12 DISEASES DUE TO PROTOZOA 



DIAGNOSIS. 



In the early stages one must differentiate it from Malaria, Typhoid, 

 Typhus, Yellow fever. Seven-day fever and Influenza. The following 

 are the main points to watch : — 



(i) For spirochaetes in the blood. 



(2) Malarial parasites in the blood. 



(3) Agglutination ; add a drop of suspected serum to a drop con- 

 taining spirochastes, mix, cover with cover-glass, seal, incubate at 

 37° C. for half an hour. Clumping of spirocha?tes into non-motile 

 masses is positive. 



(4) Typhoid by absence of leucocytosis. 



(5) Typhus by absence of spirochaetes, agglutination test and 

 presence of rash. 



(6) Yellow fever by black vomit 



(7) Seven-day fever by slow pulse and absence of spirocha?tes. 



(8) Influenza, from a mild attack of Relapsing fever, not easy to 

 differentiate apart from absence of spirochaetes. 



Relapsing fever may co-exist with Malaria, Small-pox, Measles, 

 Plague. 



Diphtheria and Scurvy after famines. 



PROGNOSIS. 



This is good. Mortality 4 per cent, in Europe, 14 per cent, in 

 Egypt (Sandwith). 



Marked jaundice is bad. 



Pregnant women usually abort. 



Death may be caused by : Toxaemia during the first attack ; 



collapse during the intermission ; 



complications intervening. 



TREATMENT. 



Rest in bed is essential. 



Salvarsan, neosalvarsan, galyl or kindred preparations are specific, 

 and should be given intravenously or intramuscularly; the former is 

 better. These drugs have revolutionized the treatment of these fevers. 

 One should begin with small doses as some patients stand them badly, 

 say with 0*30 grm. 



Relieve pains with salicylates, aspirin, antipvrin and quinine. 



Opium or morphia may be necessary. 



Vomiting with ice, champagne, bismuth mixture, morphia and 

 codeine. 



Epigastric pains with fomentations sprinkled with opium tincture. 



Cough by codeine and heroin or expectorant mixture. 



