WAR ZONE FEVERS 



Definition. — ^An acute specific fever caused by Spiroschaudinnia 

 icterohcBmorrhagice (Inada, Ido, Hoki, and Keneko, 1915), and 

 characterized by jaundice, albuminuria, enlargement of the spleen, 

 pains in the muscles, with sometimes haemorrhages and a high 

 mortality. 



History. — ^The disease was first mentioned in Minorca in 1745, 

 and then along the coast of Italy. Larrey, in 1800, seems to have 

 described this disease as seen in Napoleon's army in Egypt. It 

 was also noted by Carville in 1859, ^"^^ Worms in 1865, while a 

 number of cases occurred during the American Civil War. As the 

 mortality from jaundice was low in the South African War, it is 

 probable that it was absent. In the present war it has occurred 

 in the British, French, Italian, Serbian, and German armies, though 

 it has been confused with the milder type. In 1886 Hirsch popu- 

 larized the complaint and Weil again drew attention to the disease, 

 and in 191 1 Hecker and Otto wrote a monograph on it. As regards 

 the tropics, it was noted in India in 1849, subtropical countries 



it was seen in Smyrna and Egypt. In this history authors noted two 

 types, a mild, resembling simple catarrhal jaundice, and a severe, 

 which some of them called a type of bilious remittent fever, and said 

 that some of the cases had haemorrhages and nervous symptoms. 

 During the last few years it has received much attention, because 

 cases of jaundice have been frequently noted in the armies. In 

 1915 the Japanese investigators mentioned above discovered the 

 causal agent, and this has been confirmed by French, English, 

 Italian, and German workers. Noguchi has found that strains of 

 5. icterohcBMorrhagicB isolated from patients in Japan and Belgium, 

 and from rats in America, are identical morphologically and sero- 

 logically. He has created for the organism a new genus, Lepto- 

 spira, which will probably be generally accepted in the near future. 



-ffitiology. — ^The causal agent isSpiroschaudinnia icterohcBmorrhagicB 

 (p. 447), which is considered to be the same as the spirochaete found 

 in the kidneys and urine of wild rats, in which it lives. It is 

 believed that the organism escaping in the rats' urine, and to a 

 less extent in human urine, is the source of infection, which takes 

 place through the skin when walking barefoot on sodden ground 

 or by entering the alimentary canal in water. 



Pathology. — ^The jaundice is probably caused by obstruction to 

 the smallest bile ducts, brought about by a polymorphonuclear 

 exudate into the tissues surrounding them. 



Symptomatology. — ^The incubation period varies from five to seven 

 days, the average being six days, which agrees with an accidental 

 infection. 



The onset is usually abrupt, with occasional shivering and high 

 fever, faintness, giddiness, and prostration. The patient is flushed 

 and looks and feels very ill. The spleen and liver enlarge, and the 

 superficial lymph glands may become palpable. 



Co«/;'s^. —Jaundice appears two or three days after the onset. 

 The tongue is coated with a brown fur, and sordes form on the lips 



