SUPPLEMENT 631 



the blood in greater numbers. The symptoms last three to four days 

 and end in a crisis with profuse sweating and fall of temperature 

 below normal. The day before the crisis there is a pseudo-crisis, 

 when the temperature falls but there is no improvement. The 

 patient is left weak and tired. Recovery may follow, but more usually 

 a relapse occurs. The intermission period varies ; five to eight days 

 is common. The symptoms of the relapses are like those of the first 

 attack.. The number of relapses varies, five to eleven may occur. 



The treatment recommended is by salvarsan, as for the European 

 relapsing fever. 



With regard to prophylaxis, localities where ticks abound must 

 be avoided and the parasites themselves destroyed. Native huts 

 should be avoided. Mosquito nets, a bed well off the ground and 

 the use of night lights are advised by Manson to avoid attacks by 

 ticks, which are often nocturnal in their habits. 



In North Africa (Algeria, Tunis, Tripoli, Egypt), and sometimes 

 in the Anglo-Egyptian Sudan, a spirochaetosis due to S. berbera 

 occurs. According to Castellani and Chalmers, the incubation period 

 varies somewhat. The fever reaches its height during the first twenty- 

 four hours, and afterwards shows a morning remission. Jaundice 

 is often absent, but there may be hepatic tenderness and splenic 

 enlargement. One or two relapses usually occur. The treatment is 

 on the same lines as for the other spirochaetal fevers. Sergent and 

 Gillot 1 (1911), working at the Institut Pasteur of Algeria, have had 

 good results by using injections of salvarsan in doses of 0*75 to 

 ro eg. per kilogramme weight of the patient. The prophylactic 

 measures are directed against lice and other biting insects. Personal 

 cleanliness is most necessary. 



In Asia, a relapsing fever, due to the spirochaete named S. carteri 

 by Manson in 1907, producing a mortality of about 18 per cent., 

 occurs. The symptoms have a general resemblance to those produced 

 by S\ recurrentis, but on the fall of temperature to subnormal on the 

 sixth or seventh day, when profuse perspiration and polyuria occur, 

 instead of improvement following, the patient often becomes collapsed, 

 with a clammy skin and feeble pulse. Improvement is slow. The 

 first relapse occurs about the fourteenth day of the attack, when the 

 temperature may be higher than for the first attack. There are 

 seldom more than four relapses. The treatment is by salvarsan, of 

 which doses of not more than 5 gr. intravenously should be given. 

 Sudden heart failure being common, Castellani and Chalmers state 

 that cardiac stimulants should be given. Prophylaxis is the same as 

 for European relapsing fever. 



1 Bull. Soc. Path. Exot., iv, p. 440. 



