1528 THE DIAGNOSIS OF A TROPICAL FEVER 



FEVERS OF MORE THAN EIGHT DAYS' 

 DURATION. 



Fevers of more than eight days and less than six weeks' duration 

 may be classified as follows: — 



A. Fever of intermittent type : — 



With malarial parasites or pigment in blood or with enlarged 

 spleen: — 



I. Fever every day — Quotidian malaria. 

 II. Intermittent fever every third day — Tertian malaria. 

 III. Intermittent fever every fom*th day — Quartan malaria. 



B. Fever of the relapsing type : — 



I. Without malarial parasites or pigment, and not reacting 

 to quinine therapy. Intervals between attacks several 

 days. During attack spirochsetes in blood — Relapsing 

 fevers. 



IT. With malarial parasites and no signs of spirochsetes, and 

 reacting to quinine therapy — Malaria. 



TIL Without parasites, and only one or two relapses; not 

 reacting to quinine therapy. After a long fever pre- 

 sumed or proved to be enteroidea in type. Examine 

 fseces and urine for enteroidea ovgdjAsTCiS— Enteroidea 

 type of fever. 



C. Fever remittent or continuous : — 



I. Reacting to quinine therapy — Malaria. 

 II. Not reacting to quinine therapy. 



A. WITH MARKED PHYSICAL SIGNS. 



1. W ell- defined local pain and tenderness : — 



Examine blood films. Leucocytosis, blood cultures, urine 

 cultures. Lastly, examine cerebro-spinal fluid (earlier 

 if head or spine symptoms) — Septiccemias or toxcemias 

 due to foci of deep suppuration. 



2. Signs of lung disease : — 



Examine sputum: — 



[a] Tubercle h3.ci\\\— Tuberculosis. 



(b) Other organisms and signs of pneumonia — 



Broncho-pneumonia. 



3. Organic cardiac murmurs : — 



With or without petechial eruptions. Signs of gonorrhoea 

 or rheumatism — Infective endocarditis. 



4. Nervous symptoms : — 



Pain in the head, retraction of the head. Kernig's sign. 

 Examine cerebro-spinal fluid — Meningitis. 



