THE DIAGNOSIS OF A TROPICAL FEVER 



{h) Sudden attack of fever, with: great tenderness over, 

 and pain in, the os calcis or other tarsal bone, which 

 begins to increase in sizo^Endemic enlargement of 

 the OS calcis. 

 I. Symptoms pointing to the connective tissue : — 



Rigors with fever and aching or dragging sensation, and 

 outline of a worm under the skin of affected area — 

 Dracontiasis. 

 J. Symptoms pointing to the nervous system : — 



(a) Almost any acute sign or symptom pointing to the 

 nervous system, including signs of mania, melan- 

 cholia, or dementia, and associated with fever, with 

 or without enlargement of the spleen. Examine 

 blood for malarial parasites or mononucleosis — 

 Malaria. 



{b) Signs of meningitis present — e.g., Kernig's sign, re- 

 traction of the head, etc. , Examine cerebro- spinal 

 fluid:— 



1. Polymorphonuclear leucocytes and cocci present — 



Epidemic cerebrospinal meningitis. 



2. Trypanosomes present ; also in juice from enlarged 



neck glands. Residence in Tropical Africa— 



Sleeping sickness. . , 



(c) Signs of acute alcoholism :— 



If picked up by the police, even if there is a smell of 

 alcohol, examine spleen and take blood films if 

 necessary. Drunk or dying in the tropics is often a 

 question of alcoholism or malaria. Fever may be 

 absent in both instances— ^c^^/^ alcoholism or 

 malaria. 



D. DERANGEMENT OF SOME ORGAN. 



The signs and symptoms associated with some organ of the body 

 may be considered under the following headings: — 



1. The Spleen. 



2. The Liver. 



3. The Pancreas. 



4. The Suprarenal Capsules. 



5. The Parotid. 



A. The spleen : — 



I. Enlargement slight : — 

 Rose-coloured spots on the abdomen. Symptoms of 

 typhoid fever. Make blood cultures and faecal cultures 

 — Enter oidea fevers. 



