TRANSCRIBER’S NOTE
Italic text is denoted by _underscores_.
Bold text is denoted by =equal signs=.
A superscript is denoted by ^x or ^{xx}, for example P^2O^5.
A subscript is denoted by _{x}, for example NH_{4}OH.
Basic fractions are displayed as ½ ⅓ ¼ etc; other fractions are shown
in the form a/b, for example 4/10 or 1/40.
The tables in this book are best viewed using a monospace font.
Some minor changes to the text are noted at the end of the book.
THE DIAGNOSTICS
AND
TREATMENT OF TROPICAL DISEASES
BY
E. R. STITT, A. B., PH. G., M. D., SC. D., LL. D.
REAR ADMIRAL, MEDICAL CORPS, AND SURGEON GENERAL, U. S. NAVY, GRADUATE,
LONDON SCHOOL OF TROPICAL MEDICINE; MEMBER NATIONAL BOARD OF MEDICAL
EXAMINERS; MEMBER ADVISORY BOARD, HYGIENIC LABORATORY. FORMERLY:
COMMANDING OFFICER AND HEAD OF DEPARTMENT OF TROPICAL MEDICINE,
U. S. NAVAL MEDICAL SCHOOL; PROFESSOR OF TROPICAL MEDICINE,
GEORGETOWN UNIVERSITY, PROFESSOR OF TROPICAL MEDICINE,
GEORGE WASHINGTON UNIVERSITY; LECTURER IN TROPICAL
MEDICINE, JEFFERSON MEDICAL COLLEGE; ASSOCIATE
PROFESSOR OF MEDICAL ZOOLOGY, UNIVERSITY
OF THE PHILIPPINES
FOURTH EDITION—REVISED
WITH 159 ILLUSTRATIONS
LONDON
H. K. LEWIS AND CO., LTD.
1922
COPYRIGHT, 1922, BY P. BLAKISTON’S SON & CO
PRINTED IN U. S. A.
BY THE MAPLE PRESS YORK PA
PREFACE TO FOURTH EDITION
In this revision it has seemed desirable to adhere to the original
plan of the manual as such an arrangement of the contents gives to
the student or tropical practitioner a concise and readily accessible
presentation of the subject.
Accepting the spirochaetal etiology of yellow fever, as worked out
by Noguchi, I have transferred the chapter on this disease to the
section dealing with protozoal diseases and have endeavored to
present the more important features of the recent extensive additions
to our knowledge concerning this scourge of the tropics.
There is not a chapter in the book that has not been carefully
revised and brought up to date. Of the revisions made, the most
important deal with advances in the study of food deficiency
diseases, as will be noted under beriberi and pellagra.
I have enlarged various paragraphs on treatment, the additions
including descriptions of the treatment of hookworm disease by carbon
tetrachloride and of the methods of administering arsphenamine and
antimony.
Six new chapters have been added to the book, viz. Epidemic jaundice,
rat bite fever, tularaemia, tables of helminthic and arthropodan
diseases, trench fever, in Part I, and, in Part II, a chapter on the
diagnostics of tropical joint, muscle and bone lesions.
Extensive additions have been made to Chapter XLIII, “Diagnostic
problems and procedures, together with cosmopolitan diseases in the
tropics”; and in the chapter on blood examinations will be found a
presentation of our latest views as to acidosis as well as a table
giving the significance of the findings in blood chemistry.
Many new illustrations have been added and some of the older ones
replaced by others of greater teaching value.
Every effort has been made to retain the feature of a pocket manual
but it has been necessary to increase the number of pages from 524
to 610. The illustrations in the third edition numbered 119; in this
edition, 159.
In particular I have to express my indebtedness to Commanders C. S.
Butler and H. W. Smith of the Naval Medical Corps for advice and
assistance in the preparation of this edition. Dr. G. W. McCoy,
Director of the Hygienic Laboratory, has given me valued suggestions
as to changes in some of the old chapters and in the preparation of
the new chapter on Tularaemia.
Lieutenant Commander Bunker, the head of the Chemical Laboratory of
the Naval Medical School, has made the revisions of the subjects
dealing with physiological chemistry. Others, who have given me
advice and suggestions, have been Lieutenant Commander Reed and
Lieutenants Harper and Chambers of the Naval Medical School.
To Lieutenant Peterson I am indebted for assistance in the
proofreading and preparation of the index as well as in going over
the recent literature of tropical diseases.
PREFACE TO FIRST EDITION
There is no more striking evidence of advance in general medicine
than the present attitude of the physician or rather internist in the
diagnosis of the cases met with in a modern hospital ward. Instead
of first considering the evidence obtainable at the bedside and
then noting the laboratory findings as something apart and entirely
subordinate, we now find the two aids to diagnosis so correlated
that it is as difficult to note one kind of information as bedside
and other as laboratory as it formerly was to separate signs from
symptoms in the study of a case.
