PAPPATACI FEVER 



ize infective serum; moreover, this action may be demonstrated 

 during a period varying from one week to two years after an attack. 

 An attack of fever confers a relative immunity, as relapses are seen, 

 but reinfections are believed never to occur, and the natives of an 

 endemic region are believed to be immune, possibly because there 

 has been a previous attack during childhood. 



Morbid Anatomy.—In the few post-mortems which have been 

 performed, the signs exhibited have been those of the complica- 

 tion from which the patient died, as the disease per se is not 

 fatal. 



Symptomatology — Incubation.- — ^The incubation varies from three 

 to seven days. Prodromal symptoms in the form of malaise, vague 

 pains, discomfort, and weariness, are generally present in India, 

 but rare in Europe and Africa. 



Attack.- — ^The onset is sudden, with a slight rigor or a feeling of 

 chilliness and severe frontal headache, lumbar and body pains. 

 The conjunctivae are injected and the cheeks slightly flushed. In a 

 fairly large number of cases the flushing of the face and neck is 

 extremely well marked, almost amounting to an erythematous rash. 

 A peculiar feature of this symptom has been described by Castellani 

 — ^viz., the flushing is persistent, lasting eight to fifteen days after 

 the fever is over, and fades away so slowly that in many cases it is 

 not difficult to diagnose the disease in persons convalescent there- 

 from. The skin is hot and dry, and the temperature rapidly rises, 

 reaching 104° F., or rarely 105° F., in twenty-four hours. The pulse 

 may reach 100 to 116, but is often unduly slow. The patient is 

 very irritable, and intolerant to sounds. Movements of the eyes are 

 painful, the conjunctivae are injected, and often show a red band 

 running from the cornea across the sclera. Sleep is impossible at 

 times, but at other times the patient may be very drowsy. The 

 tongue is coated on the dorsum with a white or brown fur, and the 

 edges may be red. The appetite is lost and the sense of taste 

 destroyed, but vomiting is uncommon, though there is pain in the 

 epigastrium and sometimes diarrhoea. The mouth and throat are 

 congested and irritable, and the gums may show a tendency to 

 bleed, and there may be a little bronchitis. The cough is generally 

 dry, with thick, tenacious, muco-purulent expectoration. The 

 tonsils may be enlarged and the uvula congested, but this is not 

 constant. Not only is there the congestion of the tonsils and 

 pharynx, but the mucosa of the soft palate presents a peculiar 

 appearance, showing small hyperaemic roundish spots. The erup- 

 tion is sharply limited by a line of demarcation between the soft 

 and hard palates. This appearance is not peculiar to the disease, 

 being found in certain cases of relapsing fever, typhus, and malaria. 

 It is rare in typhoid. The liver and spleen are normal. Vertigo 

 and faintness may be present, and pains in the joints, especially in 

 the elbow and knee, as well as in the bones and muscles, and burning 

 sensations in the palms and soles. Cramps are not uncommon. Ex- 

 citation is frequent, and delirium occasionally seen. 



