190 TROPICAL MEDICINE AND HYGIENE 



attack of relapsing fever, but only lasts a short time, as two 

 or even three attacks may occur in the same person. 



Prognosis. The prognosis of an uncomplicated case 

 of relapsing fever is good. The mortality varies in 

 different epidemics, probably depending upon the con- 

 dition of the infected population. When the disease 

 prevailed in Great Britain the mortality was estimated at 

 about 4 per cent. A similar rate is said to be common 

 in Russia. In Bombay, however, Vandyke Carter found 

 that the mortality was 18 per cent. His statistics were, 

 however, based upon hospital experience. The death-rate 

 amongst cases treated in the municipal hospital in Bom- 

 bay during the last ten years has been much higher than 

 this, something like 30 to 40 per cent., and Choksy records 

 2,832 deaths out of 9,275 cases, from 1898-1907, an 

 average mortality of 30*6 ; but in the northern parts of 

 India the mortality is not high, nor is it in the form in 

 which it occurs in North America, nor in that found 

 in Egypt. 



Death is most likely to occur during the acme of the 

 initial attack and may be due to collapse or to heart 

 failure, or may occur during collapse following the crisis. 

 The risk is greater in the first attack. As might be 

 expected, extremes of age are unfavourable. 



The case mortality is slightly higher among women 

 than among men, though abortion is usually followed by 

 recovery. 



In cases complicated by pneumonia the prognosis 

 is unfavourable, recovery being rare. 



Severe jaundice also renders the prognosis unfavour- 

 able, and, as has been seen, cerebral haemorrhage is always 

 fatal. 



Diagnosis. While a typical case of relapsing fever is 

 easily recognized, instances occur in which it is impossible 

 to arrive at a correct diagnosis by means of the clinical 

 signs alone, and the real nature of the disease may quite 

 easily be overlooked, even at the autopsy. It can be 

 understood, also, that a patient seen for the first time at 



