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.