CHAPTER LX 



THE DIAGNOSIS OF A TROPICAL FEVER 



Preliminary — Thermometric pseudo-fever — Acute fevers — Fevers of less than 

 eight days' duration — Fevers of more than eight days' duration — Chronic 

 fevers — Summary. 



PRELIMINARY. 



The method of diagnosis contained in the present chapter is not 

 intended to be comprehensive, and the reader who expects to find 

 every possible situation dealt with will be disappointed, because 

 this is not our intent, and, indeed, would be a practical impossibility. 



We are endeavouring to place before him such information as 

 we have found necessary to use in some twenty-odd years of tropical 

 life, and we may perhaps be pardoned if we mention some plain 

 facts before starting on our subject. 



Firstly, we trust that our reader will realize that it is one thing 

 to draw up a nice-looking scheme of diagnosis upon paper, and it is 

 quite a different thing to give a system which will be applicable 

 at the bedside; but no one knows better than we do how difficult it 

 is to write a system so applicable. 



Secondly, we trust that our reader has not forgotten that there 

 is such a thing as clinical medicine — that is to say, a system of 

 diagnosis based upon the bedside examination of the patient. 

 In our opinion, every patient should be most carefully examined, 

 from the crown of his head to the soles of his feet, by ordinary 

 clinical methods before any attempt is made to utilize the resources 

 of the laboratory. 



A systematic clinical examination of every patient is most 

 essential. It is the sum total of the various symptoms, none 

 alone pathognomonic, which establishes the diagnosis in conjunc- 

 tion with which the results from the laboratory must be considered. 

 A practitioner who is unable to come to some sort of a diagnosis 

 without the aid of a laboratory should, in our opinion, utilize his 

 earliest spare moments in a course of post-graduate instruction 

 with regard to clinical methods. 



Thirdly, we are of the opinion that the laboratory work should 

 never be omitted as a check to confirm or to adjust this clinical 

 diagnosis. Specimens sent for diagnosis to a laboratory should 

 always be carefully collected. This collection should at least be 

 supervised by the practitioner, and not left to subordinates entirely, 



1511 



