THE MACULAR FEVER OF TUNISIA 



1467 



WOOLLEY'S FEVER WITH JAUNDICE. 



This fever was described by Woolley as occurring in the Andaman 

 Islands. He thinks that it is separate from malaria. 



Jaundice appears on the third to fourth day, and in bad cases 

 there are haemorrhages, delirium, and a rapid pulse, while 40 per 

 cent, of the cases die. 



It seems to us that it must be Febris casirensis gravis — i.e., Weil's 

 disease. 



THE MACULAR FEVER OF TUNISIA. 



Synonym. — La fidvre boutonneuse de Tunisie. 



Definition. — An acute febrile disorder of unknown causation, characterized 

 by a peculiar macular eruption on the abdomen, palms of the hands, and 

 soles of the feet, which often persists for several days after the temperature 

 has fallen to normal. 



Remarks. — This fever was described by Conor, Bruch, and Hayat in 1910 

 in Tunisia, and by other persons more recently. 



JEtiology. — The causation is unknown, and inoculations into monkeys 

 were negative. 



Symptomatology.— The onset is sudden and accompanied by rigors, fever, 

 pains in the joints, injection of the conjunctiva, nausea, vomiting, constipa- 

 tion, and insomnia. The rash appears on the second to fourth day in the 

 form of rose-red or dark red spots about the size of a lentil, which disappear 

 on pressure. The blood shows a lymphocytosis of about 35 per cent. These 

 spots appear upon the abdomen and the palms of the hands and feet. After 

 lasting about two weeks the temperature falls to normal, and after a few da^'s 

 the rash dies away without any desquamation. 



Diagnosis. — The characteristic feature of this fever is the distribution of the 

 eruption and the fact that it frequently persists for several days after a normal 

 temperature has been reached. It most nearly resembles Brill's disease — 

 that is to say, a mild form of typhus fever — wiiich, indeed, it may well be. 



Prognosis. — This is good. 



Treatment. — The treatment is purely symptomatic. 



TACAMOCHO FEVER. 



In 1918 Henao gave an account of five cases of a fever at Taca- 

 mocho, on the Antioquia Railway, Colombia. It was characterized 

 by high fever, vomiting, intense headache, and diarrhoea. The 

 vomit might have blood in it or might be bilious. The liver was not 

 enlarged. There was temporary suppression of urine, followed by 

 albuminuria in the cases which recovered. Two cases died. 

 Microscopical findings did not confirm the idea that it was a form 

 of yellow fever. 



KYOTO FEVER. 



A fever lasting for seven days in Kyoto, Japan, and described by 

 Masuda in 1918. Ineda found a spirochsete in the blood. The 

 peculiar feature was that adult males of the farmer class were the 

 principal sufferers, and that it produced a cloudiness in the vitreous 

 humour of the eye. 



