VARIETIES— TREA TMENT 



1317 



With regard to the frequency of the relapses, Rogers gives the 

 following percentages: — - 



Without relapse 23*8 per cent. 



With one relapse .. .. .. 49*2 



With two relapses .. .. .. 20-0 



With three relapses .. .. .. .. 5*o 



With four relapses .. .. .. 2*0 



Varieties. — ^The typical course may be varied in about 25 per 

 cent, of cases, and present (a) a short, irregular, remittent fever ; 

 [h) a so-called bilious remittent fever , called by Carter ' icteric fever.' 



[a) Short, Irregular, Remittent Fever. — ^This is very like malaria, 

 from which it is only to be diagnosed by blood examination. 



(h) So-called Bilious Remittent Fever (Icteric Fever). — So-called 

 bilious remittent fever very closely resembles typhus fever, and to 

 some extent yellow fever, showing deep jaundice, with an eruption 

 of red spots. The temperature is irregular, and the pyrexia pro- 

 longed; prostration comes on early, and may develop into a ' status 

 typhosus.' The death-rate of these cases is high, being 70 per 





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Fig. 650. — Temperature Chart of the Relapsing Fever of India, 

 (Chart made by Major Archibald.) 



cent. They are to be diagnosed from typhus by the blood examina- 

 tion, and from yellow fever by the absence of black vomit. 



Complications. — ^These are the same as in the European type. 



Diagnosis. — ^This is based on the microscopical examination of 

 the blood. 



Prognosis. — prolonged, irregular first attack, ending by lysis, 

 and attacks showing marked jaundice are bad omens. 



The mortality is higher than in Obermeyer's type, being i8'02 

 per cent., of which about one-half take place in the attack, and 

 one-quarter in the first interval, and one-fifteenth in the first 

 relapse, and the remainder from complications. 



Treatment. — ^The treatment and diet differ in no respect from 

 that already laid down, except that these patients often stand 

 large doses of salvarsan badly, and therefore one should not give 

 more than 5 grains of the drug by intravenous injection; more- 

 over, the disease being of a severer type than the European form, 



