SYMPTOMATOLOGY— MOSSMAN FEVER 1465 



symptom. The physical examination of the patient will reveal 

 nothing abnormal, apart from, occasionally, signs of slight anaemia. 

 The liver and spleen are not enlarged. In a few cases some super- 

 ficial lymphatic glands may be slightly enlarged. In some cases 

 the red blood cells are decreased. An interesting feature in most 

 cases is the distinct increase in the number of eosinophile leucocytes, 

 even when no evidence of intestinal worms can be found in the 

 motions. The course of the fever is very long. We have seen cases 

 lasting six months. 



Diagnosis. — ^This fever may be diagnosed from Malaria by the 

 absence of Laveran's parasites, and by the fact that the spleen is 

 not enlarged; from Malta fever, a type of which it closely resembles 

 clinically, by the absence of the Micrococcus melitensis in the blood, 

 and the constant negative result of Wright's reaction; from trypano- 

 somiasis by the absence of trypanosomes; from low fever of tuber- 

 cular origin by the negative cutireaction. 



Prognosis. — ^This is good — quoad vitam — but the patient feels 

 weak, tired, nervous, and unfit to do his work properly for months. 



Treatment. — change of climate is always beneficial, and often 

 quickly stops the fever. A long course of injections of quinine 

 cacodylate is useful in many cases. The ordinary preparations of 

 quinine by the mouth or by injection do not influence the fever 

 in the least. 



HIGH INTERMITTENT NON-MALARIAL FEVER. 



Remarks. — ^This fever has been described by Castellani in 1909 

 in children in Ceylon. 



Symptomatology. — ^Apart, perhaps, from slight anaemia, the child 

 does not show any symptoms except the fever. He takes his food 

 well, runs about and plays, and seems apparently in his usual 

 health. The fever begins in the late morning, and lasts several 

 hours every day, reaching 103° to 104° F. and more. There is no 

 shivering fit at the onset, nor perspiration when the temperature 

 falls to normal. The blood does not show anything abnormal, 

 except, occasionally, a slight degree of anaemia. The course of the 

 fever is very long, lasting at times several months. 



Treatment. — Quinine does not influence it in the least. As a 

 rule, a change of climate stops the fever almost immediately. 



MOSSMAN FEVER. 

 Synonym. — Endemic glandular fever. 



In 1 910 Smithson described a fever, which he called Mossman fever, and 

 which was characterized by an irregular remittent fever of three to twenty- 

 one days' duration, accompanied by painless enlargement of the posterior or 

 subscapular group of axillary glands, which were tender. The symptoms were 

 mild, accompanied by a macular or vesicular rash. It almost exclusively affects 

 sugar-cane cutters. The blood is normal and the death-rate is low, but it 

 may end fatally, apparently from a form of septicaemia. It affects white and 

 black people in the endemic area. The incubation period is six to ten days, 

 and the onset is sudden or gradual. 



