THE NATURE OF HUMAN TICK-FEVER 
commenced on October 15th, four clays after the bite. On his arrival at Sendwe, October 
24th, where he was employed as a labourer, patient seemed strong and well, and it was 
not until about a week later (October 31) that he was noticed to be ill. It is very 
doubtful whether there was any rigor, and the history of fever during the first four 
or five days of the disease is uncertain. The patient says that his illness commenced 
with a " bad mouth," and a distaste for food. Pain in the eyes with frontal headache, 
pain in the nape of the neck and in the loins successively appeared. Patient asserts 
that these symptoms persisted, though lessening in intensity, up to the present (Nov. 6). 
There has been no vomiting or diarrhoea — took native enemata. The resident European 
says that patient is certainly thinner and less robust than on his arrival here. 
Present Condition : — Pulse, respiration, and temperature normal. Patient is a thin 
man, has apparently lost flesh; is obviously weak; has pained expression; eyes watery. 
Physical examination showed nothing abnormal ; spleen not enlarged or tender. The 
lymphatic glands of the inguinal region were alone enlarged. Blood examination : — 
Many fresh, centrifuged. and stained preparations of the blood were taken. No malarial 
parasites, trypanosomata or spirochaetes were seen. A few filaria, sheathed and 
unsheathed, were present. Fresh and stained specimens of spleen juice showed no 
parasites. Gland juice was examined with negative result. 
The history and record of examination of this patient are typical of six other cases 
who have been broug'ht to us, some weeks after the commencement of their illness, 
but while thev were still weak. 
CASE 4 (Chart No. 1). — Female, age 14, seen at Nyangwe, November 15, 1904; 
under observation for four days preceding death. 
History : — Patient was born and has always lived in this neighbourhood. On 
November 7, at about midnight, she was bitten on the foot by a tick. Before daybreak 
fever, headache, vomiting, and purging came on. The diarrhoea persisted for four 
days. The vr.miting quickly stopped, and recurred only once on the third day of the 
disease. Though patient has always eaten well, she does not seem to have relished her 
food. On the second day of her illness she was brought to Nyangwe. She then had 
generalised headache and pain in her legs ; she was in a fever, trembled continually 
and felt very weak. In spite of these symptoms she has continued work in the gardens. 
Present Condition. — Temperature 103. S, pulse 166, respiration 45. Patient is a 
well-matured, but slight and thin child ; is too weak to walk alone, and prefers to lie, 
not sit on the floor. 
Although patient and her master deny that there has been any abeyance in the 
symptoms, it seems that she is more ill to-day (November 15) than yesterday. This 
morning she claims to have got up well and to have gone to work as usual, but as the 
sun became hot she became " tired." 
Physical examination revealed no abnormalities save slight pufPiness and yellowish- 
ness of face about the eyes, and a greatly enlarged spleen, which reached, patient lying 
on back, to below the umbilicus. Its superficial markings, in the recumbent position, 
are indicated in the accompanying photographs (PI. 3, fig. 1). 
Blood examination : — Coverslip preparations showed large numbers of spirilla. No 
malarial parasites or trypansomata were ever seen in this case. On splenic puncture 
the fluid aspirated contained spirilla in apparently the same numbers as finger blood. 
The patient became steadily weaker, spirochaetes were constantly present in her 
blood, and she died early in the morning of November 19. 
Autopsy: — The examination commenced at 9 a.m., six hours after death. The body 
was that of a thin, but not emaciated girl. Post mortem rigidity present throughout. 
Skin fairly clean, no eruption. Oedema of dorsa of both feet and of upper and lower 
eye'ids. Pupils equally and widely dilated ; mouth clean ; no icterus. The usual 
incision was made ; subcutaneous fat fair in amount ; much light-coloured blood escapes 
from cut vessels — looks like blood-stained water : no oedema present over abdomen. 
Abdomen: Contains about seem, slightly blood-stained fluid; omentum retracted. 
