STUDY OF TSUTSUGAMUSHI DISEASE. 21 



February 3 : Breathing is thoracic and shallow, face flushed ; femoral glands 

 painful; eruption more dusky. The pulse is rapid and irregular. 



February 4: No change. Blood shows no malarial parasites; leucocyte count, 

 4,300. 



February 6: The patient feels better this morning; the pulse is of good ten- 

 sion, the eruption fading. 



February 9 : Improved. Patient looks brighter and feels very well. His 

 mental condition is peculiar, not normal. 



February 10 : Delirious all night and to-day. Face flushed ; pulse remains 

 fairly strong. 



February 11: Improved, quiet no pain. 



February 13: Improved, hungry. The pulse is good and the rash disappearing. 

 Urine normal. 



February 16: The patient has improved. He has no pain, the pulse is strong, 

 the eruption and glandular enlargement have disappeared. 



February 19: The Widal reaction is negative after one hour. 



Case B. — H. D. P.; age, SJf; teamster. 



Family history. — Negative. 



Personal history. — The patient has had diseases of childhood, "typhoid-mala- 

 ria" in 1894, dysentery in 1903. There is no history of syphilis or gonorrhoea. 



Present illness. — February 2, 190(5: The patient has felt badly for five days 

 and has had headache, pain in the back and limbs and in abdomen, and the ap- 

 petite has been poor. There was no chill and but slight cough. Two days ago 

 he noticed enlarged glands in the rigiit axilla and right groin. Yesterday he had 

 diarrhoea. He was admitted to the hospital to-day suffering from fever, pain in the 

 head, back, legs, anus and abdomen, enlarged and painful lymphatic glands in 

 the right axilla and groin, and diarrhoea. 



Physical examination. — The heart is normal; dry rales are heard over the 

 upper lobes of both lungs. The abdomen is tender around the umbilicus, the 

 spleen enlarged. A rose-colored, irregular, macular rash shows on the head, 

 trunk and limbs. There is a general enlargement of the superficial lymphatic 

 glands, more marked in the right axilla and groin. The tongue is moist and has 

 a white, central coat and red edges. No malarial parasites found in the blood. 

 (See Chart B.) 



February 3 : No malarial parasites. The patient is dull, the face flushed, 

 the axillary and inguinal glands painful. 



February 4 : There is no change. Leucocyte count, 3,200 ; no malarial para- 

 sites. 



February 5 : The patient appears better this morning. The pulse is of good 

 tension, the eruption fading. There was a marked chill after a plunge bath. 



February 6: The eruption is fading, the pulse is good, the tongue dark and 

 dry. No malarial parasites in the blood. A differential count of white cells 

 shows: Small lymphocytes 20, large lymphocytes 8, polymorphonuclears 60, eosin- 

 ophiles 2, transitionals and large mononuclears 4, per centum. 



February 9 : Still improving. A gland was removed from the right groin for 

 examination. 



February 10 : Improving. Face flushed, eyes injected, mouth dry, and the 

 tongue shows a yellowish coat. The pulse is of good tension, the eruption eon- 

 fluent and fading. No malarial parasites in the blood. 



February 12: Patient is still improving. He sleeps well. Bacteriological ex- 

 amination of the excised gland was negative. 



