1348 SPOTTED FEVER OF THE ROCKY MOUNTAINS 



have thoroughly estabUshed the difference between Rocky Mountain 

 fever and typhus. 



The tsutsugamitshi fever may present a course very similar to the 

 Rocky Mountain spotted fever, but the presence of one or more 

 eschars near the genitals or the axilla, and the eruption begin- 

 ning on the face, and not becoming petechial, are characteristic. 



Prognosis. — It appears that the prognosis is much more serious 

 in some localities than in others. In Montana the mortality has 

 been as high as 90 per cent., while in Idaho it has always been 

 very low (5 per cent.). The reason for this difference may be that 

 there are two distinct varieties, one spread by D. andersoni (D. 

 venustus) and the other by D. maturates. When the eruption is 

 not much marked and not generalized, the prognosis is favourable. 



Treatment. — Quinine has been advised and given in large doses, 

 but it does not show any specific effect. Atoxyl and salvarsan have 

 no effect. Adrenalin has also been advised. The treatment can 

 be only symptomatic. To relieve the severe headache cold appli- 

 cations may be used, or, with prudence, small doses of antipyrin, or 

 pyramidon, or Dover's powders. Large quantities of water should 

 be drunk, so as to flush out the kidneys. The water may be slightly 

 acidulated. Tepid sponging is useful and refreshing. When the 

 temperature rises above 103° F., cold sponging should be used, and, 

 if necessary, the cold bath or cold pack. Should the pulse become 

 small and irregular, cardiac stimulants must be administered. 

 The room should be darkened, and the patient kept undisturbed. 



The diet should be liquid, chiefly milk and broths. Alcoholic 

 stimulants may be indicated in some cases. 



Prophylaxis. — ^This may be considered under two headings: — 



(a) Man. 



[b) The Tick. 



[a) Man. — This consists in avoiding as much as possible localities 

 where the ticks are abundant, and destroying these arachnids. A 

 tick should be removed by applying ammonia, turpentine, kerosene, 

 or carbolized vaseline, and then the bite may be cauterized with 

 pure carbolic acid. Some authorities advise the internal adminis- 

 tration of quinine, but this does not prevent the development of 

 the fever. 



(b) The Tick. — ^The prophylaxis campaign against the tick is 

 divided into: — 



1. Destruction of ticks. 



2. Removal of natural tick hosts. 



3. Protection of domestic animals against the tick. 



These ends are accomplished by periodic dipping of cattle and 

 horses in the usual arsenic solution to destroy the ticks, by poisoning 

 and shooting rodents, by restricting the movements of domestic 

 animals from infected areas, and prohibiting the entrance of animals 

 into these areas during the period from February to July. 



