CHAPTER LI 



TSUTSUGAMUSHI FEVER AND ALLIED 



FEVERS 



Synonyms — Definition — History — Climatology — i3itiology — Pathology — 

 Symptomatology — Diagnosis — Prognosis — Treatment — Prophylaxis — 

 Allied fevers — References. 



TSUTSUGAMUSHI FEVER. 



Synonyms. — Japanese River fever, Flood fever, Island disease (Shima 

 disease), Kedani disease (' kedani ' is the hair-louse), Akamushi disease 

 (' mushi ' is the Japanese for a bug or insect; ' akamushi ' means ' red insect '), 

 Shima mushi disease (Island bug disease), Tochu-bio, Shashitsu, Pseudo- 

 typhus. 



Definition.' — ^Tsutsugamushi disease is an acute endemic febrile 

 disorder caused by the bite of a mite, Microtromhidium akamushi 

 Brumpt, 19 10, producing a small local necrotic area, painful en- 

 largement of the proximal lymphatic glands, and an exanthematous 

 eruption. 



History. — ^Tsutsugamushi disease is said by Ashburn and Craig 

 to have been mentioned under the term ' shashitsu ' in Chinese 

 writings more than one thousand years ago, when it was described 

 as a fever due to the bite of a mite, which produced a pustule in 

 summer-time in people who entered those parts of the country 

 which had been flooded by the spring rains. The Japanese litera- 

 ture on the subject is considerable, but the descriptions written in 

 European languages are not extensive, the earliest contributions 

 being by Palm in 1878 and Baelz in 1879, while Ashburn and Craig, 

 in 1908, give an excellent account of the disease and its causation, 

 together with a comparison with the spotted fever of the Rocky 

 Mountains. 



Climatology. — ^The geographical distribution is limited to the 

 island Nippon, of Japan, where it is confined to the districts Akita- 

 ken and Nugata-ken (' ken ' means a ' district '), in which certain 

 lands are flooded in June, in the former district by the Rivers 

 Omonogawa and Minasegawa, and in the latter by the Rivers 

 Shinanogawa, Akagawa, Uwonumagawa, and Hajadegawa. Further, 

 it is limited to certain parts of the regions flooded by these rivers. 

 The floods only last a few days, and the regions do not become 

 dangerous till after a few weeks, when a red mite appears, which 

 may attack any person entering these places. In fact, so great 



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