It is thought that the medium of trans mission is through suctorial insects. Tic tin (Centralb. f. Bakt. Parasit., etc., Feb.
15, '97) studied this question during an epidemic which occurred at Odessa, Rus sia, in which 10,000 cases occurred. Hungry bed-bugs were allowed to bite a monkey that had the spirilli in his blood, and the blood of the insects was then examined. Organisms were found that were active for some time. A healthy monkey being then inoculated with this blood by injection, it rapidly developed the disease.
The morbid changes are not very marked; the spleen may, however, be greatly enlarged and soft, and the other viscera show evidences of degeneration. Nathanson noted changes in the cardiac ganglia, the degenerative process involv ing the protoplasm and the nucleus.
Phagocytosis occurs in the circulating blood in relapsing fever. In examining the blood of a patient shortly before death fragments of spirilla discovered in many of the leucocytes as well as large numbers of more perfect spirilla in the plasma. The intracellular spirilla stained but feebly, and were apparently in process of disintegration. Subsequent examination of the blood of a large num ber of patients suffering from relapsing fever showed similar appearances in all, and the same was true of the blood of a large number of artificially-immunized monkeys. Indeed, in these last the spirilla could be detected only in the corpuscles; none were found in the plasma. The inference drawn is that the immunity in these cases is due to heightened phagocytosis. Ivanoff (Cen tralb. f. Bakt. u. Parasit., xxii, 117, '97).
Sex and age do not seem to influence the development of the disease, though the mortality among women and old sub jects is greater. It is thought to be con tagious and to afford no immunity against subsequent attacks.
Treatment.—Quinine is absolutely use less, except as a tonic during convales cence, and no medicinal treatment seems to curtail the attacks or prevent them. Symptomatic treatment, coupled with hygienic measures and nutritious, though easily-digested, food are indi cated. An antispirochetic serum has recently been used with apparent suc cess.
Glandular Fever. — This is an infec tious disease of children, having, as a rule, no prodromata, and characterized by slight redness of the throat, a marked febrile movement, and enlargement and tenderness of the lymphatic glands of the neck, especially those behind the sterno cleido-mastoid muscles. The febrile
movement is of short duration, but the glandular enlargement persists for a period varying from ten days to three weeks. (This disease should not be con founded with glanders or farcy, which is an entirely different disease.) SYMPTONS.—The onset is sudden, pain on moving the head and neck being the first noticeable symptom. There may be some abdominal pain, accompanied by nausea and vomiting. The temperature ranges 101° to 103° F. The tonsils may be slightly congested and the lym phatic tissues swollen, but the throat symptoms are of slight importance and of short duration. The glandular en largement appears on the second or third day, and while it lasts the glands may vary in size from a pea to a goose-egg. The glands are painful to touch ar press ure, but there is rarely any redness or swelling of the skin covering them, though there may be, occasionally, some puffiness of the subcutaneous tissues of the neck and a slight difficulty in swal lowing. When the tracheal and bron chial glands are involved, as they may be, there may be a feeling of discomfort in the chest, with a spasmodic cough. The glandular swelling usually continues for two or three weeks. The complica tions reported in this disease are sup puration of the swollen glands (Neumann has reported thirteen cases), hmmorrhagic nephritis, acute otitis media, and retro pharyngeal abscess.
—The diagnosis of this dis order is easy, as the symptoms are charac teristic.
— Gland ular fever may occur in epidemic form. West, of Bellaire, Ohio, describes an epi demic of 96 cases in children between the ages of seven and thirteen years. A marked feature in these cases was a bi lateral swelling of the carotid lymph 0-1-md,. In three-fourths of the cases the post-cervical, inguinal, and axillary glands were involved. The mesenteric glands could be felt in 37 cases, the spleen was enlarged in 57, and the liver in S7 cases. There was no coryza and no bron chial or pulmonary symptoms. The cases occurred between the months of October and June. The nature of the infection is not known.