SOME UNCLASSIFIED FEJ'ERS 395 



An attack does not confer immunity. 



Poor people of reduced resistance entering the infected lands from 

 Julv to October may contract the disease. 



SYMPTOMATOLOGY. 



Incubation is four to ten days. 



Prodromata, nothing definite, sometimes malaise and giddiness. 



Course. It lasts about fourteen days. Rigors, frontal headache, 

 temperature 101° to 103° F. 



Tender enlarged lymphatic glands nearest to the bite of the mite ; 

 a vesicle or blackish necrotic patch indicates the latter. 



Temperature rises to 105° F. The necrotic area is thrown off 

 leaving a circular red punched-out ulcer. 



The sixth to seventh day a large red papular (2 to 5 mm.) eruption 

 occurs on the face and then spreads over the body with a somewhat 

 macular appearance. The rash does not itch. 



The gums may become spongy and bleed. 



Respirations are increased, B. S. harsh, rhonchi all over chest. 



The conjunctivae are injected. There is lachrymation. 



Hyperaesthesia is common and is present all over the body. 



Lysis begins about the fourteenth day and lasts about one week. 



In bad cases, coma, hvperpvrexia, cardiac failure or pulmonary 

 oedema ma}- carrv off the patient. 



MORTALITY. 



About 30 per cent. die. It increases with age. i2'5 per cent, 

 during the first ten years of life and 57 per cent, in the seventh decade. 



TREATMENT. 



This is symptomatic. 



(2) PIGMENTARY FEVER (Cobb). 



Occurs in Bengal during the hottest months. 



Sudden onset; the temperature rises to io3°-i04° F. Headache, 

 nausea, vomiting, and a peculiar pigmentation of the nose and cheek. 

 The fever lasts eight to ten da^'S. Little is known about it. 



(3) HYPERPYREXIAL FEVER. 



Seen on the West Coast of Africa and Ceylon. 

 Onset like malarial fever with sweating, but no parasites are seen. 

 The second day the patient feels almost normal. 

 The third day the temperature begins to rise and reaches from 

 i04°-io7° F., at which it tends to remain. 

 Drue's are useless. 



