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

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