RELAPSING FEVER — TREATMENT 47 



is the last one felt; in the African type, on the other hand, there 

 are usually four or five relapses, of shorter duration and more 

 irregular in occurrence. In a Gibraltar case Manson observed 

 eight distinct relapses, but this is very unusual. Hemorrhages 

 under the skin and in various organs of the body often occur, 

 and cases have occurred recently in Hungary in which the men- 

 inges (tissues covering the brain and spinal cord) were severely 

 affected, causing various nervous disorders. Spleen, liver and 

 other organs are frequently affected. 



Even the African type of the disease does not ordinarily have 

 a high mortality, though some epidemics are more serious than 

 others. In an epidemic in Tonkin in 1912, 48 per cent of 703 

 cases were fatal. In India the fatality is often high on account 

 of the well-meant but pernicious habit of depriving fever-stricken 

 people of food, thus often increasing the exhaustion caused by 

 the disease. Abortion is a common result in pregnant women. 

 A single attack gives permanent immunity to any one particular 

 type of the disease but not to others. 



Treatment and Prevention. — Ehrlich's famous spirochtete 

 poison, " No. 606," or salvarsan, destroys the spirochsetes of 

 relapsing fever more readily, if anything, than it does other 

 species of spirochsetes, since the parasites live in the blood stream 

 into which the drug is directly injected. A single injection 

 nearly always causes the disappearance of the parasites from the 

 blood and prompt recovery from all symptoms of the disease. 

 Preventive and curative inoculations of the serum of highly im- 

 mune animals has been found to be effective in rats and monkeys. 

 The power of the immune serum can be so increased by repeatedly 

 inoculating an animal that very small injections of it are sufficient 

 not only to cut short the course of the disease in these animals 

 but also to give an immunity of considerable duration. It is 

 probable that the same serum would immunize human beings 

 as well. 



Eradication of vermin from person and home and avoidance 

 of places where infected parasites might be acquired are the 

 most important protective measures in places where an epidemic 

 is raging. Methods for the control of ticks are discussed on page 

 369, of lice on page 400 and of bugs on page 383. Since the 

 parasites are not ordinarily introduced directly into the blood 

 by the beak of the transmitter, but are simply voided with the 



