I530 



THE DIAGNOSIS OF A TROPICAL FEVER 



II. Not benefited by quinine: — 



{a) Test the serum reactions for typhoid and the para- 

 typhoids, and the other common enteroide organ- 

 isms of the period and locahty. Confirm by blood 

 cultures — large quantities, lo c.c, of blood taken 

 at night — or by f?ecal cultures — Enter oidea group. 



(h) Test for Mediterranean fever by serum reactions and 



blood cultures — Undulant fever. 



(c) Culture of aseptically collected urine — Pyelitis. 



[d) Examine motions for eggs of intestinal worms — In- 



testinal toxcemias due to worms. 



{e) Wassermann reaction — Syphilis. 



if) Cuti reaction for tuberculosis — Tuberculosis. 



(g) Other causes having been excluded. Bodily tempera- 

 ture 99°-ioi° F. ; shows only slight rise once a day. 

 Patient indisposed during the attack — Low inter- 

 mittent fever. 



{h) Patient residing in locality with high atmospheric 

 temperatures. Patient not indisposed during the 

 attack — Low heat fever. 



(i) Same as in (g), but in children with higher tempera- 



tures, i03°-i04° F., or more — High intermittent 

 fevers. 



CHRONIC FEVERS. 



By the term ' chronic fevers ' we mean those which continue longer 

 than six weeks. 



A. Intermittent in type : — 



I. Occurring every third day, with enlargement of the spleen 

 and malarial parasites, or yielding to quinine therapy — 

 Tertian malaria. 



II. Occurring every fourth day, with enlargement of the 

 spleen, and malarial parasites or pigment in the blood, 

 or yielding to quinine therapy — Quartan malaria. 



III. Occurring every day, with enlargement of the spleen and 

 malarial parasites, yielding to quinine therapy — 

 Quotidian malaria. 



B. Relapsing in type : — 



Attacks of fever lasting a few days, separated by intervals of 

 several days, with severe symptoms. Examine blood for 

 spirochsetes. If necessary, inject monkeys and examine 

 blood during an attack of fever for spirochsetes — Relapsing 

 fevers. 



