TRAUMATISMSKIN ERUPTIONS 



1513 



A. TRAUMATISM. 



The presence of a traumatism suggests that an acute fever may 

 be septic in nature, but in the tropics no one should forget the 

 possibiHty of the fever being caused by the reawakening of old 

 malarial infections, or even being associated with a new malarial 

 infection, acquired, perhaps, at the same time as the traumatism. 



If the fever is intermittent, recurring every third or fourth day, 

 it is malaria. If it is quotidian, pay attention to the following 

 points: If the spleen is hard.it is probably malaria — ^make a blood 

 film; if Laveran's parasites are present or marked mononucleosis, 

 it is probably malaria; if polymorphonuclear leucocytosis is 

 present, it is probably septic fever. 



If the evidence is in favour of sepsis, or if malaria has been ex- 

 cluded, bacteriological examination of the blood and of the local 

 discharge should be made, and should include search for aerobic 

 and, if necessary, anaerobic organisms. 



B. SKIN ERUPTIONS. 

 These may be considered under the following headings: — 

 r. Erythematous eruptions. 



2. Papular eruptions. 



3. Urticarial eruptions. 



4. Purpuric eruptions. 



5. Vesicular eruptions. - 



6. Bullous eruptions. 



7. Pustular eruptions. 



8. Pigmentation. 



I. ERYTHEMATOUS ERUPTIONS. 

 tA) Erythematous Rash Generalized. 

 L The rash is more or less typical of scarlet fever :— 



(a) Onset of eruption less than forty-eight hours after the 



appearance of the sore throat — Scarlet fever. 



(b) Onset of eruption more than forty-eight hours after the 



appearance of the sore throat — Erythema or dermatitis 

 scarlatiniformis. 

 {c) Throat symptoms mild or absent : — 



(a) Examine blood for malarial parasites: — 



1. If present — Malaria, 



2. If absent inquire into drugs, especially quinine — 



Anaphylactic drug eruptions. 



II. The rash has some maculo -papular elements : — 



(a) Coryza and Koplik's spots have been or are still present— 

 Measles. 



{b) Coryza and Koplik's spots absent : — 



With enlargement of the occipital, cervical, and other 

 lymphatic glands — German measles. 



