THE RELAPSING FEVERS 



and sudden heart failure being common, cardiac stimulants should 

 be given during the attack, and preparation made for preventing 

 the collapse by means of hypodermics of strychnine and ether, or 

 camphor in ether, as well-as by hot bottles, blankets, etc. 



Prophylaxis. — See remarks with reference to the European type. 



Manchurian Relapsing Fever. 



This type of relapsing fever is due to a spirochsete which Toyoda 

 in 1916 demonstrated by immunity experiments to be distinct 

 from the African and the European types. The organism is short, 

 7-20 microns by 0-4 micron, and its spirals number 4-8; it is spread 

 by lice. 



Liver enlargement and albuminuria are physical signs of import- 

 ance. The first paroxysm lasts five to thirteen days, the first 

 interval two to fourteen days; the second attack one to nine days, 

 interval two to thirteen days; the third paroxysm lasts one to six 

 days, the third interval two to ten days; the fourth paroxysm lasts 

 two to six days. 



The mortality rate is 5-3 per cent. Two paroxysms are common. 



THE TICK GROUP. 

 THE RELAPSING FEVERS OF AFRICA. 



The tick relapsing fevers of Africa may be classified as follows:- — 



1. West African relapsing fever. 



2. East African relapsing fever. 



I. The Relapsing Fever of West Africa. 



Synonyms. — Tick fever (Livingstone), African tick fever. 



Definition. — An acute specific relapsing fever caused by Spiro- 

 schaudinnia duttoni Novy and Knapp, 1906, and spread by Ornitho- 

 doros mouhata Murray. 



History. — ^The peoples of Africa from time immemorial have had 

 a dread of tick-bites, which they thought caused fever, and this 

 appears to have been noted by Livingstone, Kirk, Hinde, and 

 many other people, with the result that a tick fever of an unknown 

 nature was spoken of as occurring in Africa. Nabarro, in August, 

 1903, was the first to observe a spirochsete in human beings in 

 Uganda, but as his publication, through no fault of his own, did 

 not appear till much later, his discovery was forestalled by those 

 of Ross and Milne in 1904, and Dutton and Todd, also in 1904, who 

 found the cause of the tick fever to be a spirochsete, the latter 

 observers also proving that it was introduced into the blood by 

 the bite of a tick — Ornithodoros mouhata. Since that date Koch, 

 Todd, Novy and Knapp, Breinl and Kinghorn, and others, have 

 studied the disease carefully. Frankel has proved by biological 

 tests that the spirochsete of East African relapsing fever differs 

 ' from 5. duttoni, as observed in West Africa, and Nuttall proposed 



