AMERICAN RELAPSING FEVER 13 



Constipation by laxatives and enemata. 



High temperature by cool sponging. 



Give appropriate feeding during the intermission. 



A serum has been promised. 



PROPHYLAXIS- 



Keep bugs, lice and biting insects away from the patient. 

 Wooden bedsteads should be abolished and iron ones substituted. 

 Practice the strictest cleanliness, disinfect clothing, houses, &c. 

 Doctors, nurses, hospital attendants and laundry hands are very 

 liable to attack. ~ - _ . 



MORBID ANATOMY. 



There is an enlargement of the spleen, five or six times its normal 

 size, and may weigh five or six pounds. On section it is dark coloured^ 

 soft with enlarged follicles, showing congestion and a cellular increase. 

 There may be minute abscesses and wedge-shaped infarcts. 



The liver is enlarged up to five pounds in weight, the lobules are 

 poorly defined with cloudy swelling, fatty infiltration and leucocytic 

 infiltration into the portal system. 



The kidneys are enlarged, congested, cloudy swelling, and fatty 

 degeneration. The stomach is congested. 



The heart is soft and flabby. 



The bronchi are congested, frothy mucus, lungs hypostatic con- 

 gestion. 



The brain is congested. 



All the viscera may be stained vellow with bile. 



The bone marrow is hyper^emic. 



Sometimes there is a submucous petechias. 



AMERICAN RELAPSING FEVER. 



It is present in North, Central and South America. In the two 

 latter instances the fever is similar, but the spiroch^ete has not yet 

 been definitely classified. 



ASIATIC RELAPSING FEVER. 



The causative parasite is the S. carteri. The carrier is unknown. 

 The disease has long been endemic in India, commonest in the 

 Bombay Presidency. Infected bugs can convey the disease to 

 monkeys, but Rogers suspects mosquitoes as human carriers, while 

 Mackie favours Pediculus capitis. 



The spirochcetes are found in the blood during the acute attack, 



