SFIROCH.WrOSIS ICTERO HEMORRHAGIC A 17 



SPIROCH.^TOSIS ICTEROH.EMORRHAGICA (WEIL'S 



DISEASE). 

 DEFINITION. 



An infective febrile jaundice caused by S. icleroha^morrhagica and 

 characterized by pyrexia, marked prostration, jaundice, albuminuria 

 and haemorrhages. 



HISTORY. 



1849, Larrey first described it. After him were several other French 

 workers prior to Weil in 1886. 



1914, Inada and Ito in Japan found the causative parasite. 



1916, Martin and Pettit found the disease to be present amongst the 

 French troops in Flanders. 



DISTRIBUTION. 



There are widespread epidemics in the United States. 

 The disease is epidemic and endemic in Japan. 

 It is also found in India, Africa, the Near East, and amongst the 

 French troops in Flanders and on the Italian front. 



AETIOLOGY. 



The causative organism is the S. icteroh^emorrhagicae. 



They have been recovered from the blood and urine; from the 

 former during the first days of the disease, and the latter from the 

 ninth to the fifteenth day. They disappear at the end of the fifth week. 

 They have also been found in the kidneys of the field rat, which animal 

 is now held to be a reservoir host for the spiroch^etes. 



An immune body has been found during the disease in the blood 

 which is said to destroy and dissolve the spiroch^etes. It is very 

 difiticult to find them at all in some severe cases of the disease. 



Sera have been suggested for prophylaxis and treatment. 



Infection is probably by infected rats, passing infected urine and 

 fouling the water and food such as could so easily happen in the 

 trenches in Flanders. 



SYMPTOMATOLOGY. 



The incubation is doubtful, probably six to eight days. 



The onset is sudden. 



There are : conjunctival congestion, headache, general body pains, 

 bilious vomiting, slight swelling of lymphatic glands, gastric disturb- 

 ance, epistaxis (17 per cent.), fever, ioo°-i04° F., lasting ten to four- 

 teen days, jaundice (60 per cent.) — this comes on the fourth or fifth 

 day when present — albuminuria, constipation, liver and spleen slightly 

 enlarged. Marked general weakness and prostration. 

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