1258 



PAPPATACI FEVER 



slowness of the pulse, and the leucopenia, but both diseases may 

 exist together; from sunstroke by the absence of the severe symp- 

 toms, nervous symptoms, and the lower temperature; from dengue 

 fever it can only be distinguished by the fever ending the third 

 day, and by the absence of the rash. In countries where pappataci 

 fever and typhus are endemic the diagnosis at the onset between 

 these two fevers may be extremely difficult. Examine the blood: 

 in pappataci there is generally leucopenia; in typhus no leucopenia, 

 frequently leucocytosis. 



Varieties. — ^An afebrile variety, with only headache and body 

 pains, is described, as well as an abortive form lasting two days. 

 Relapses and true reinfections may also occur. 



Complications.— The complications are bronchitis and phlebitis. 



Sequelae. — Pains in the bones, neuritis, and a peculiar loss of 

 memory may be sequelae. 



Prognosis. — ^This is good, as no one has been known to die of the 

 uncomplicated complaint. 



Treatment. — ^The treatment is purely symptomatic, and consists 

 in sending the patient to bed, in administering a saline purga- 

 tive, and following this by aspirin in 5 to 15 grain doses given three 

 times a day. This treatment is said not merely to relieve the pains, 

 but to render the attack milder. Pyramidon also promptly relieves 

 the pains, while it has been recommended that the phlebotomus bite 

 should be painted with tincture of iodine. 



Franz and Kolar recommend the subcutaneous or intravenous injections 

 of colloidal silver, but this hardly appears necessary in such a mild fever. 

 Atoxyl has been found to be useless, and quinine to be harmful. 



During convalescence a change of air and an iron tonic may be 

 recommended. 



Prophylaxis. — ^The only obvious means of prophylaxis consists in 

 isolating the sick and protecting them against the phlebotomus by 

 means of mosquito curtains of a sufficiently fine mesh. It must be 

 remembered that the little fly bites mostly in darkness, and chiefly 

 in houses. 



As regards ordinary prophylaxis, a fine mosquito curtain, together 

 with the use of camphor, is to be tried. Fumigation by burning 

 pyrethrum may also be tried. 



REFERENCES. 



Castellani (1917). Journ. of Trop. Med., August 15. (Tropical Diseases in 

 the Balkans.) 



Castellani (191 8). Ann. Med. Nav., vol. i., Nos. 3 and 4. 

 Delmege and Staddon (191 8). Brit. Med. Journ., April 6. 

 DoERR, Franz, and Taussig (1909). Das Pappataci-fieber. Leipzig. 

 Du BiRT (1910). Journal Royal Army Medical Corps. London. 

 Gabbi (1918). Malaria, vol. ix., Nos. 3 and 4. 

 HiGGiNS (1916). British Medical Journal, i. 166-167. 

 HowLETT {1915). Bulletin of Entomological Research, December. 

 Lambert (1918). Journ. Roy. Nav. Med. Serv., vol. iv.. No. 2. 

 McCarrison (1906). Indian Medical Gazette. Calcutta. 

 Seidelin (191 2). Yellow Fever Bulletin. Liverpool. 



