miliary tuberculosis, the fever associated 

 with visceral syphilis, fevers due to infection with metazoan parasites, fever due to old 

 malaria infection, cases of idiopathic splenomegaly, certain septicsemic conditions, paracolon 

 and atypical paratyphoid fevers, B. coll infections of the urinary tract and the febrile 

 disorders commonly put down to the effects of sun, chill or fatigue and about which we 

 know very little. 



There is no need to deal here at any length with the first class. So far as one 

 knows, with the single exception of diphtheria, the facts gathered concerning them are in 

 accord with those which have been set forth regarding them in India and elsewhere. 

 Diphtheria and spirochaetosis receive special chapters to themselves in this Eeport and 

 nearly all the others have claimed attention, either in previous Reports or in our 

 Second Eeview Supplement. 



The pre-suppurative stage of hepatitis lias, however, not been mentioned, but, thanks Pie-suppura- 

 to the work of Eogers- in India, one has been on the look-out for cases of this kind. "^'^ s'=ig<5 of 



, hepatitis 



Quite recently one was encountered in the Egyptian Army Hospital, Khartoum, under the 

 care of Captain A. G. Cummins, E.A.M.C. He had been running a temperature since 

 admission, 23 days previously {Ghart I.) Blood examination was negative, so far as 

 parasites were concerned, and his stools showed nothing abnormal. Captain Cummins 

 had detected a slight increase of liver dullness and there was some pain and tenderness 

 in the hej)atic region. On the right side there was also a transitory pleural rub leading 

 to a suspicion of pneumonia. There was no shoulder pain and only slight insomnia. 

 At first the case was regarded as an indefinite type of pneumonia but, as will be seen 



1 Sutherland, D. W. (September 12, 1908), "The Differential Diagaosis o£ Fevers." Lancet, London. 

 - Rogers, Leonard (1910), Fevers in the Tropics, Second Edition. 



