I5i8 THE DIAGNOSIS OF A TROPICAL FEVER 



Rash a couple of days or more after commencement of the pain. 

 Usually confined at first to painful region, and then becomes 

 general, but may be general from first. Vesicles dome- 

 like or flattened, become umbilicated; no inflammatory 

 areola; leave scars — Vesicular fever (Castellani and 

 Chalmers). 



nr. Onset mild and without severe local pain, without history of 

 recent vaccination : — 



Rash on first to third day. Often first sign of illness. Appears 

 on back, chest, and abdomen. First in form of pale red 

 macules, often with raised centre, quickly developing into 

 superficial unilocular vesicles, some of which may become 

 umbilicated — Chicken-pox. 



IV. Onset mild, history of vaccination twelve to twenty-two days or 

 more before eruption : — 



Generalized vesicular eruption, not umbilicated at first, and 

 preceded by a papular rash. Vesicles become umbilicated 

 — Generalized vaccinia. 



6. BULLOUS ERUPTIONS. 



Bullous eruptions may be caused by plants and drugs. In newly- 

 born children bullse on the hands and feet suggest congenital 

 syphilis. 



I. There is a well-defined raised erythematous area upon 

 which the bullae are present. Bull?e to be examined 

 for streptococci — Erysipelas. 

 II. No such area present, but wounds, enlarged lymphatic 

 glands, with severe constitutional symptoms, common 

 in the tropics. Examine blood and bullae for organisms 

 — Septic pemphigus. 

 III. In recently-born children examine bullae for strepto- 

 cocci and other pyogenic organisms — Pemphigus 

 neonatorum* 



7. PUSTULAR ERUPTIONS. 



It will be remembered that there are pustular syphilides un- 

 attended by fever, and pustular tuberculides of which fever is not 

 a marked sign, 



I. Clear history of recent vaccination with Jennerian vaccine: — 



Small dark-coloured or black centre in the vaccine area, 

 surrounded by dark reddish swollen area, on which are the 

 vaccinial vesicles and pustules. Around this a bluish area, 

 the whole surrounded by a wide erythematous blush — 

 Gangrenous vaccinia. 



