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the clinical features, as described, are quite unlike those spirillum fever as met with in Uganda.
The disease is certainly not a new one in Uganda, though in times past it was confused with and mistaken for malaria.
Apart from the fact that it is now more definitely recognised and diagnosed, there is no doubt that it is becoming more prevalent. This in a great measure is due to there being more traffic on the main roads than formerly, and it is in the tick-infested camps on these roads that the infection is generally picked up.
Owing to their careless and unobservant habits the natives are the chief sufferers. In order to avoid repetition the notes about to be given will be based on observa- tions on all classes of patients.
The total number of cases which came under observation during the year was 143, as follows:—
Europeans Asiatics Natives
Total
9
12
122
143
In not more than 10 of these cases could the infection be traced to Entebbe, by far the greater number occurred among natives who had recently come off journeys.
Incubation Period.-This is a difficult matter to determine, but from various observations I am inclined to put it at about 10 to 14 days in a susceptible subject.
Immunity. There is little doubt that one attack confers a partial immunity, and it is more than probable that after a second or third infection this immunity becomes complete.
I have seen two cases in natives of what must have been either a very late In each of these cases relaps or a second infection, after a period of six months.
In
only one attack occurred. A case of a European is also suggestive. In this instance the patient had spirillum fever, with five relapses in July and August of 1905. November he was exposed to the risk of fresh infection while travelling from his station to Entebbe. He arrived on November 22nd and, on December 15th, had a sharp attack lasting three days. Spirilla were found but very scantily. After an interval of 19 days he had a relapse, and this time also the parasites were very sparse. It remains to be seen whether any more relapses will occur, but I am inclined to think the long incubation period of 23 days in this case was due to a partial immunity.
Amongst natives it is quite a common occurrence for a patient to have one single attack without any relapse.
Number of Relapses.-Owing to the long drawn out course of the discase it is difficult to keep patients, especially natives, under observation throughout the whole time. During the apyretic period the general health may Le quite good and the patient refuse to remain in hospital,
In only two instances did I have the opportunity of watching European patients from the Leginning to the end; reference will be made to these two cases later.
In 30 cases among natives I obtained a fairly complete record. In 21 of them there was only one attack (initial) without any relapse. In 2 there were 2 attacks, 1 initial and 1 relapse.
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The time which elapsed between the initial attack and the first relapse varied from 5 to 9 days.
The interval between the--
1st and 2nd relapse varied from 5 to 8 days; 2nd and 3rd relapse varied from 5 to 9 days; 3rd and 4th relapse varied from 8 to 36 days; 4th and 5th relapse was 8 days in one case.
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28107
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