38o DISEASES OF UNCERTAIN ETIOLOGY 



The urine may be detained. 



Paralysis of the sphincters or grave complications terminate the 

 attack. 



About the thirteenth or fourteenth day the fever terminates by crisis, 

 profuse sweating, critical diarrhoea and diuresis, with excess of urates. 



Convalescence then begins. 



Second attacks are rare. 



COMPLICATIONS. 



Bronchitis, Broncho-pneumonia, Retention of urine. Hyperpyrexia, 

 Parotid bubo, Pyasmic abscesses. Thrombosis of femoral vein, Bed 

 sores. Gangrene of extremities. Relapsing fever and Acute miliary 

 tuberculosis. 



TREATMENT. 



Good air and plenty of it is essential for this disease. 



Shield the eyes from excessive light. 



Liquid and bland foods should be given as they can be assimilated. 



All noise in the sick room should be avoided. 



Strychnine, digitalin, &c., are necessary for the heart. 



Hyoscine, bromides, or morphine may be required for nerve 

 symptoms. 



20 c.c. intravenously of the serum from patients who have been 

 convalescent twelve days have been useful in some cases; repeated if 

 necessary. 



All clothing must be thoroughly disinfected at once. 



All hair must be shaved ofif and the whole body thoroughly 

 cleansed. No lice, no t3^phu9. 



H^MOGLOBINURIC FEVER (Blackwater Fever). 



DEFINITION. 



An acute fever of uncertain causation characterized bv excessive 

 blood destruction, jaundice, h^emoglobinuria, diminution and sup- 

 pression of urine. 



DISTRIBUTION. 



Most commonly in tropical Africa and parts of India. 



It is less commonly found in South Italy, Sicily, Greece, Asia 

 Minor, Southern Russia, China, Siam, Malay Peninsula and the 

 Southern regions of the United States. Central and South America 

 and Brazil in particular, West and East Indies, and Polynesia. 



It is extremely rare in the Roman Campagna, the classic land of 

 malaria. 



Its endemicity is said to be limited to low swampy grounds. 



