CHRONIC FEVERS 



1531 



Remittent or continuous in type : — 



I. Benefited by quinine therapy — Malaria, 

 IT. Apparently not benefited by quinine therapy: — 



[a] Ulcers or tumours present in some part of the body. 

 Examine thoroughly, including nose, naso-pharynx, 

 and all apertures of body. Especially examine the 

 teeth, particularly crowned teeth or bridges. Ex- 

 amine fingers and toes carefully — Septic infection or 

 absorption. 



[h) Cutaneous dark pigmentation a marked feature : — 



1. Examine spleen for enlargement and blood for 



malarial parasites or mononucleosis. Insuffi- 

 cient quinine administered — Malaria. 



2. Fever generally absent. No signs of malaria. 



V«)miting at times. Weakness, etc. — Addison s 

 disease. 



(c) Splenic enlargement a marked feature : — 



I. Examine blood films: — 

 No malarial parasites seen. 



(a) Marked increase in white cells, lymphocytes, 



or with myelocytes — Leukcmnia. 



(b) Having excluded leukaemia, hut not before, 



examine blood obtained by splenic punc- 

 ture: — 



1. Malarial pigment or parasites present — 



Malaria. 



2. Leishman-Donovan bodies present — Kala- 



azar. 



3. Leishman - Donovan bodies absent — 



Febrile splenomegaly. 



4. Toxoplasma-like bodies present — Toxo- 



plasmatic febrile splenomegaly. 



5. All parasites absent — Pseudo-kala-azar . 



(d) CEdema a marked feature :—- 



I. Examine blood for malarial pigment, parasites, 

 or mononucleosis, and the spleen for enlarge- 

 nient — Chronic malaria. 



II. No signs of malaria: — 



(A) Examine motions for eggs of intestinal 

 worms, especially ancylostoma ova — 

 Ankylostomiasis. 



(b) No eggs or signs of worms. In South 

 America. Examine blood during an attack 

 of fever for trypanosomes — Chagas' 

 disease. 



