1396 THE ENTEROIDEA GROUP OF TROPICAL FEVERS 



there is little fever; but the enlargement oi a group of lymphatic 

 glands will arouse suspicion as to the true nature of the disease. 



Plague pneumonia may be distinguished from the pneumonic 

 form of enteric fever by an examination of the sputum. 



Yellow Fever. — Mistakes are most apt to occur at the commence- 

 ment of a yellow-fever outbreak before the disease is recognized. 

 The diagnosis may be effected by the rapid onset of the fever, the 

 tenderness in the region of the pylorus, and by the albuminuria 

 which is often present on the first day, and later by the vomit. But 

 in such an important point as the diagnosis between yellow fever 

 and typhoid fever, bacteriological examination of the blood and 

 motions should not be neglected. 



Typhus. — This fever may be distinguished by its sudden onset, 

 and by the early appearance of mental symptoms, and especially 

 by the early appearance of delirium and coma, while the macular 

 petechial eruption appearing on the fourth day materially assists 

 the diagnosis. Brill's disease is merely a mild form of typhus, 

 and may be differentiated by the appearance on the fifth or sixth 

 day of a maculo-papular eruption, which does not disappear on 

 pressure, and does not appear in crops. 



Influenza. — The diagnosis between influenza and enteric fever 

 can be made by the presence of catarrhal symptoms in the 

 former. 



Trichiniasis. — The presence of oedema of the eyelids, together 

 with swelling and painful tension of the muscles, associated with 

 dyspnoea, are in favour of trichiniasis. The blood should be 

 examined for any signs of eosinophilia, while the worms may be 

 discovered in the motions. 



Acute Miliary Tuberculosis. — The differential diagnosis here is 

 very difficult, and is complicated by the fact that the two diseases 

 may occur together. The fever in acute miliary tuberculosis is 

 irregular, and the pulse and respiration are rapid, and there is 

 embarrassment of the breathing, often leading to cyanosis; but 

 the diagnosis is very difficult, and may have to depend entirely 

 upon bacteriological research. 



Appendicitis. — In appendicitis the onset is usually abrupt, and 

 the pain in the right iliac fossa is distinctive, but there are cases 

 which closely resemble enteric ; and it must be remembered that 

 the typhoid bacillus can cause appendicitis. 



Pneumonia. — Enteric fever may, though very rarely, begin with 

 a typical attack of pneumonia, when the specific organisms may be 

 found in the sputum; otherwise, a diagnosis must be made by the 

 examination of the blood, or later clinically, when the more typical 

 symptoms of enteric arise in the second week. 



Rat-Bite Disease. — This may be recognized by the history, by 

 the blotchy, measly eruption, and by the fact that the fever ends 

 for the first time after a few days, only to reappear again later. 



Psittacosis. — This enteric-like fever may be suspected by the 

 history of there having been sick parrots in the house in which the 



