In kala-azar the recommendation has lately been made to excise the somewhat enlarged glands and make smears from a piece of such gland and then examine the smear for leishman bodies. Gland puncture has not given as satisfactory results.
It is often stated that the superficial cervical glands are enlarged in dengue but not in dengue-like fevers. I have not observed in the cases I have seen either constant or well marked glandular enlargements.
In yaws there may be glandular enlargement. According to Finucane the cervical glands are often involved in Fiji children. These glands do not tend to break down.
In pediculosis of the hairy scalp the scratching back of the neck may result in pus infection with enlargement of the tributary cervical glands.
American leishmaniasis.—Not only is there often enlargement of the lymphatic glands but likewise we may have lymphangitis lines leading from the ulcer to the glands. The glands may be large and painful and may remain enlarged after the recovery of the patient.
Anaemia
The old idea that tropical life produced an anaemia is no longer held, the view now being that such anaemic conditions are almost invariably due to some well recognized cause, the most important of which is malaria. Natives of the tropics may appear bleached out but show a normal red count and haemoglobin percentage. Chamberlain’s observations have shown that a residence in the tropics of approximately two years has no appreciable influence on the red cell count or haemoglobin content of the blood of white men and that the actinic rays do not seem to be operative in producing anaemia.
Malarial Cachexia.—Although the malignant tertian infection has the greatest tendency to produce anaemia yet any type may, when untreated, bring about the more or less profound anaemia with earthy skin, enlarged spleen, dyspnoea on slight exertion, and oedema of the ankles characteristic of malarial cachexia.
Oroya Fever.—In this disease we have what might well be termed a fulminating pernicious anaemia. The rod-shaped protozoon which attacks the red cells seems to be peculiarly active in the bone marrow, excruciating bone pains being quite a feature of the disease.