I3I4 



THE RELAPSING FEVERS 



doses of heroin; in other cases an expectorant mixture will be 

 found useful. Constipation must be treated by laxatives or enemata, 

 and high temperatures by cool sponging, which, however, will but 

 seldom be required. The comphcations must be met by the treat- 

 ment laid down in textbooks on general medicine. 



Prophylaxis. — Prophylaxis consists in the destruction of lice by , - 

 steaming clothes, as can be done in railway trucks by leading in 

 steam from the engine or by boiling clothes, while the patient is 

 thoroughly bathed. For further particulars see the prophylaxis 

 of typhus (p. 1338). 



THE RELAPSING FEVER OF NORTH AFRICA. 



Synonyms. — Algerian relapsing fever; Egyptian relapsing fever; Arabic; 

 Homa el Hugga, Homa en Naxy, Naushah. . ! 



Definition. — An acute specific fever caused by Spiroschandinnia 

 berbera Sergent and Foley, 1910, and spread by the agency of 

 Pediculus corporis de Geer, 1778. 



History. — It was noticed by the surgeons of Napoleon's army in 

 Egypt, and later by Griesinger in 1851, when it was called ' bilious 

 typhoid ' ; while more recently Sandwith, Cummins, Bousfield, 

 Balfour, and Graham-Smith, have published excellent accounts of 

 the disease. In 1910 Sergent and Foley differentiated 5. berbera 

 Sergent and Foley, in a case in South Oran. The transmission of 

 the disease by lice has been worked out by Nicolle, Blaizot, and 

 Conseil. Toyoda's immunological experiments show that this 

 fever is closely related to the European type. 



Climatology. — It is known to exist in Algeria, Tunis, Tripoli, 

 Egypt, and the Anglo-Egyptian Sudan. 



iS)tiology. — It is caused by S. berbera Sergent and Foley, iQio, 

 spread by the agency of lice, as shown by Nicolle, Blaizot, and 

 Conseil {see p. 447). 



Symptomatology. — The length of the incubation period is not 

 known, but is believed to be more 'than twelve days. The fever, 

 which may be associated with rigors, reaches its height during the 

 first twenty-four hours, and afterwards shows morning remissions. 

 The spleen enlarges, and the liver becomes tender and painful in 

 some cases; but jaundice is generally absent. Vomiting is present, 

 but diarrhoea is absent. The attack is apparently not very severe.^ 

 Apyrexia lasts from two to nine days, and is followed by one, 

 two, or, more rarely, three relapses. 



Diagnosis. — ^The spirochsetes must be found in the blood, as the 

 cases may occasionally resemble cerebro-spinal meningitis and acute 

 rheumatism. 



Prognosis.— This is usually good, the mortality being nil in 

 fifty cases. 



Treatment. — ^This is the same as for the other relapsing fevers. 



