1526 THE DIAGNOSIS OF A TROPICAL FEVER 



D. Suprarenal capsules : — 



Signs suggestive of acute peritonitis — i.e., high fever, distended 

 tympanitic abdomen, quick pulse. No effusion into abdo- 

 minal cavity. Examine blood for malarial parasites and for 

 mononucleosis. If absent, give quinine and again test blood 

 — Acute malaria attacking suprarenals. 



E. Parotid glands : — • 



Painful tender swelling of parotid, especially if bilateral — 

 Mumps. 



II. ACUTE FEVERS WITHOUT STRIKING PHYSICAL SIGN. 



A Patient is carrying on his ordinary work : — 



I. Fever is intermittent, every third or fourth day. Examine 

 spleen for enlargement and tenderness, and examine blood 

 _^ for malarial parasites and mononucleosis, which may be 

 absent. Clinical symptoms alone may be positive — 

 Malarial Jevers. 



II. Fever is quotidian. Examine spleen for tenderness and 

 enlargement. Examine blood for malarial parasites 

 and mononucleosis. If none, give quinine and note 

 action on fever — Malaria. 



III. No malarial parasites, and quinine therapy without effect : — 

 (a) Pulse dicrotic; slow in proportion to the temperature. 

 History of several days' indisposition. Tongue 

 furred, constipation, or diarrhoea. Gurgling on 

 pressure in right iliac region. Make blood and 

 fecal cultures, and examine for enteroidea organisms 

 — Enteroidea group of fevers, 

 {b) Pulse not dicrotic ; slow in proportion to the tempera- 

 ture. Attack sudden, with at first pain and tender- 

 ness, which later disappear in the region of the 

 appendix. No malarial parasites in blood — Gan- 

 grenous appendicitis. 



(c) Abrupt onset, catarrhal symptoms, with sensation of 



considerable illness and with generalized pains, often 

 in epidemic form — Influenza. 



(d) With or without signs of bronchitis, enlargement of 



liver and spleen, or with signs of broncho-pneumonia. 

 Examine sputum for tubercle bacilli, or if lung 

 symptoms absent test cuti-reaction — Acute phthisis 

 or tuberculosis. 



(e) Gradual onset, temperature increasing every night. 



Headache and rheumatoid pains in body and limbs. 

 Tongue furred. Blood cultures for M. melitensis 

 and M . paramelitensis — Undulant fever. 



