WAR ZONE FEVERS 



of leucopenia, and the usual signs of enteric fever, while blood cul- 

 tures fail to demonstrate the typhoid bacillus and its allies. 



From septic jaundice it can be separated because the jaundice 

 appears at an early and not at a late stage in the disease, and by 

 the absence of septic infections clinically and by hsemoculture. ■ 



From malarial jaundice, and especially the Weil's disease-like 

 type, by the absence of the malarial parasites in numbers and by 

 the presence of the slight leucocytosis. 



From acute yellow atrophy by the absence of the diminution 

 of urea and uric acid, by the absence of leucine and tyrosin in the 

 urine, and by the increase in size of the liver. 



From typhus by the absence of the peculiar facies, of the sub- 

 cuticular mottling and the typical rash, and by the presence of 

 jaundice, which is only occasionally seen in that disease. 



From hlackwater fever by the absence of haemoglobin from the 

 urine. 



From pneumonia with jaundice by the absence of right-sided lobar 

 pneumonia. 



Vrom yellow fever by the pulse being rapid from the first and falling 

 as the temperature falls. 



From relapsing fever by the absence of abundant ordinary spiro- 

 chaetes from the blood, and by the peculiar characters of the typical 

 spirochsetes of Weil's disease when present in blood, in which it is 

 found only in small numbers. 



Prognosis. — ^This is serious, the death-rate being some 30 per cent,, 

 and convalescence being prolonged. 



Treatment. — ^The repeated subcutaneous or intravenous injection 

 of 20 to 60 c.c. of the serum prepared by Inada, Ido, Hoki, I to 

 and Wani or of Martin and Pettit's immunized horse serum is 

 recommended. Salvarsan and its allies are useless. Symptomatic 

 treatment for constipation by salines and aperients is also to be 

 remembered. 



Prophylaxis. — ^Disinfect the urine of patients for some nine weeks 

 from the onset of the attack. Catch and kill rats. Disinfect the 

 ground of the endemic area or remove the persons from this area. 



ICTERUS CASTRENSIS LEVIS. 

 Synonym. — Camp jaundice. 



Definition. — slightly febrile disorder, characterized by mild 

 febrile symptoms, followed by a mild attack of jaundice lasting 

 some two to eight weeks, after which there is a very prolonged 

 convalescence. 



Remarks. — ^We have abready noticed that older writers have 

 divided Weil's disease into two types, one mild and the other severe. 

 Camp jaundice represents the mild form, and clinically is practically 

 indistinguishable from catarrhal jaundice. It was very common 

 in Eastern war zones, and its symptomatology may be divided into 

 the pre-jaundice period and the jaundice period. 



