SYMPTOMATOLOGY 



1257 



The blood shows a leucopenia — 4,000 to 5,000 leucocytes per 

 cubic millimetre — and the differential count is as follows: — 



Polymorphonuclears .. .. .. .. ..61*7 



Lymphocytes . . . . . . . . . . . . 21*3 



Mononuclears . . . . . . . . . . . . 14*0 



Eosinophiles . . . . . . . . . . . . 2-7 



The blood-pressure is normal during the attack, but somewhat 

 diminished during convalescence. 



The urine is diminished in quantity, but is of normal colour, specific 

 gravity, and acid reaction, and does not contain albumen, except 

 rarely, and then only a trace. Ehrlich's diazo-reaction is negative. 



The skin is usually dry throughout, but profuse sweating may 

 occur, and erythemata of a morbilliform or a multiform character 

 may be seen, as well as a few roseolse, but are very rare. A skin 

 change, which starts at the commencement, is a delicate subcuticular 

 mottling of the chest and abdomen, ' Cutis marmorata.' 



Course. — In thirty-six to forty-eight hours the temperature falls 

 to normal, but may show a terminal rise. This fall is often accom- 

 panied with epistaxis, more rarely with sweating, vomiting, or 

 diarrhoea. When the temperature falls the symptoms abate, but 

 much weakness is felt, the convalescence being prolonged. A post- 

 critical rise is not very rare, and occasionally there may be a low 

 irregular fever lasting for about a week and even longer. 



V 102° 



101° 



100° 



99° 

 ifcnrnl 

 98° 



rr 



102° 



101° 

 100° 



98° 



Figs. 636 and 637. — Temperature Charts of Pappataci Fever. 



Diagnosis. — In a country where sand-fiies exist the disease may be 

 diagnosed by (i) the sudden onset of the fever, ending on the third 

 day without any roseolar-like rash; (2) rheumatoid pains all over 

 the body, very well marked; (3) no enlargement of the spleen; 

 (4) persistent erythematous flushing .of face and neck after defer- 

 vescence in 40-50 per cent, of cases-— so-called Ca tellani's sign. 

 There is, however, no certain sign for diagnosis except human inocu- 

 lation, and as the incubation is so long the fever will have declared 

 its character before the inoculated person develops the attack. 

 Cuti- and ophthalmo-reactions have failed to be demonstrated. 

 The differential diagnosis from malaria can be established by failing 

 to find the parasite in the blood, and by the absence of enlargement of 

 the spleen; from typhoid fever by the sudden onset; from influenza 

 by the absence or mildness of catarrhal symptoms, the relative 



