370 DISEASES OF UNCERTAIN ETIOLOGY 



Recovery is rapid. 



If fatal, then jaundice deepens, bleeding becomes worse, urine is 

 suppressed, subsultus tendinum is seen, coma and convulsions precede 

 the fatal issue. Death may ensue in an acute attack, preceded by a 

 rapid rise of temperature. 



Relapses may occur at any time within two or three weeks of the 

 attack, and are predisposed to by dietetic errors. 



PROGNOSIS. 



As a rule convalescence, when it has set in, is not protracted or com- 

 plicated. Pre-existing heart or kidney affections are bad. 



Congestion of the lungs, abscesses, gangrene and intussusception 

 are dangerous complications. 



Dvsentery and hepatitis are common sequelae and add to the gravity 

 of the case. 



In the United States the mortality is lo to 25 per cent. 



In West Africa and the endemic area the mortality is 45 to 80 per 

 £ent. 



In children ihe mortality is low. 



Anuria, hvperpyrexia, black vomit, malsena are all bad omens. 



All cases are serious, especially for alcoholics. 



Abortion is the rule. 



DIAGNOSIS. 



Early cases are always difificult. 



Typical attacks are easy. 



Mild attacks in a non-endemic area are difficult. 



It is all-important to diagnose early. 



Look for albuminuria, Faget's sign, jaundice, and the black vomit. 



Dengue shows a preliminary rash, leukemia, no albuminuria, and 

 "Faget's sign is absent. 



Subtertian malaria shows the blood plasmodium and absence of 

 Faget's sign. 



Blackwater fever shows a mononuclear increase with destro^'ed hb. 

 rin the urine. 



Relapsing fever shows blood parasites and a leucocvtosis. 



TREATMENT. 



The indications are : — 



(i) To prevent the spread of the infection. 



(2) To eliminate the toxins rapidly. 



(3) To alleviate the symptoms. 



We will deal with preventive measures last. 



