REVIEW — THOPICAL MEDICINE, ETC. 189 



regard to plague. The natives in tick districts have a considerable immunity, probably Spirochates 



through attacks in youth, as monkeys that have had a severe attack are quite immune and Spiro- 



against a new infection. Infection can generally be easily avoided by not sleeping in chaetosis— 

 native huts or rest-houses, the favourite haunts of the ticks. continued 



A very good account of the disease in Uganda is given by Moffat. ^ He believes it 

 to be distinct from the tick disease of the Zambesi, and states that he has never seen 

 the incubation period less than seven days. One attack confers a certain degree of 

 immunity, and after a second attack this immunity probably becomes complete, at least for 

 a time. 



The number of relapses seems to vary from one to five. Moffat points out that in a 

 susceptible subject the initial attack is followed by from three to five relapses, and that 

 if only two relapses occur he suspects a partial degree of immunity. 



In the earlier attacks parasites are generally more numerous than in the late ones, 

 in which they may be excessively rare, but this does not always hold good. The 

 symptoms are described and special attention drawn to a curious condition affecting the 

 eyes. It resembles an iritis, but is possibly a condition resulting from thrombosis in the 

 vessels of the ciliary body and iris, leading possibly to haemorrhages into the vitreous. 

 At times it does develop into an acute iritis with resulting adhesions of the usual kind. 

 The portion of the paper dealing with diagnosis is given in full, as there is every 

 probability that this disease exists in the Southern Sudan, although hitherto unrecorded. 

 It is true we have not yet found 0. mouhata, but the closely allied 0. savignyi occurs. 



The spirochffltae can easily be found in fresh blood if present in large nutabers, but a thin, evenly-spread 

 film is quite unsuitable, and in such they may be overlooked even when numerous. A film of moderate thickness 

 is preferable, and in such the agglomerated masses of corpuscles will sometimes be seen vibrating from the 

 movements of the contained parasites if the latter are sufficiently plentiful, and by a careful focussing they 

 may be seen semi-detached wriggling in the surrounding serum. Being very refractile they are best seen with 

 little light and appear as rapidly moving threads ; sometimes they may bo made out quite distinctly moving over 

 and against the dark background of a thick layer of corpuscles. There is no doubt, however, that they are 

 much more easily found in stained jireparations. I have tried the two methods side by side in the same case, 

 and after a vain search through the fresh film I found them at once in the stained one. The quickest way is to 

 take a fresh film and a dry one at the same time. A few minutes are devoted to the former and, if the 

 parasites are numerous, they will at once be seen and the trouble of staining is avoided. If the search prove 

 negative, staining can be proceeded with. I have for the most part used Leishman's stain, which is simple 

 and eflfective, and the parasites can easily be seen under a sixth. At times they are very sparse, necessitating a 

 prolonged search through several slides. In the absence of means for making a blood examination, it is not 

 possible to make an absolutely definite diagnosis. A history of previous tick bites, or of a possible exposure to 

 such, will aiiord strong suspicion as to the nature of the fever, but in places where the disease is endemic there 

 are many other biting things, and people are so accustomed to their attacks that very often there will be no 

 distinct remembrance of such. The disease with which it is most likely to be confused is malaria. In its 

 onset it differs from it in the absence of any rigor, though it must be remembered that in the malignant tertian 

 the rigor is represented often by a slight and evanescent feeling of chilliness, but otherwise the initial symptoms 

 are very much alike, though, as a rule, they are more aggravated in spirillum fever, especially the headache and 

 vomiting. In the greater number of cases of malaria there is no particular enlargement or tenderness about 

 the liver, whereas in spirillum fever they are almost constant features. The splenic enlargement is common to 

 both. The appearance of the tongue, with its thick, creamy white deposit of fur, is quite unlike the dirty, dry 

 tongue of malaria. As regards the temperature, there is usually in malaria a distinct tendency to intermission 

 or, at any rate, a marked remission, such being generally preceded by profuse sweating. Spirillum fever attacks 

 are sometimes so short that a sudden termination cannot be attributed to the influence of any remedy 

 administered, and therefore the action of quinine on the temperature cannot be relied upon as a means of 

 di.agnosis, except to exclude malaria when the drug fails. The quick breathing and pains in the chest seen in 

 spirillum fever do not occur in malaria. In the pneumonic form a diagnosis can only be made by watching 

 the course of the disease, but it may be noted that the physical signs in the chest not only disappear, but develop 

 much more rapidly than they do in an ordinary pneumonia. 



The eye symptoms point very strongly towards spirillum fever. I formerly believed that malarial iritis 

 was a common complication of that disease, but since I began to depend for diagnosis on blood examination 

 I have not seen a case of iritis following malaria. Probably in my earlier cases the antecedent fever was spirillum. 



The prognosis is not unfavourable as regards life, but the disease causes much suffering and leaves the 

 patient greatly debilitated. Pneumonia is a dangerous complication. There is no specific treatment, but 

 arsenic possibly diminishes the number of relapses. Symptomatic treatment is indicated, and the exhibition of 

 atropine on the first sign of eye trouble. 



In this connection one may note that benzidine has proved useful in experimental tick 

 fever, and pyramidon has been found to reduce the temperature, though it leaves the 

 spirochaetK unaffected. Judging by analogy, atoxyl is likely to prove of value, but Breinl and 

 Kinghorn found it useless in one case. 



» Moffat, R. H. (January 26th, 1907), " Spirillum Fever in Uganda." Lancet, Vol. I. 



