I5I2 



THE DIAGNOSIS OF A TROPICAL FEVER 



otherwise mistakes will be possible. The specimens should always 

 be collected and forwarded in the most aseptic method possible, 

 and should be accompanied by a statement recording the nature 

 of the specimen, the date and time of its collection, the nature of 

 the examination desired (which should not be vague — e.g., not 

 * urine for examination,' but clearly stated, ' urine to be examined 

 quantitatively for sugar'), and a brief statement of the salient 

 features of the case and the suspected clinical diagnosis, because 

 it is the duty of the practitioner to help the laboratory in its work. 



Finally, we desire most earnestly to impress upon the reader 

 that the essential feature in the diagnosis of a tropical fever is a 

 combination of clinical examination with laboratory work. 



THERMOMETRICAL PSEUDO-FEVER. 



The practitioner working in high air temperatures should re- 

 member that the clinical thermometer, being of the maximum 

 type, will rise quickly to some temperature corresponding to that 

 of the air, and will remain thereat. Mistakes have been made, such 

 as recording a number of cases of fever in an institution. In high 

 air temperatures the thermometer should be taken out of cool 

 water, placed in the patient's mouth, left there long enough to 

 record the actual temperature, and then quickly replaced into cool 

 water, in which it is examined. 



The practitioner knows well the precautions re hot liquids or 

 solids having been placed in the mouth before the thermometer, 

 thus giving high readings, and the effect of draughts falling on 

 the cheeks preventing the rise of the mercury; or, in other words, 

 of the possible thermometrical fallacies of which these are examples. 



ACUTE FEVERS. 



' The acute fevers may, for purposes of diagnosis, be divided into 

 those which have lasted less than eight days, and those which have 

 been in progress eight or more days when seen by the practitioner. 



FEVERS OF LESS THAN EIGHT DAYS' DURATION. 



These fevers may be divided into : — 



I. Those exhibiting some striking physical sign. 

 II. Those not exhibiting any striking physical sign. 



I. WITH SOME STRIKING PHYSICAL SIGN. 



The physical signs to which we refer may be classified into :— 



A. Traumatisms. 



B. Skin eruptions. 



C. Derangement of some bodily system. 



D. Localized derangement of some organ. 



