i6 DISEASES DUE TO PROTOZOA 



There is often some local inllammatory reaction at the site of the 

 bite. In this variety there is more vomiting and diarrhoea with blood- 

 streaked stools. 



The spiroch^etes are very sparse in the blood, as compared with the 

 other varieties, but heavy infections have been met with in Arabia. 



On the second day of the illness there is restlessness, thirst, splenic 

 pain, cough, the temperature has a morning fall without any relief of 

 the symptoms, and an evening rise. There may be delirium. 



The Hver does not enlarge, but the spleen does. 



There is polychromatophile degeneration of the red cells and a 

 marked increase in the number of blood platelets. 



After the third or fourth day there is a crisis preceded by a pseudo- 

 crisis. 



Relapses are very common, five to eleven, lasting three days each, 

 and spreading over a month or more. All crises are preceded by 

 pseudo-crises. 



In the relapses, oedema of the eyelids is a common feature. 



Iritis is a common complication. 



There is often an abrupt violent delirium (Porot). 



Some consider that there is a mild and a severe form of the disease. 



The mortality is not known, but it is generallv low. 



A rapid fall of temperature without improvement of the svmptoms 

 usually indicates the approach of death. 



All Europeans should encamp 20 to 30 metres away from native 

 huts, rest houses or caravans. The bed should be well above the 

 ground, and a good mosquito net used with its lower ends well tucked 

 under the mattress. 



In North Africa. 



In North Africa the causative organism is S. berbera, as a rule. 

 It is probably spread by lice. It is common in Algeria, Egypt, 

 Tripoli and Tunis. 



The surgeons of Napoleon's Army noticed the disease. 

 The incubation is believed to be about twelve days. 

 The fever reaches its height during the first twenty-four hours. 

 The spleen and liver enlarge, but jaundice is generally absent. 

 Vomiting is common, but not diarrhoea. 



Urethral Spirochcvtosis. 



^lacfie found a case of acute urethritis on the Gold Coast due to 

 spirochcete infection. The temperature was slightly raised and joint 

 pains were troublesome. 



The name S. urethras was proposed for the parasite. 



