Tropical Diseases due to Microscopic Organisms. 219 



severe as to amount to an erythematous rash, which often involves 

 the neck. I would call attention to the appearance of the skin of 

 the chest, and at times the abdomen, which shows frequently a 

 delicate subcuticular mottling — cutis marmorata. The fever keeps 

 high (102° to 104° F.) for thirty-four to forty-eight hours; it drops 

 by crisis on the third day. Occasionally the fever lasts for four 

 or five days, and may not drop so suddenly. At times some 

 superficial lymphatic glands are enlarged. 



V. — Other Tropical Diseases, 



Xext to malaria, the diarrliceas and dysenteries are the most 

 common affections in the Balkans. Attention should be called to 

 a type of diarrhcea seen in Serbian soldiers who had suffered 

 terribly from starvation during the Albanian retreat. This 

 diarrhcea closely resembled the famine diarrhcea observed in India. 



So-called Camp Jaundice is common {icterus castrensis). Accord- 

 ing to my experience two varieties can be distinguished : (1) a 

 very severe ha3morrhagic type with high fever lasting ten to twelve 

 days, showing occasionally a relapse — true Weil's disease, rore ; 

 and (2) a mild type (icterus castrensis levis), often afebrile, very 

 common. Weil's disease, as is well known, is of spirochsetic 

 origin, but in my opinion it is probable that many cases of the 

 mild type are also spi.rochfetic. 



Fevers of the enteric group are fairly frequent in the Balkans, 

 but during the last years have never assumed an epidemic type. 

 Paratyphoid A and B are in certain districts more frequently met 

 with than true typhoid. 



With regard to the prophylaxis of these fevers I may perhaps 

 be permitted to say that the method of combined vaccination I 

 devised many years ago has given good results. It has recently 

 been adopted in all the Allied Armies. 



Of Malta Fever I have seen only two cases in Macedonia and 

 the interior of the Balkanic Zone ; it is more frequently met with on 

 the coast and in the islands. 



Kala Azar of adults I have never seen in the Balkans : of the 

 infantile type I have seen many cases in certain islands of the 

 Adriatic and ^gean Seas. It is rare in Macedonia, where I have 

 seen only one case. 



Bronchomycosis is common : I have seen cases of broncho- 

 moniliasis, broncho-oidiosis, broncho-liemisporosis, aspergillosis, 

 penicilliosis and nocardiasis. Bronchospirochtetosis is not rare. 



Pellagra is quite common in several districts of Macedonia, but 

 I do not think chere is any danger for our troops. I have seen a 

 case of leprosy and a typical case of granuloma inguinale. 



Of the tropical diseases which are of rarer occurrence, I may 



