THE RELAPSING FEVERS 



when injected into monkeys, while, according to Lamb, the former 

 only causes one relapse. Moreover, the two spirocha^tes may be 

 differentiated by immunization and agglutination tests. S. macaci, 

 observed by us in monkeys in Ceylon, appears to be closely related 

 to 5. carteri, and may be identical with it. 



Strong, experimenting with white mice, has come to the conclusion 

 that the Indian Spiroschaudinnia is closely allied to the European 

 and North-American types. 



Pathology. — ^The morbid anatomy resembles that of the European 

 type. 



Symptomatology. — In accidental inoculations in the post-mortem 

 room the incubation period varies from three and a half to seven 

 days, during which prodromata resembling those of the European 

 type may occur. 



The onset is generally sudden, but in most cases without the 

 rigors defined in Europe, though chilliness occurs, and the disease 

 progresses as in the Obermeyer fever. On the fall of temperature 



to submormal, however, on the 

 sixth or seventh day, which is 

 associated with profuse perspi- 

 ration and polyuria, instead of 

 the patient feeling better, he 

 often becomes collapsed, with 

 a small weak pulse and a cold 

 clammy skin, in which condition 

 he may resemble at first sight a 

 cholera patient. In the first 

 intermission, which lasts from 

 three to twelve days — generally 

 about eight days — the patient 

 improves slowly, there being 

 much debility, and in one case 

 in six there is a sudden tem- 

 porary rise of temperature after 

 the crisis. Spirochsetes are not 

 to be seen in the blood, but Carter and Pisani have described 

 pecuhar structures. The first relapse occurs about the fourteenth 

 day of the disease, and the seventh of the intermission, and 

 resembles the first attack, but the temperature may reach a higher 

 level, and the illness is shorter, ending in a crisis. 



The second intermission may last about ten days, being longer 

 than the first, and a second relapse takes place, often commencing 

 with chills. The liver does not markedly enlarge, but the spleen 

 increases in size. The fever is remittent or intermittent, and the 

 crisis is not marked. It is now rare for the disease not to end, but 

 after an interval of fourteen to seventeen days a third relapse may 

 take place, with a sudden rise of temperature, which lasts one to 

 four days. Very rarely a fourth intermission of about eleven days 

 ends in a fourth relapse, lasting only two days. 



Fig. 649. — Spiroschaudinnia from 

 A Case of Asiatic Relapsing 

 Fever. 



(From a microphotograph by 

 J. J. Bell.) 



