ACUTE FEVERS WITHOUT STRIKING PHYSICAL SIGN 1527 



B. Patient unable to carry on his usual duties : — 



(a) Liver and lymphatic glands enlarged. Spleen not en- 



larged. Examine blood. Signs of great destruction of 

 red blood-corpuscles (presence of Bartonella hacilliformis) . 

 Residence in Peru — Oroya fever. 



(b) Sudden onset, with injected conjunctivse (pink eye), high 



fever, comparatively slow pulse. Severe rheumatoid 

 pains. Liver and spleen normal. Patient irritable, 

 with pain in head and eyes, and may be delirious. 

 Endemic area iovPhlebotomus flies — Pappataci fever. 



{c) Sudden onset, with severe pain in some part of the body 

 or all over the body. With or without enlargement of 

 the lymph glands, with generally a maculo-papular erup- 

 tion on the third or fourth day. Conjunctivse injected. 

 Fauces congested. Pulse increases proportionately with 

 the fever. Endemic area for stegomyia (perhaps also 

 for Culex fatigans) — Dengue fever. 



(d) Sudden onset. Hyperesthesia over shins. Pains in the 



legs. Often slight splenic enlargement. Mononucleosis 

 in blood. May or may not be history of association with 

 lice. Blood examination excludes malaria, relapsing 

 fever, etc. — Trench fever. 



[e] Sudden onset, with or without rigors and pains. Examine 



blood for malarial parasites — Malaria. 



(/) Gradual onset. Signs of enteric fever. Make blood and 

 faecal cultures — Enteroidea group of fevers. 



(g) Blood examination reveals marked polymorphonuclear in- 



crease. Examine gums, teeth, ear, nose, throat, fingers, 

 toes, bones, and every orifice of the body, for possible 

 source of infection; make blood cultures — SepticcBmia. 



[h) Blood examination. Examine night and day blood for 



microfilarise^ — Filariasis. 



{i) Examine faeces for intestinal eggs, especially after a purga- 

 tive — ToxcBmias due to intestinal worms. 



(j) Gradual onset, with marked pains in the joints, profuse 

 sweating, high fever, and relatively slow pulse. Furred 

 tongue — Undulant fever. 



{k) Sudden onset, with hyperpyrexia, delirium, or coma asso- 

 ciated with high atmospheric temperatures — Thermic 

 fever [heat-stroke). 



(I) Sudden onset, with or without history of fever. Syncope 

 associated with high atmospheric temperatures — Heat 

 syncope. 



