By Everard L. Napier, M.R.C.S., L.R.C.P. (Lond.). In charge Kala-azar research, Calcutta School of Tropical Medicine. Second edition. 185 pages of text with 15 charts in the text, 18 plates, and an appendix of references to literature, author index and subject index. Oxford University Press. London, Bombay, Calcutta, Madras, 1927
In reply to a state wide questionnaire survey on the occurrence of relapsing fever in Texas, 258 cases were reported for the years 1930 to 1934 inclusive. In eighty of these cases the clinical diagnosis was confirmed by finding the spirochete in blood films from the patient. In the others the diagnosis seems well established by careful clinical observation including specific response to antispirochetal treatment.
Practically all these cases occurred among farm and ranch people. In the few which occurred within city populations, there were definite possibilities for the infection having had its origin during some trip to the rural districts. Seasonal incidence, late summer and fall, coincides with the seasonal activity of the Texas relapsing fever tick, O. turicata. The actual incidence of the disease appears to be restricted to certain tick infested localities within a given district.
Race, age, or sex appear to have no part in immunity to the disease as it occurs in Texas.
In Texas the disease must be differentiated from malaria, dengue, typhus and, in some instances, tularemia. In its symptomatology, relapsing fever in Texas presents as acute type of reaction as may be observed in other parts of the world. In relapsing fever in Texas the patient's temperature may reach 105° to 106°F., during the onsetting reaction. In the absence of specific treatment there is little or no abatement in temperature or discomfort during the next three recurrences. Relapses subsequent to these, however, gradually become less severe. In the severe cases there is a marked irregularity in the length of the afebrile period. In the less severe cases, the period between relapses is four to five days. A macular rash is present in about one half the cases. There seems to be no correlation between the severity of the disease and the presence of the rash. Splenic enlargement and tenderness are quite common. Jaundice is rather uncommon. Liver enlargement is but infrequently observed. Severe organic damage as manifested by complications and sequellae is not characteristic of relapsing fever in Texas, only 2 cases in 258 showing a neuropathy (facial paralysis) and some 5 cases displaying evidence of myocardial damage. On the other hand, myalgia and a stubborn muscular asthenia are common sequellae of the disease as it occurs in this state. Single doses of neosalvarsan (0.01 gram per kilogram of body weight) very often prove to be inadequate for effecting a cure. No fatal cases were reported to this survey.