(67)
without result, attention will be directed to the alimentary system and an
endeavour made to find or to exclude a local infection there. In this case
the search will be begun in the mouth (including the teeth, gums, and tongue),
and the pharynx and fauces will be examined. A general examination of the
abdomen by inspection, palpation and percussion will then be made and
afterwards a special examination, by palpation and percussion, of the stomach,
the liver and gall-bladder, the spleen and the intestines. A specimen of the
fces should be examined microscopically for the eggs of intestinal worms.
(See page 22.) The physical examination of the genito-urinary system will be
concerned chiefly with the palpation of the kidneys, with the physical,
chemical, and microscopical examination of the urine and with a search
for signs of gonorrha or syphilis. The examination of the nervous
system will be conducted with the object chiefly of excluding heat stroke and
cerebro-spinal meningitis. By a careful examination of each system in this
manner-and it is necessary to mention that the examination of the ear, the
throat, and the nose (especially for septic conditions) must not be omitted-we
shall have narrowed down considerably the limits of our enquiry. Hitherto
we shall have been occupied in attempting to arrive at a correct diagnosis of
the cause of the fever by a process of exclusion; we shall have found that
the cause does not lie in a local infection in any of the systems examined.
We have excluded, let us say, all except the following diseases:-
The initial fever of small pox
Malta fever.
and other exanthemata.
Typhoid fever.
Dengue fever.
Relasping fever.
Heat stroke.
Filarial fever.
Simple continued fever.
Malarial fever.
Cerebro-spinal fever.
Splenic leukmia.
Kala azar.
Malarial cachexia.
We may now allow ourselves to proceed by the alternative method and
to think of the possibilities of the fever being due to one or other of these
diseases. Assuming that our patient is suffering from only one disease-we
cannot, of course, deal in this small book with complicated cases -it will be
seen that the diseases just enumerated can be divided into two classes,
namely, (1) those in which the spleen may be very greatly enlarged (splenic
F 2