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War Surgery and Medicine

Clinical Features

Clinical Features

Three-day Fever: The onset was usually sudden with generalised aches and pains; frontal headache; soreness of the eyes or pain on lateral movement of the eyes. Severe backache was not infrequent, and sweating was common.

Five-day Fever: The symptoms were very similar, but the course was more prolonged, and loss of appetite was more complete.

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Although a few blood films were examined to exclude malaria and relapsing fever, only a very few white blood counts were done. Although the impression was that leucopenia was the commoner finding, the estimations were too few in number to permit of any definite conclusions being drawn.

Over five days: In those cases where the fever lasted over five days, some were six, some eight, and some ten-day fevers. There was nothing distinctive in the clinical features, but the patients were more ill. Some looked almost like cases of typhoid, but suddenly the illness came to an end.

In none of the three groups was there any respiratory symptoms, and this was one of the main features which differentiated these short-term fevers from influenza.

In only 2.7 per cent of the cases was the spleen palpably enlarged. In none was neck rigidity a feature.

The cases which had to be evacuated to hospital, and in which a diagnosis was made later, consisted of a great variety of different conditions. The commonest were otitis media, sinusitis, prostatitis, pyelitis, rheumatic fever, catarrhal enteritis, bacillary dysentery and infective hepatitis.

Of the 25 cases which remained undiagnosed when recovery was complete, 5 were well by the time the base hospital was reached, and in another 5 the temperature became normal before time permitted full investigations to be made. In these cases only blood film examinations and white blood counts had been done.

In the remaining 15 the fever, calculated from the day of admission to hospital, lasted from seven to twenty-five days, and in one case there was intermittent fever for seven weeks. In each of these cases full investigations were made: repeated blood films; total and differential blood counts; agglutination reactions; cultures from blood, stools, urine; sedimentation rate; and, where indicated, the chest was X-rayed, the histamine test and icterus index done, and in some the Weil-Felix test.

Complete physical examinations were repeated regularly. One feature which the cases all had in common was a leucopenia with a slight relative diminution of polymorpho-nuclear cells. The total count was in no case higher than 7200. The usual was about 4000–5000 with 50–60 per cent of polymorphs.

In such cases it seemed clear that we should continue to adopt the honest course of making no definite diagnosis and that the term PUO was the most fully descriptive one.

In 2 NZEF in the period July 1941 to December 1945 there were 2848 admissions to medical units with a diagnosis of PUO, and these made up 3.55 per cent of all sick admissions.