CLINICAL VARIETIES 



1321 



symptoms last three to four days, and end by a crisis marked by 

 profuse sweats and a fall of temperature below normal. On the 

 day before the crisis there is a pseudo-crisis, with a fall of tempera- 

 ture, but no improvement in the symptoms. 



Intermission.— 'The patient feels weak and tired, but slowly re- 

 gains his appetite and strength, and no parasites are found in the 

 blood. The disease may now terminate, or the intermission may 

 last from one to twenty-one days, according to Ross; but five to 

 eight days is more usual. 



Relapse. — -The first relapse begins with a rise of temperature 

 and a return of the original symptoms, and also of the parasites 

 into the peripheral blood. After lasting three to four days, it 

 ends in a crisis marked by sweating, and showing a pseudo-crisis 

 on the preceding day. 



Intermissions and relapses follow one another regularly or 

 irregularly, the intervals being from one day to two months, and 

 the relapses usually lasting three days, and showing a pseudo- 

 crisis on the second day and a crisis on the third day. As many as 

 five to eleven relapses may take place, and end by reducing the 

 jpatient both in weight and strength. (Edema of the eyelids has 

 been noted in the relapses. 



Complications and Sequelce. — Iritis is frequently observed. 



Clinical Varieties. — According to Ross, there appears to be a 

 marked difference in the severity of the attack in new-comers, such 

 as Europeans, and natives. Though the attack shows much the 

 same symptoms in natives as in Europeans, it is often far less 

 severe, and the spleen may not enlarge. The attack frequently 

 lasts twenty-four to forty-eight hours, and ends by crisis, after 

 which the patient rapidly recovers, as a rule without a relapse. 

 Should this, however, take place, it is found to be less severe than 

 the attack. Koch believes that these mild attacks and the native 

 immunity are due to infection in early childhood. Button and 

 Todd, on the other hand, describe cases very much resembling 

 that in the European, with enlargement of the spleen, and with more 

 than one relapse, leaving the patient anaemic, thin, and weak. 

 Hence it may be concluded that the disease shows two types in 

 natives — a mild type and a severe type — and that the latter may 

 end in death. 



Diagnosis. — ^This can only be made by finding the spirochaetes. 

 Lowenthal's method of agglutination can be applied in doubtful cases. 



Prognosis. — ^This is usually good for both the natives and 

 Europeans, but death may occur in both races, and is signalled by a 

 rapid fall of temperature without improvement of the symptoms. 



No figures have so far been recorded with regard to the mor- 

 tality, but it may be taken that it, as a rule, is low, though under 

 adverse circumstances it may be high. Dutton and Todd record that 

 of twenty men who contracted the disease in one caravan, ten died. 



Treatment. — ^This is the same as for the European form (see 

 P- 1313)- 



