1354 TSUTSUGAMUSHI FEVER AND ALLIED FEVERS 



Diagnosis. — ^The differential diagnosis from Rocky Mountain 

 spotted fever and typhus has already been discussed (p. 1347). 

 the onset — ^when the inguinal or other lymphatic glands are enlarged 

 and painful — ^plague might be suspected. The presence of the 

 necrotic area, and, in any doubtful case, the microscopical examina- 

 tion of the gland juice, which in plague contains numerous bi-polar 

 staining bacilli, will enable a diagnosis to be made. 



Prognosis. — ^The prognosis is good in the young, and in second 

 and third attacks, which are always milder than the first. It, 

 however, gets worse as age progresses, and especially in first attacks. 

 The mortality is about 30 per cent., but increases markedly with 

 age, being only 12-5 per cent, in the first, and 57 per cent, in the 

 seventh decade of life. 



Treatment. — Quinine is generally administered, but it does not 

 influence the fever to any marked extent. Salvarsan might be 

 tried. Narcotics may be required to combat the sleeplessness, and 

 constipation must be relieved by purgatives and enemata. Phen- 

 acetin, antipyrin, and salicylates are generally badly borne by the 

 patient. 



Prophylaxis. — ^The prophylaxis consists in the avoidance of the 

 infective regions during the months of July to October inclusive, 

 while the cultivation of the infected regions, and especially the 

 planting of Eucalyptus globulus and Paulonnia imperialis, are 

 advised, as well as the smearing of the exposed parts of the body 

 with eucalyptus oil and balsam of Peru, which are said to keep 

 away the mites. 



The natives believe that the manuring of the infected lands with human 

 faeces for three consecutive years will make them free from the mites, provided 

 there is no flooding during that period. 



ALLIED FEVERS. 



PSEUDO-TYPHUS OF DELI, SUMATRA. 



In 1902 Schiiffner observed a peculiar fever in Deli, Sumatra, 

 which he described in 1913, and which he thinks may possibly be 

 due to a tick. 



In occurs from June to August and from November to January. 



The site of the inoculation is marked by a small red spot, followed 

 by necrosis of skin and inflammation of the local lymphatic glands. 

 The necrotic ulcer may measure 2-7 mm. in diameter, and shows 

 little tendency to heal, while other lymph glands enlarge. 



On or about the second to third day a roseolar eruption appears 

 all over the body, being most marked upon the trunk and flanks, and 

 less so on the face and limbs. This eruption slowly fades during 

 eight to ten days. Sometimes it is but slightly marked; sometimes 

 it is hasmorrhagic and followed by desquamation. 



The fever is like that in enteric fever, and is associated with severe 

 nervous symptoms. 



