I5I4 



THE DIAGNOSIS OF A TROPICAL FEVER 



III. The rash has the characters of a blush, with or without oedema : — 

 {a) The rash, though general, is more marked in one area : — 



1. Evidence of a bite or sting — Bite or sting of a venomous 



animal. 



2. No such evidence, special region pits on pressure: — 

 Examine night and day blood for microfilariae — 



Filariasis. 



3. Macules on wrist and ankles only becoming general 



on third day; severe symptoms; yellow tinge in con- 

 junctivae. Occurs in Rocky Mountains — Spotted 

 fever of the Rocky Mountains, 

 {b) The rash is not specially marked in one area: — 



Examine blood for eosinophilia and the faeces, after a purge, 

 for the eggs of intestinal worms — Helminth infections. 



IV. Erythema fugitive, faint, annular, most marked on trunk : — 

 History of residence in Tropical Africa. Glands in posterior 



triangle of neck enlarged. Examine gland juice and blood 

 for trypanosomes — Sleeping sickness. 



V. Erythema with marked cerebral symptoms, vomiting, retraction of 

 head — Kernig's sign. 



1. Examine the blood for malarial parasites, if present — 



Malaria. 



2. If absent, perform lumbar puncture and examine for 



meningococci — Epidemic cerebrospinal meningitis. 



VI. Erythema mild, amounting to very severe blushing, and most 

 marked on the face : — 

 Eyes injected, severe pain at back of eyes, high fever. Occurs 

 in locality where phlebotomus is endemic — Pappataci fever. 



VII. Erythema with little or no fever, but with marked gastro-intestinal 

 symptoms : — 



With or without signs of collapse — Ptomaine poisoning. 



(B) Erythematous Rash Localized. 



I. Rash distributed on parts exposed to light : — 



On face, neck, and hands, often feet; associated with gastro- 

 intestinal and nervous symptoms. Fever is not a marked 

 feature of simple pellagra, and when this occurs it is due to a 

 complication, generally with one of the ent erica group of 

 fevers — So-called typho-pellagra. 



1 1. Rash not specially confined to parts normally exposed to light : — 

 {a) Associated with oedema in some part : — 



I. (Edematous and erythematous areas coincide. Area 

 defined by sharp edges. Sometimes vesicles present 

 and leucocytosis — Erysipelas. (b) Lymphatics in- 

 flamed, microfilariae in blood. — Filarial lymphangitis. 



