192 
Relapsing Fever 
usually escapes the fever, and Nuttall (1909) suggests that this may be 
due to the protective effect of a local reaction. 
In the majority of cases amongst Europeans, slight prodromal 
symptoms, such as mental depression, lack of activity and profuse 
sweating, often occur a day or two before the onset of the fever. The 
attack then sets in with headache, vomiting, pain in the back and 
limbs and severe pain in the spleen. A marked disinclination for food 
and intense thirst are also noticeable and diarrhoea is often present. The 
temperature rises rapidly and may reach as high as 104°-105° F., this 
rise in temperature being accompanied by a feeling of chilliness. The 
spleen is found to be considerably enlarged, projecting far below the 
costal margin, and spirochaetes occur in scanty numbers in the 
peripheral circulation. The attack becomes more severe as the number 
of parasites increases, and in some cases additional symptoms, such as 
iritis, may appear. The symptoms generally last from three to four 
days, and end by a crisis, during which the patient sweats profusely and 
the temperature falls below normal. There is a marked leucocytosis 
just before the crisis, and the spirochaetes disappear from the peripheral 
circulation. 
There are usrrally three or four attacks each lasting about 3-4 days, 
and during the intervening periods all morbid symptoms disappear. 
Each relapse begins with a rise in temperature and a return of the 
original symptoms together with the appearance of spirochaetes in the 
blood, also oedema of the eyelids is stated to occur in the relapses. 
The intervening periods between the relapses vary in length from 
one day up to as long as two months, but are usually about 7-10 
days. 
Iritis is often observed as a complication. 
In connection with the foregoing account of the general symptoms 
of this disease it may be of interest to describe a somewhat atypical 
case which occurred in the Quick Laboratory:— 
G. M. European, cT, aged 25. (Chart No. 1.) Patient's own notes^. 
The patient was not aware of having been bitten by the ticks but 
on April 1st had been examining a large supply of infected ticks that 
had been sent by P. H. Ross from Uganda. Next morning the 
characteristic marks (3) of the bite were noticed on the forearm. 
April 1st. Presumably was bitten on the forearm by three nymphs 
of 0. moubata. 
' My thanks are due to Mr G. Merrimau for kindly supplying me with these notes, and 
also for the temperature chart. 
