RELAPSING FEVER 199 



stricken individuals may offer less resistance to infection, 

 it has not infrequently been found that attacks have 

 occurred in the absence of any such conditions, as, for 

 example, among bodies of workmen in receipt of good 

 pay but living in dirty and overcrowded quarters. 



The liability to attack of attendants on the sick has long 

 been recognized. Doctors, nurses, students and hospital 

 servants are frequent sufferers ; laundry hands come 

 under the same category. 



Instances of place infection are common, successive 

 occupants of a house, room, or ship being attacked, and 

 the introduction of cases into a hospital has led to cases 

 among other patients. An interesting example of ship- 

 infection is furnished by the s.s. " Caledonia," in which 

 cases of relapsing fever occurred in London in October, 

 1905, and again in June, 1906, these being the only cases 

 known in this port during those years. 



Treatment. Till recently there was no specific treat- 

 ment for relapsing fever. Quinine, eucalyptus, the salicy- 

 lates, arsenic, iodide of potassium, and a variety of drugs 

 have been tried with the object of cutting short the disease, 

 but without effect. Salvarsan, whether given intra- 

 venously or by intramuscular injection, both cuts short 

 the attack and prevents the relapses. Neosalvarsan will 

 no doubt have the same beneficial effects. Treatment 

 with the serum of hyperimmunized animals is promising. 



As in all specific fevers, the patient should be confined 

 to his bed in a well-ventilated room, and his strength 

 should be maintained by careful feeding. 



A point calling for special mention is the necessity for 

 prompt and liberal stimulation on the earliest indication 

 of heart failure or collapse. The early use of alcohol in 

 moderate doses is advisable, and may be combined with 

 strychnine. The collapse of the crisis is best met by hot 

 drinks, e.g., hot brandy or whisky and water, and by hot 

 blankets and hot-water bottles. 



High temperature, per se, does not usually call for 

 special treatment in relapsing fever. Antipyretic drugs 



