FEVERS IN THE SUDAN 223 



of Castellani's low, intermittent, non-malarial fever, though, so far as I know, it has never 

 been definitely diagnosed in the Sudan. I have, however, seen cases resembling it. {Vide 

 Manual of Tropical Medicine, Castellani and Chalmers, 1910, page 788.) 



Now that we know that syphilis is a form of chronic spirochtetosis, subject to acute .Syphilis 

 or subacute exacerbations, it is not surprising that a prolonged fever of syphilitic origin may 

 occur. This is specially true of visceral syphilis, and Hermann' has recently recorded 

 a case of the kind. It is advisable, therefore, in doubtful cases to exhibit mercury and 

 l^otassium iodide or possibly even " 606," a procedure which may clear up a puzzling 

 condition in a very short space, and at the same time may prevent the occurrence of 

 symptoms which, wliile they may make the diagnosis certain, may also be distressing or 

 dangerous to the patient. 



Until recently the part played by helminths in producing fevers in the Tropics has not, 

 I think, been sufficiently I'ecognised. 



Without trespassing on the functions of our Review Supplement, I may yet mention 

 that Castellani- has drawn timely attention to the febrile condition in Ankylostomiasis, 

 while in India several papers have appeared dealing with " Eound Worm Fever." In 

 any case of obstinate and obscure fever the faeces should be systematically examined. 



Here is the chart (5) from a case which, post mortem, showed marked Schistosomum 

 lesions in the sigmoid flexure and the faeces of which were full of lateral-spined eggs. The Fevers caused 

 chronic bilharziosis was apparently the sole cause of a prolonged elevation of temperature ^^ helminths 

 extending, almost without remission, over a period of 52 days, between the date of 

 admission and the date on which death occurred. Malaria was excluded. Correct diagnosis 

 in such a case can, unfortunately, rarely lead to effective treatment. Eosinophilia, often 

 marked, is frequently the first guide to its true nature. 



Fever due to old malarial infection, when there are no parasites to be found in the blood, 

 is sometimes diflBcult to diagnose. A big spleen and a large mononuclear increase occur 

 in other conditions, while, in the Sudan, pigment-containing white cells are distinctly rare 

 in the peripheral blood. History goes for something, but what chiefly helps is to 

 enumerate the red and white cells, especially the latter, so as to exclude leucopenia and 

 to find out the relative count. Of course splenic puncture may clear things up, but it is 

 not perhaps always justifiable unless, indeed, one is excluding kala-azar, and the blood state 

 does not forbid the operation. In some cases only prolonged and efficient treatment drives 

 one to the conclusion that the case was malarial in origin, and it is quite true that 

 treatment is often as much a diagnostic as a curative agent in this class of illness. 



Of still greater interest are cases of what, for want of a better term, is called 

 idiopathic tropical splenomegaly, where a patient suffers from constant fever, marked ^^'"P^^^ic 

 splenic enlargement, some increase in the hepatic dulness, loses flesh and may look for splenomegaly 

 all the world like a kala-azar case. 



I have seen at least two examples in Europeans and the condition has, of course, 

 been recorded from the Philippines'* and India. ^ One case was in a British Officer from 

 the Blue Nile. Malaria was excluded and the symptoms, clinical signs and temperature 

 were exactly like those of a moderately severe case of kala-azar. Liver puncture was 

 performed but no Leishman-Donovan bodies were found. There was marked degeneration 



' Hermann, " Klinisch Anatomischer Beitrag zur Pathogenese dea Viszeralen Luesfiebers." Med. Klin. 

 Berlin, 1910, VI, 1015-1017. 



- Castellani, A. (SeiJtember 1, 1910), ''Ankylostomiasis." — Journul of Tropical Medicine and Hygiene. 



'■'■ Woolley, Paul G. (June 1906), "Tropical Febrile HplenomegaJj."— Philippine Journal of Science, Vol. I. 



* Faichnie, N., and Bond, J. H. R. (September, 1910), " Loug-contiuued Fever with Marked Enlargement of 

 the Spleen Cured by the Use of Sf.iK^VL."— Journal Unifal Arnin Medical Corps, Vol. XV., No. .3. 



