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I failed to find a single spirillum with a temperature of 105° on the first day of
relapse. In some cases with buboes the spirilla were found in large numbers, e.g.,
(A.R.1596) and (Mar. 3670).
In the 8 examinations of blood and mucus from relapsing fever stools (slide
smears and agar cultures) I failed to find the spirillum. On culture the bacillus coli
communis was constant, the occasional organisms being other bacilli, cocci, yeasts, &c.
Relapsing Fever Buboes—8 cultures were made from the 5 most typical cases
met with. In no case was any bacillus found. 6 of the cultures were absolutely
sterile ; in the other 2 cases a few pus cocci were found ; in one case (Mar. 3403) the
surface of the skin over the bubo had been burnt with the "marking nut " and the
pipette probably touched the skin in taking the culture. The bubo did not suppurate.
The other case (M.K.6664) had a large indurated bubo over, but not involving, the
parotid, exactly resembling a plague bubo. A few staphylo cocci were found
(pyogenes aureus and citreus), but the greater part of the agar surface was devoid of
growth. This bubo subsequently suppurated freely. This patient had three attacks
(or relapses), each ending with crisis, the temperatures rising respectively to 104°,
103° and 102°.6.
Note.-—Relapsing fever with buboes is no new thing. In one epidemic in
Russia, buboes were so prevalent that the cases were at first diagnosed as plague and
the same thing happened on the outbreak of the present epidemic in Bombay prison
where the difficulty of diagnosis was greater, owing to the presence of both diseases
amongst the community. During the major part of the present epidemic these
buboes were rare, forming only (roughly) 3 per cent. of the cases admitted into the
Maratha Hospital. For an inspection of the figures I am indebted to the courtesy of
Dr. Dhargalker. The distribution of the buboes is much the same as in plague ; but,
as a rule (to which there are exceptions), they are smaller and more numerous.
Summarising the results obtained in these examinations of relapsing fever (but
remembering the limitation of the numbers) we find :—
1. The temperature gives no indication of the number of spirilla present.
2. Clumping together of the spirilla indicates the approach of crisis.
3. A large number of spirilla found indicates a probable fatal issue to the
case.
4. Few or no spirilla found gives no indication of the severity of the case.
5. Spirilla were found in the blood of epistaxis, but not in blood from stools.
6. The buboes of relapsing fever cases examined did not contain bacilli and
were usually sterile.
Serum Diagnosis.
8 blood capsules were taken for the purpose of serum diagnosis. In the case
of a Brahmin at the Colaba Hospital the Malta fever reaction was obtained on the
21st of February. In another case (Mar. 785) an incomplete Malta fever re-
action was obtained, meaning that the patient may have had Malta fever in the past
but not in the present illness. A little boy (Mar. 3492) gave the typhoid reaction.
Two other cases having the temperature curve, diarrhoea, &c., resembling typhoid
did not give any reaction; these were adults. The other 3 cases did not give any
reaction.
Malaria.—14 examinations of blood were made for malaria, which, however, was
only found in 2 cases, and whether due to the dry season or not malaria did not
appear to be prevalent amongst the hospital cases. Most of the cases were examined
on the principle of " Diagnosis by exclusion," and several were thus traced to their
cause ; of these causes tuberculosis appeared to be the most common. One case wag
abscess of the lung and in one or two other cases simple abscesses formed.