1504 



WAR ZONE FEVERS 



the time required to induce the disease experimentally by infected 

 lice when permitted to bite healthy persons. Experimentally it is 

 six to eight days from the time that infected lice faeces are rubbed 

 into scratches, and five days after the inoculation of infected blood. 

 During this stage there may be slight prodromata in the form of 

 headache and pains in the limbs, but these may be absent. 



Attack. — ^The onset is sudden, the patient feeling giddy, weak, 

 and shivering. He feels so ill that he has at once to stop his work, 

 and complains of shortness of breath, pain in the left side, in the back, 

 legs, and behind the eyeballs, as well as of headache. The tempera- 

 ture quickly rises to 101° to 104° F. The conjunctivae are injected, 

 and nystagmus may be present if the eyes are turned completely 

 sideways. 



There are two curious types of this stage of the illness — viz., the appendi- 

 cular and the cerebrospinal. In the former, the patient suffers from abdominal 

 pain, constipation, slight abdominal distension, tenderness, and vomiting, 

 and in Allied and German armies the diagnosis of appendicitis has been made. 



At other times there may be pains and stiffness of the neck, and the case 

 may be mistaken for cerebro -spinal meningitis. 



The Course of the disease is that the next morning the temperature 

 has fallen to normal or nearly normal, but it may remain high, the 

 appetite is lost, the tongue is furred, and there may be pharyngitis 

 and constipation. Now the patient complains of pains in the 

 muscles and bones of the legs, and has tenderness in the shins, over 

 which there is cutaneous hypersesthesia, and there may be pain and 

 tenderness in the fibula, humerus, ulna, or along the vertebral column. 



Herpes lahialis may appear, and fairly often a discrete roseolar 

 rash, and very rarely a scarlatiniform or small papular rash, may be 

 seen on the chest, back, or abdomen. The spleen and more rarely 

 the liver may now enlarge. The blood shows a leucocytosis, with 

 a relative mononuclear increase. The red corpuscles are not 

 reduced in amount, but the haemoglobin is usually reduced, and 

 there is polychromatophilia. 



First Intermission. — ^After twenty-four to forty-eight hours, or 

 longer, the temperature falls to normal, the symptoms disappear, 

 and the patient feels well, though sometimes he feels slight discom- 

 fort in the muscles and bones. 



Second Attack. — Some two to ten, but more usually five, days after 

 the cessation of the first attack the patient begins to feel ill, with 

 headache, pains in the legs, and fever, the temperature rising to 

 about 101° F. Next day the temperature is normal, and this attack 

 may cease, or the fever may recur in the evening, but usually ceases 

 next day. 



Intermissions and Attacks. — ^These now succeed one another at 

 regular intervals of about five days' duration, but the attacks of 

 fever become shorter and shorter and the temperature lower and 

 lower, so that unless care is taken to register the temperature every 

 two hours about the time of an expected attack, the fever may 

 be missed by the day and night temperature chart. Although 



