It must be remembered that liver abscess has been found at autopsy where fever had not been noted. A sensation of chilliness often accompanies the evening rise of temperature.
Heat stroke.—The onset may be as sudden as in apoplexy, although there are usually prodromata of dizziness and headache. The patient is unconscious with dry burning skin, labored or stertorous breathing, and a temperature of from 107° to 111°F.
The hyperpyrexial malarial paroxysm presents much in common with heat stroke.
Climatic Fevers.—From many parts of the tropical world there have been reported cases of fever supposed to be due to exposure to prolonged action of tropical heat. They are often designated as climatic or inflammatory fevers.
A careful study of the clinical manifestations tends to show that many of them are much like dengue. Some may be due to infection with the Gärtner group of bacteria.
Rat Bite Disease.—Following a rather long incubation period of from six to eight weeks, during which time the bite has healed, we have a rather sudden invasion with high fever, 103° to 104°F., chill and at the same time inflammation of the site of the bite with lymphangitis and some swelling of tributary glands.
After two or three days of high fever we have a fall by crisis with profuse perspiration. The temperature remains normal for a few days during which time the local swelling and inflammation subside. The fever again comes on, frequently with an eruption, to later on disappear and reappear. At such times the fever course is irregular. There may be as many as 12 of these febrile accessions.
Tsutsugamushi.—The disease sets in about a week after the bite of the Kedani mite with headache, chills and fever of about 101°F. There is also pain in certain lymphatic gland groups which will be found to drain the area in which is located a small necrotic ulcer, the site of the bite of the mite. The temperature continues to rise during the next two or three days to 104°-105°F. and remains as a high continuous fever for about a week, when an eruption of irregular dusky macules appears, first on the face and later on chest, extremities and trunk. About the tenth day the fever begins to go down by lysis and the eruption fades. Injection of the conjunctivae is marked.
Certain authorities have considered that there is a striking clinical similarity and possible relation attaching to tsutsugamushi, Rocky Mountain spotted fever, trench fever and typhus fever. At present we believe that tabardillo or Mexican typhus is the same as the well-known typhus of temperate climates, hence that which describes typhus fever obtains for tabardillo.
Spotted Fever of the Rocky Mountains.—In tabardillo the onset and termination of the fever is rather abrupt while in spotted fever of the Rocky Mountains it climbs up gradually for a week to reach its maximum and falls by lysis.