i8 DISEASES DUE TO PROTOZOA 



Herpes labial is (42 per cent.), which becomes hccmorrhagic. 



In severe cases liiere may be marked lic-umorrliages under ihe skin 

 and from the mucous membranes. 



There is sometimes a secondary fever. 



Some workers describe a meningitis and claim lo have found tlie 

 organism in the C.S.F. (Costa and Troisier). 



The attack lasts from ten days to three weeks. 



The attack may be so slight that few of the above svmploms may 

 be present, while in severe infections all may be present and sudden 

 death caused by rectal haemorrhages. 



In some cases the spiroch^etes seem to concentrate in the duodenum. 

 There is inflammation of the mucous membranes and of the ])aj)il]a of 

 Vater. The swelling causes obstruction of the bile flow along the 

 common duct and jaundice results. 



In some cases the swelling of the affected mucous membranes causes 

 mechanical obstruction of the bile in the liver itself, follow^ed by 

 jaundice, or the swelling may be so slight that obstruction does not 

 exist and jaundice is not seen. In any case the jaundice is not due 

 to an increased formation of bile. 



PROGNOSIS. 



On the whole this is good, but marked haemorrhages are always bad. 



The mortality is under 6 per cent. On the Trentino and Isonzo 

 fronts it was only 0*55 per cent. (361 cases). 



Some cases are so slight that only an inoculation of guinea-pigs will 

 enable one to make a diagnosis at all. 



DIAGNOSIS. 



The spirochcCte can be recovered from the urine after the lenih day, 

 but it is always difficult to find it even in centrifuged blood. 



An inoculation of a guinea-pig is preferable. 



Localized symptoms will exclude Gallstones and Cholecystitis. 



Blood cultures and Widal's reaction will exclude Typhoid and 

 Paratyphoid. 



The spirochaetes can now be grown with comparative ease, hence 

 as the sera of convalescent patients cause clumping — agglutination 

 — 'of the spirochastes, we have an important diagnostic test. 



Severe forms of trench fever cannot be diagnosed from this disease 

 in the slighter attacks when no jaundice is present. 



Acute yellow atrophy is not easy to exclude in some cases because 

 we do not know the cause of it. It is suggested that one form of it 

 may be caused by this spirochaete. 



