1520 



THE DIAGNOSIS OF A TROPICAL FEVER 



A. Symptoms pointing to the alimentary canal : — 

 I. Mouth and Throat : — 



(a) Pyorrhoea, marked gingivitis, or even the presence of 



bridges, crowned or stopped teeth, with pain, 

 shrinking of the gums, etc. — Septic fever. 



(b) Angina with whitish or greyish membrane on the 



fauces or tonsils: — 



Examine bacteriologically: — 



1. Streptococci present — Streptococcal angina. 



2. Klebs-LoefHer bacilh present — Diphtheria. 



3. Fusiform baciUi present — Vincent's angina. 



II. Stomach: — 



{a) Black vomit : — 



Associated with jaundice, Faget^s sign, and severe 

 constitutional disturbance — Yellow fever, 

 (b) Vomiting, pain and tenderness in diaphragmatic region. 

 Severe constitutional symptoms, with or without 

 hiccough; passage of blood per anum — Poisoning 

 with viperine venom or phlegmonous inflammation of 

 the stomach. 



III. Intestines : — 



{a) Choleraic diarrhoea, or profuse diarrhoea, or dysenteric 

 diarrhoea with fever. 



Examine blood : — 



1. Malarial parasites — Pernicious malaria. 



2. Marked mononucleosis with enlargement of the 



spleen : — 



Splenic or hepatic puncture : — 



(A) Malarial parasites — Pernicious malaria. 



(b) Kala-azar bodies — Kala-azar. 

 - 3. Eosinophilia without enlargement of the spleen. 

 Blood cultures — Intestinal septiccemias or toxcemias 

 due to worms. 



{b) Vague bowel symptoms or signs of intestinal schisto- 

 somiasis. Examine faeces for eggs and blood for 

 eosinophilia — Fevers due to intestinal worms. 



\c) Pain in the appendicular region — Appendicitis. 



{d) Slight diarrhoea or constipation. General disturbance 

 of health slight or moderately severe. 



Examine motions for : — 



1. Amoebae — Amcebiasis. 



2. Enteric bacilli. Confirm by blood cultures — 



Enteroidea. 



