SYMPTOMATOLOGY— ICTERUS CASTRENSIS GRAVIS 1505 



the patient does not feel or look ill, the pains and tenderness in the 

 shins may become worse during each attack and may keep him from 

 sleeping. The number of relapses is variable, and may reach six 

 or seven. 



Rash. — In a fairly large number of patients a delicate macular 

 rash appears with each recurrence of the fever. It is generally 

 seen on the chest and abdomen, and consists of small red macules 

 which disappear on pressure. 



Termination. — ^After lasting a variable time (five to six weeks) , the 

 disease gradually dies out and the recovery is complete. 



Complications and Sequelae. — ^Tachycardia and so-called soldier's 

 heart may occur. 



Varieties. — ^English observers recognize a short and a long type. 

 In the former the fever lasts for three to four days, falls to normal, 

 and after a few hours rises again for two to five days, when it falls 

 to normal and the fever stops. This variety resembles dengue fever. 

 The long type is the typical fever. 



The Germans also recognized a simple paroxysmal form, but they 

 also mention a typhoidal and a rudimentary form. 



Diagnosis. — ^This has to be made from influenza, dengue, pappa- 

 taci fever, relapsing fever, malaria, smallpox, typhus, and enteroidea. 



From influenza it may be distinguished by the absence of catarrhal 

 symptoms and the mononucleosis. 



From dengue and pappataci by the absence of leucopenia. 



From relapsing fever by the absence of marked enlargement of 

 the spleen and of the spirochaetes in abundance in the blood. 



From smallpox and typhus by the absence of the severe consti- 

 tutional symptoms. 



From malaria by the absence of the leucopenia and of the typical 

 parasites from the blood. 



From enteroidea by the sudden onset and the pains in the muscles 

 and bones, and by negative hsemoculture and serological reactions. 



Prognosis. — This is good, as the mortality is nil and the recovery 

 complete. 



Treatment. — Pyramidon is strongly recommended, but constipa- 

 tion must be relieved, and the patient should be disinfected at once. 

 His clothing and bedding should be disinfected in moist heat at 

 70° C. for half an hour. 



Prophylaxis. — ^This is mainly louse destruction {vide the chapter 

 on Typhus, p. 1338), but the urine and sputum of patients should 

 also be disinfected. Cups should be provided for the sputum. 



ICTERUS CASTRENSIS GRAVIS. 



Synonyms. — Weil's disease, Epidemic jaundice, Infective jaundice, Spiro- 

 chsital jaundice, Spirochaetosis icterhsemorrhagica, Larrey-Weil disease. 

 French, Maladie de Weil, Typhus hepatique; German, Infektioser Fieberhafter 

 Ikterus, Infektionikterus, Weilschen Krankheit; Japanese, Odan-eki; Latin, 

 Icterus f ebrilis seu infectiosus, Typhus biliosus nostras, Morbus weili. 



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