In tropical medicine, however, we have for many years made our
diagnosis in the laboratory, the bedside playing a subsidiary
part—the laboratory diagnosis is controlled by the bedside findings.
It was originally my idea to prepare a book which would enable
students to have presented to them in intimate relation the
laboratory and clinical aids to the diagnosis of tropical diseases. I
was forced to abandon this plan as it did not seem possible to take
up clinical diagnosis prior to the obtaining by the student of a
comprehensive knowledge of the facts in connection with each separate
tropical disease. There was not the same difficulty attaching to a
book exclusively devoted to the diagnostic methods of the laboratory
so that in 1908 a laboratory manual was published. More recently it
has occurred to me that my methods in teaching tropical medicine
from the clinical rather than the laboratory standpoint might be of
assistance to those who are interested in this very important branch
of medicine.
When we consider that a knowledge of malaria, blackwater fever,
amoebic dysentery, bacillary dysentery, liver abscess, pellagra and
hookworm disease is just as important for the medical man in the
Southern States of the United States as for the physician in tropical
colonial possessions, it will be realized that there is more of a
practical side to tropical medicine than is usually admitted.
Although this is intended as a companion volume to the one on
laboratory methods yet, in order to make it complete in itself, there
has been prepared under each disease a paragraph dealing with the
laboratory diagnosis of the disease under consideration.
Furthermore, under the sections on the blood, faeces and urine in the
diagnosis of tropical diseases, the laboratory methods which are of
practical application have been given.
The chief feature of the book is in presenting in Part II the
clinical side of tropical diseases from a standpoint of the signs
and symptoms of these diseases which are connected with anatomical
or clinical groupings rather than from the side of the individual
disease. Thus in Chapter XLIV the diagnostic points which may be
obtained from a study of the temperature chart are given while in
Chapter LII the neurological manifestations, which may be noted in
various tropical diseases, are presented.
In Part I each individual tropical disease is treated as taken up
in any of the well-known books on tropical medicine. It has seemed
to me, however, that the paragraphs on epidemiology and prophylaxis
should receive especial attention. Again, in order to bring out
more strongly the symptomatology of each disease, I have followed
the paragraph on symptomatology in general with a section dealing
with the symptoms in detail, as shown in a consideration of the
circulatory, respiratory, digestive, nervous and other systems.
The paragraph devoted to the definition of each important disease has
been prepared with a view to giving the reader a brief description of
the disease in its clinical and etiological aspects.
Small type has been used rather to supply headings than for the
purpose of indicating less important matter because in a book so
condensed it has not seemed advisable to present any subject not of
practical value.
This book is written from the standpoint of the teacher who aims not
only to give the essential points but to present them in a manner so
cross-referenced that the student has the subject presented to him
from every angle.
It has been my custom in preparing my lectures to abstract the
various works on tropical medicine in order that special points in
one book, not noted in the others, would stand out prominently.
In this connection I am deeply indebted to the manuals of Manson,
Scheube, Castellani and Chalmers, LeDantec, Jeanselme and Rist as
well as to the monographs in Maladies Exotiques, Albutt’s System of
Medicine, Osler’s System of Medicine, Mense’s Tropenkrankheiten and
Traite Pratique de Pathologie Exotique.
In particular I am indebted to Ruge and zurVerth’s
Tropenkrankheiten, to Brumpt’s Precis de Parasitologie and to the
only work in the diagnosis of tropical diseases I have been able to
obtain, that of Wurtz and Thiroux, entitled Maladies Tropicales.
In the section on blood examination I have advocated the adoption of
the scheme of differential counting brought out in Schilling-Torgau’s
work on the blood in tropical diseases.
I have freely consulted the various journals dealing with the subject
of tropical medicine as to recent advances in this branch of medicine
and I would particularly express my indebtedness to the Tropical
Diseases Bulletin which should be in the hands of every student of
tropical medicine, not only as an index to original papers but as
a guide as to the advisability of consulting such papers. These
abstracts are prepared by authorities in the different tropical
diseases and many of the abstracts indicate the value or lack of
value of the paper abstracted.
The tropical diseases are classified under those due to protozoa,
those due to bacteria, those due to filterable viruses, infectious
granulomata and tropical skin diseases. Sprue is classified as a food
deficiency disease for the reason that the cure seems to rest solely
in dietary treatment. Certain diseases which did not definitely
belong to any of the above-named sections were taken up under
diseases of disputed nature or minor importance. The second part of
the book deals with the clinical diagnosis of tropical diseases.
CONTENTS
PART I
TROPICAL DISEASES AND THEIR TREATMENT
DISEASES DUE TO PROTOZOA
CHAPTER I.—Malaria, 1.