Fevers in the tropics: their clinical and microscopical differentiation, including the Milroy Lectures on Kala-azar / by Leonard Rogers.

  • Rogers, Leonard, 1868-1962.
Date:
1908
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Licence: In copyright

Credit: Fevers in the tropics: their clinical and microscopical differentiation, including the Milroy Lectures on Kala-azar / by Leonard Rogers. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    to a fatal termination, and the mental symptoms, which are so characteristic of the disease, are due to this extension of the habitat of the parasite, for they are absent as long as the trypanosome remains limited to the blood and the lymphatic glands. The organism is sometimes present in the spinal canal in such numbers as to be readily found by a simple examination of the freshly drawn fluid, but usually it is necessary to centrifuge in order to discover the organism. According to Christy a temporary marked increase of the parasites in the cerebro-spinal fluid, without any rise in the number in the peripheral blood, may be accompanied by a marked rise in temperature. The operation of lumbar puncture is described on p. 325, LYMPHATIC GLAND PUNCTURE.—It has been known for a century that the earliest symptom of approaching sleeping sickness is a more or less general enlarge- ment of the lymphatic glands, especially those in the posterior triangles of the neck. It was not, however, until Greig and Gray discovered that the Trypanosoma Gambiense can easily and constantly be found in a small quantity of fluid with- drawn by puncturing such glands, that their significance was fully realized. Owing to the rarity and inconstancy of the parasite in the peripheral blood, in all stages of trypanosomiasis and sleeping sickness, gland puncture is a greatly improved diagnostic measure, and allows of the detection of the trypanosome in the earliest stages of the primary uncomplicated disease, when there are commonly few if any clinical symptoms to draw attention to the serious infection which has taken place, and in a stage when treatment may have a considerable value in at least warding off or postponing the fatal extension to the nervous system. For the purpose of this examination a small syringe with a tightly fitting piston is necessary, as good suction power is required. It is best to detach the needle before withdrawing it, so as to prevent the small amount of material within its lumen . being dispersed into the barrel of the syringe. It is then diluted with a little citrated salt solution and examined fresh as soon as possible for the motile organism, another portion being stained if permanent specimens are desired. DIAGNOSIS.—In the EARLY STAGE OF UNCOMPLICATED TRYPANOSO- MIASIS fever is the symptom which usually first brings the patient under observa- tion. As the pyrexia is of an irregular intermittent character, malaria will probably be suspected, and must be excluded by the absence of malarial parasites from the blood and the failure of quinine to rapidly subdue the pyrexia. If a differentia] leucocyte count is made at the same time, the constant decrease of the polynuclears and increase of the proportion of the lymphocytes, and commonly also of the large mononuclears, especially if accompanied by a slight degree of leucocytosis, should, in the absence of malaria, lead to a suspicion of trypanosomiasis if the patient has resided in the endemic area of that disease. Enlargement of the superficial lymphatic glands should then be carefully sought for, and if a fairly general affection of them is found the suspicion will be greatly strengthened. One or more cubic centimetres of blood should be centrifuged, and the layer