1522 THE DIAGNOSIS OF A TROPICAL FEVER 



D. Symptoms pointing to the urinary system : — 



(a) Urine black, due to haemoglobin : — 



1. Following on a dose of quinine — Quinine hemo- 



globinuria. 



2. With malarial parasites in numbers in blood — 



Malarial hcBmoglohinuria. 



3. Not associated with quinine or malarial parasites 



in numbers in the blood — Blackwater fever, 



4. Associated with the administration of some drug 



such as chlorate of potash for a sore throat — 

 Toxic hcBmoglohinuria. 



(h) Suppression or marked diminution of the urine: — 



Differentiate by the history of the case, the region of 

 infection, the presence or absence of Faget's sign, 

 black vomit, etc. — Blackwater fever or Yellow fever ^ 



(c) Passage of large quantities of urine:' — 



Examine for malarial parasites or other signs of 

 malaria — e.g., enlarged and tender spleen — 

 Pernicious malaria. 



(d) Bile in the urine : — 



1. Associated with haemoglobin — Blackwater fever. 



2. Not associated with haemoglobin: — 



(a) In epidemic form : — 



Examine blood and urine for spirochsetes. 

 (i.) Mild cases — Icterus castrensis levis. 

 (ii.) Severe case with haemorrhages — 

 Icterus castrensis gravis {Weil's 

 disease) . 



(b) Not in epidemic form: — 



No spirochcetes. During or after an attack 

 of typhoid or paratyphoid fever — Bacillary 

 jaundice (Enteric jaundice) . 



E. Symptoms pointing to the reproductive system : — 



(a) Chill, sudden pain and swelling along the spermatic 



cord, with often severe fever, but no erysipelatous 

 appearance of the skin — Endemic funiculitis. 



[b) Fever after childbirth. Examine the aseptically 



collected uterine discharge for streptococci and 

 other OTga^nisms— Puerperal fever. 



F. Symptoms pointing to the lymphatic system : — 



(a) Cervical glands enlarged : — 



I. Most marked on the left side, associated with 

 obstinate constipation and mild symptoms. 

 Puncture of glands reveals no organisms — 

 Pfeiffer's glandular fever. 



