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Scrub-Typhus

1. The classical signs of the disease are an eschar, lymphadenitis, headache, orbital pain, remittent fever up to 105° for fourteen or more days and a maculopapular rash. The convalescent period usually lasts from 6–8 weeks.

2. The diagnosis is made on the basis of the classical signs and a rise in titer up to 1:80 or above in the agglutination of the OXK strain of the proteus bacillus.

3. The outstanding features observed in a series of 173 cases of scrub typhus fever occurring in the New Guinea Archipelago during the last 8 months of 1944 are reported.

4. The mortality in the entire group was 3.5 per cent; however, all six deaths occurred in a single unit at one locality, having a total of 16 cases during a 3 weeks period. It should be emphasized that the mortality rate depends on the virulence of the Rickettsia orientalis at a given time in a particular area and that this may change rom time to time in the same, as well as in different localities.

5. The disturbances in physiology in the serious and fatal cases, and the pathology found in the six fatal cases, have been presented and discussed. The transitory nature of the changes in the cardiovascular system of the cases that recovered have been emphasized. The common error of interpreting the pulmonary complications due to extravasation of blood into the lungs as bronchopneumonia or congestive heart failure have been emphasized.

6. Eighty-one per cent of the entire group were returned to duty within an average period of 8 weeks. It was necessary to prolong hospitalization in 15.5 per cent because of certain temporary sequelae listed in this paper and other coexistent complications.

7. The program of management during the acute and convalescent phases of the disease have been outlined and discussed.

8. The complications and sequelae have been enumerated in order of frequency. We are of the opinion that there will be no permanent sequelae of this disease.

Received June 25, 1945.
¹ Lt. Colonel, MC, AUS.

² Captain, MC, AUS.

³ Major, MC, AUS.

⁴ Captain, MC, AUS.