398 DISEASES OF UNCERTAIN ETIOLOGY 



cytes as the fever subsides. Bone cells are seen in the blood. A mild 

 eruption is seen in some cases. 



Quinine and salvarsan are said to be useless. 



Collargol is said to act as a specific when given, lo c.c. of a i per 

 cent, solution three doses intravenously. This is said to cure (Heyden). 



(11) RAT-BITE FEVER. 

 DEFINITION. 



An acute infectious disease, probably caused by spirochaetes 

 characterized by a local ulcer, followed by constitutional disturbances 

 of pyrexia, eruption and body pains. 



DISTRIBUTION. 



It is found in Japan, England, the United States, and Italy. 



iETIOLOGY. 



Futaki discovered spirochaetes in the blood and tissues of patients 

 in 1916. The organism was pathogenic to guinea-pigs. 



Spirochaetes have been found in the suprarenals and kidneys of 

 people dead of the disease. 



At first the organism circulates in the blood ; then, when immune 

 bodies are formed, they are found in the kidneys. The antibodies 

 thus formed act upon the causative spirochaetes, producing degenerate 

 forms. In this particular the disease simulates Spirochetosis ictero- 

 hsemorrhagica. 



The etiology seems now to be established, so that upon con- 

 firmation of the above findings it will be necessary to include this 

 disease in another section of this work. 



SYMPTOMATOLOGY. 



The incubation is one to three weeks. 



The onset is sudden. An ulcer forms seven to fifteen davs later 

 at the site of the bite which had previouslv healed. The proximal 

 glands are swollen. 



There is a papular purple eruption on the body in some cases, pains 

 about the joints and muscles, pyrexia to 104° F., and sometimes 

 delirium. 



After a few days the fever abates and the patient feels better; then 

 it recurs. These relapses are rather characteristic of the disease. 



Each attack leaves the patient somewhat better, but it may be 

 months or years before the disease has run its course. 



The prognosis is good and complications rare. 



The mortality is about ip'5 per cent. 



TREATMENT. 



Arsenical treatment is the rule — as for Relapsing fever. 



