Page:Transactions of the Royal Society of Tropical Medicine and Hygiene, volume 9 (7).djvu/9

Rh four cases of cerebro-spinal fever amongst the Canadian troops while in Canada and before embarkation; three cases occurred during the voyage, two, a soldier and a steward's clerk on a transport, and one soldier on another.

This case came from a transport on board of which no case occurred during the voyage. Three more cases occurred amongst the Canadians on the Plain on the following dates respectively—27th October, 30th October, and the 4th November, 1914.

Between January 9th, 1915, and July 31st, 1915, there was quite an epidemic, the following being the number of cases that were notified:— Civilians, 2,290; Troops, 1,088; the highest incidence being in the week ending March 13th, 1915, the numbers notified for that week being:— Civilians, 147; Troops, 87.

Incubation.—The period of incubation varies from three to five days. The former limit would appear to be the more usual period, while in the malignant forms this may be still further shortened. The number of cases on which it may be gauged are few.

Invasion.—The onset is, as a rule, sudden, frequently being ushered in by a rigor, then follow the usual symptoms of an acute specific fever, viz., a temperature of 102° F. to 104° F., usually rising rapidly, and attaining to a fairly high degree on the first day.

A short period of general malaise is succeeded by headache, which is often intense. A striking feature in many cases is complete loss of appetite, amounting even to absolute revulsion against any kind of food; this is frequently followed by vomiting, then follow pains in the neck and limbs, retraction of the head, and some degree of catarrh of the nose, throat, eye or ear.

In severe cases delirium soon supervenes, followed by coma and death. There is a peculiar distinctive cry about this delirium.

The height of the temperature forms no criterion of the severity of the disease, some of the most rapidly fatal cases shewing but a very slight rise. The pulse is usually quickened, but as a rule not to the extent which would be expected from the temperature. The occurrence of a pulse of (30 to 80 accompanying a temperature of 101° F. to 103° F.