14 



ASHBOKN AND CKAIG. 



tsutsugamushi disease — -continued. 



Symptoms, early — Continued. 



Superficial lymphatic glands become 

 enlarged elsewhere than near 

 wound. 



Temperature 38°. 3 C. (101° F.) 

 to 39°.5 C. (103° F.). 



Injection of conjunctivae and pho- 

 tophobia are frequent. 



Nose and throat normal. 



Tongue moist, slightly coated. 



Constipation. 



Spleen enlarged. 

 Symptoms, later: 



Fever to 40° C. (104° F.) or 40°.5 

 C. (105° F.), continuous. 



Pulse may be slow, but is usually 

 rapid and weak. May be di- 

 crotic. 



Exanthem usually fourth to seventh 

 day. First on face and temples. 



Indistinct or absent on thighs and 

 arms. 



Macules or papules, dusky. 



Usually lasts four to seven days. 



Does not become hemorrhagic. 



Frequently shows in mouth. 



Hyperesthesia common through 

 disease. 



Partial deafness frequent. 



Tongue and lips may crack and 

 bleed. 



Gums spongy, may ooze blood. 



Cough may be severe and par- 

 oxysmal, expectoration tenacious. 



Perspiration common. 



Remission at end of second week. 



Ulcers may be long in healing and 

 glands remain tender. 

 Complications : 



Parotitis, maljena, mania. 

 Coma, cardiac weakness, pulmonary 

 oedema. 

 Mortality: 



30 per cent. Increases steadily 

 with age. 

 Pathological anatomy: 



Ulcers, lymphadenitis, large spleen, 

 hypostatic congestions. May be 

 nephritis. 

 Immunity : 



Not conferred by attack. 



spotted fever — continued. 



Not so. 



Not so constant. 



Same. 



Sore throat occasional. 



Same. 



Often present, but not as a rule. 



Same. 



More irregular and may be higher or 



lower. 

 Almost always , rapid and weak. May 



be dicrotic. 



Usually second to fifth day. Usually 



first on wrists and ankles. 

 Not so. 



Macules or petechia?. 

 Fades more slowly. 

 Becomes hemorrhagic. 

 Not so. 

 Often present. 



Less frequent. 

 Same. 



Not so. 



Cough common, and oedema of lungs 

 common at end. 



Not noted. Skin often dusky or 

 marbled. 



No constancy. Most patients dead be- 

 fore that. 



No such condition. 



Not noted. 

 Frequent. 



75 per cent. No steady increase with 

 age. 



No ulcers. Lymphadenitis not noted. 

 Large spleen ; hypostatic congestions. 

 May be nephritis. 



Probably conferred by one attack. 



