STUDY OP TSUTSUGAMUSHI DISEASE. 15 



XIII. PROPHYLAXIS. 



The only prophylactic measure which as yet has been put to any 

 general use against either disease is avoidance of the infected regions. 

 This is much easier in the case of tsutsugamushi disease than in that 

 of spotted fever, because the dangerous regions are so much smaller 

 and are plainly marked off by the very flooding that makes them 

 dangerous, and moreover they are not residence sites. Some of the 

 Japanese investigators are recommending that persons who are compelled 

 to enter the dangerous regions should wear clothing saturated with 

 petroleum. The use of carbolic baths, benzine, oil of peppermint and 

 balsam of Peru are also advocated. The effectiveness and applicability 

 of these measures remain to be proved. It is stated that cultivation 

 of the soil and the use of human f seces as manure will free an infected 

 area from the disease in about three years, if its submersion meanwhile 

 is prevented. 



XIV. TREATMENT. 



So far as personal observation enables us to form opinions on this 

 subject, it indicates that the treatment in both diseases is divisible into 

 two classes : 



1. Expectant-symptomatic. 



2. Hoped-for specifics, which are apt to be the result of guesswork 

 or of reasoning from false premises or erroneous observations. 



The ' clinical symptoms of both diseases and the results of practice 

 in clinically similar diseases, such as typhoid and typhus, indicate that 

 each offers a field for a more extended use of hydrotherapy than either 

 has yet received. 



XV. CASE HISTORIES OF TSUTSUGAMUSHI DISEASE. 



The following are such histories and notes as could be obtained in 

 regard to the cases of tsutsugamushi disease seen by us this year : 



Case I. — 8. Igarashi; male; age, 17 years; farmer. 



Family history. — Negative as regards tsutsugamushi disease. 



Personal history. — Patient had been in the infected locality at various times 

 and does not know when he was bitten by mites. This is his first attack of 

 the disease. 



Present illness. — The disease began on July 24, 1907, with a chill. The next 

 day the patient entered the hospital. At that time the glands of one axilla 

 were enlarged and tender, and examination of the region drained by them 

 showed the small ulcers resulting from three bites. There was no skin eruption 

 and the spleen was not demonstrable. The pulse was strong, frequent and 

 regular, appetite decreased and the bowels constipated. Urine was normal. 

 The temperature is shown by Chart 1. 



On July 26 an eruption of rose-colored macules appeared on the face. Later 

 it gradually spread over the body and limbs. The diazo-reaction was well 



