THE EXANTHEMATA 401 



which becomes relapsing in one-half of the cases, erythematous spots 

 in 70 to 80 per cent, of cases, enlargement of the spleen, and slight 

 albuminuria. 



The fever may be but one sharp rise, or it may oscillate for four to 

 six days, or relapse over six to seven weeks, wdth intervals of five to 

 seven days. Some patients have had some fever for periods of forty 

 to sixty days with only slight remissions. 



There are three to five, or even seven relapses. 



RecoverA' is the rule. 



TREATMENT. 



This is symptomatic. Arsenical preparations as for Relapsing 

 fever can be tried. 



All lice should be destroyed and clothing sterilized. 



Sputum cups and special urine bottles should be reserved for 

 patients and their contents sterilized. 



THE EXANTHEMATA. 



As the majority of these are described in general text-books of 

 medicine a few remarks only will be necessary. 



Scarlet fever may be introduced into the tropics, but does not spread 

 there. 



Measles is endemic in most tropical countries and may give rise to 

 severe epidemics. 



Chicken-pox is usually mild, but it may be severe. It more often 

 attacks adults in the tropics. It is common in India from February 

 to March. 



Variola has long been present in India and Africa. It was perhaps 

 introduced into China from India about the third century B.C. 



An African mummy has been found with a cutaneous eruption 

 belonging probably to the twenty-eighth dynasty (1200-1100 B.C.). 

 How it came to Africa and India is not known. It is common all over 

 the tropics to-day. 



" Alastrim." — Perhaps this is a mild variola that does not breed 

 true. 



This acute specific fever resembles a mild form of variola. 

 It is widely distributed in the tropics. 

 Jenner's vaccination is generally held to be protective. 

 It differs from chicken-pox because of — 



(i) Confluence of the vesicles in certain cases. 



(2) Its frequency amongst adults. 



(3) Partial protection by Jenner's vaccine. 



