STUDY OF TSUTSUGAMUSHI DISEASE. 



13 



phatic enlargement and the eruption. The character of the epidemic 

 and the presence of plague bacilli in the sputum, glands or viscera would 

 distinguish the disease from plague. A mild ease of typhus occurring 

 in the endemic region at the proper season would possibly be very hard 

 io differentiate. The darker, more jjrofuse and petechial eruption, the 

 absence of characteristic lymphatic enlargement and of the bite and the 

 contagiousness should make the diagnosis reasonably certain. 



Spotted or tide fever of Montana bears a much closer resemblance to 

 typhus and, in our opinion, can only be distinguished from it by its sea- 

 sonal and geographical limitations and its lack of contagiousness. Spot- 

 ted fever may also present a great resemblance to cerebro-spinal menin- 

 gitis, from which, in the most nervous cases, it can be differentiated by 

 consideration of season and locality, the more ephemeral nature of the 

 nervous symptoms, the absence of such serious signs as blindness, and the 

 occurrence of other and less nervous cases. Finally, it can be diagnosed 

 by the autopsy. Malaria, with the exception of recurrences of the dis- 

 ease contracted elsewhere, does not occur in the spotted-fever country. 

 Typhoid can be excluded by the blood examination and by the appearance 

 of the rash. 



While the wide geographical separation of the two diseases renders 

 it improbable that anyone else will be called upon to differentiate between 

 tsutsugamushi disease and tick fever of Montana, it is germane to the 

 subject of this paper here to summarize the points of differentiation by 

 means of parallel tables. 



TsrTsrtiAMr.sm mskask. 



Confined to Ecliigo and Akita Prov- 

 inces in Japan. 



Contracted on ground that actually 

 has been submerged. 

 Season : 



First of March to end of June 

 (usually). 

 Etiology : 



Due to bite of infected larval 

 Trombidium. 

 Incubation: 



Five to twelve days ( usually ) . 

 Symptoms, early : 



Onset. Usually by chill, followed 

 by headache, malaise. 



Pain and swelling of lymphatic 

 glands on first or second day 

 leads to discovery of bite. 



Bite always present and demon- 

 strable. Shows small black area 

 of necrosis. 



SPOTTED FEVER. 



Confined to parts of the Rocky Moun- 

 tain region. 



Contracted on ground that has not 

 been submerged. 



End of June to October. 



Due to bite of infected Dermacentor 

 occidentalis. 



One to eight days. 



Same. Headache and backache more 



common. 

 Not so. Tick bite, if present, may be 



inflamed. 



Not so. When present it is usually a 

 red mark. 



