DERANGEMENT OF SOME ORGAN 



1525 



II. Enlarged and tender : — 



{a) Examine blood films for malarial parasites and for 

 spirochsetes — Malaria or Relapsing fevers. 



{b) With oedema of the face and enlargement of the 

 thyroid and lymphatic glands and liver. Residence 

 in South America — Chagas' American trypano- 

 somiasis. 



III. Enlargement considerable : — 



{a) Generally a history of illness lasting some time, of 

 which present fever is only a recurrence. Firm 

 enlargement. Malarial parasites in blood — Exacer- 

 bation of chronic malaria. 



{b) No malarial parasites in the blood : — 



Great increase in white blood cells with myelocytes — 

 LetikcBmia. 



(c) No malarial parasites and no great increase of leuco- 

 cytes in the blood : — 



1. Splenic or hepatic puncture shows Leishman- 



Donovan bodies — Kala-azar. 



2. Shows no Leishman-Donovan bodies — Febrile 



splenomegaly. 



3. Toxoplasma bodies present — Toxoplasmosis. 



B. The liver : — 



Enlarged and tender : — 



1. Pain in the right shoulder, rigidity of right rectus, 



diminution of movement of right side of the dia- 

 phragm. Examine motions for amoebic cysts and 

 the blood for mononucleosis (present) and malarial 

 parasites (2bs&Ri)— Amoebic liver abscess. 



2. Signs of severe septic infection, jaundice, etc. If 



origin of sepsis not evident, examine faeces for intes- 

 tinal worms and for enteroidea micro-organisms — 

 Multiple septic liver abscesses. 



3. Slight yellowish tinge in the sclerotic, seldom signs of 



general jaundice. Patient not seriously ill. No 

 amoebiasis — Tropical liver. 



^ C. The pancreas : — 



I. With intense pain in the upper and left part of the abdomen, 

 which is distended with gas; vomiting and constipation — 

 Acute pancreatitis. 



II. Signs and symptoms of diabetes; threatened Kussmaul's 

 coma. Recurrent attacks of fever every other day. 

 Examine for malarial parasites; if absent and if only 

 polymorphonucleosis give a few doses of quinine and 

 note action on fevex — Malaria and diabetes. 



