04 



NOTES ON HUMAN SPIBOCH.T'.TOSIS 



Prostralion 

 ami weakness 



Spiroch^etes 

 found in films 



Morphology 

 ■f the par.isiies 



AniBinia was present in five cases, in two to a marked degree. 



Epistaxis was noted in two cases, a definite rigor in one, herpes labialis in one and 

 vomiting in two. 



Prostration and weakness were marked in all, but, with the subsidence of the fever, 

 rapid recovery ensued in all but one debilitated case. 



Headache, backache and a moist white furred tongue were seen in all, and three 

 complained of pain and tenderness over the tibiir. 



Jaundice, eye affections, albuminuria and diarrhoea were never encountered. 



The heart and the lungs were normal, though one case showed some congestion of 

 the right base. 



The two cases which were admitted in March, 1910, to the ]*jgyptian Army General 

 Hospital, Abbassia, pi-esented symptoms not encountered in the Khartoum series. 



One was admitted with a temperature of 10.3 P., in a lethargic condition, quite 

 conscious, but with motor apiiasia. 



The pulse was 116, respirations 28, and some rilles and diminutiuii of In-eath sounds 

 were noted at the right base. 



The spleen and liver were not enlarged. 



Next day his knee jerks, cremasteric and abdominal reflexes could not be elicited, 

 and there was some cervical rigidity and tenderness over the spine, but Kernig's sign 

 was absent. 



He was thereupon isolated, as cases of epidemic cerebro-spinal meningitis were 

 occurring at that time. 



.\ fair number of spirochffites were found in his blood, and on the third day his 

 temperature rose to 104 F., fell by crisis with profuse sweating, and his speech and reflexes 

 were restored within three days. 



He had no further pyrexia, but gave a history of two attacks of fever lasting 

 6-7 days during the previous month, so that this was probably his second relapse. 



The second case was admitted with a temperature of 102 F., slightly enlarged spleen, 

 and considerable pain in both knee-joints. 



Blood examination showed nothing abnormal, and, under salicylates, his temperature 

 fell to normal, and he was thought to be suffering from a mild attack of rheumatic fever. 



Eight days later his temperature rose to 101 F., and the next day a few 

 spirochaetes were found in his blood ; the following day very many were found in 

 the films. 



On the fifth day his temperature fell by crisis from 103 F. to normal, accompanied by 

 profuse diaphoresis. There were no complications during this attack of fever, but, three 

 days later, his right knee-joint became swollen, hot, very tender, and distended with fluid ; 

 there were no constitutional symptoms and no rise of temperature occurred. The condition 

 cleared up in four days without salicylates, and there were no further relapses. 



I think the joint condition must have been due to his spirochietal fever, and was not 

 of rheumatic origin ; at no time did he have a sore throat. 



Dr. .\ndrew Balfour has studied the morphology of the spirochaetes found in the 

 Khartoum cases {pa'je 67), and only a few remarks need be made here. 



In some cases the spirochaetes were very numerous, in others they could only be found 

 after prolonged search. 



They were only found during the periods of fever, and though careful search for 

 possible intra-corpuscular forms during the apyrexial periods was made, yet none were 

 noted. 



