RAT-BITE FEVER THE BRDTLSJRM~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~EDICA that with less than three injections relapse is likely to occur. Three to six injections are advocated. Local and other treatment is symptomatic.
Case HistoryA married woman, aged 40, with a previous medical history of cholecystectomy, 1-para and no miscarriages, deliberately, and of set purpose to kill the animal, trod on a rat in a farmyard. She was wearing slippers, and the rat turned and bit the dorsum of her foot. There was little to be seen at the time, but she applied tincture of iodine at once to the two small puncture wouinds. Apart from a little soreness no pain followed, and the lesion healed in the usual waiy in the course of a day or two. No scar resulted.On the fifteenth day, when the patient was first seen, she complained of " pain and swelling of the leg." No definite rigor had occurred, but she " felt shivery." The tongue had a white fur, and she had no appetite for food. A bluish-red, indurated, unbroken swelling wNas found on the dorsum of the foot. Surrounding this, and below the level of the raised lesion, considerable oedema was present. The lymphatic glands in the corresponding groin were " sore " but not appreciably enlarged at this stage.On the sixteenth morning a rigor occurred and the lesion had become black in the centre, wvith a circumscribed, very painful red area fading into the oedematous tissues. The temperature had risen from normal to 99.60 and the pulse was 64. She felt ill.On the eighteenth evening the temperature had risen to 101 .20, but the pulse remained low at 86. The black central slough had begun to separate. One small separation was removed for examination. The ulcerated area wvas treated by eusol fomentations. As these seemed to give more pain than plain hot-wvater foments, the latter were substituted and used afterwards. The whole extremity was aching and the portion of the limb within six inches of the ulcer was exquisitely tender. The patient vomited once during the day.On the nineteenth day the general disturbance w,as marked, the temperature being 101°. There was restlessness, retchinlg, anid much flatulence. Vomiting occurred at intervals. A dusky-red rash appeared on the body, with several spots on the face. The first injection of novarsenobilloni in a dose of 0.3 gram wvas administered intramuscularly on the n -neteenth day. Owing to the combined facts that the patient was rather obese and intravenous medication was difficult, this route was chosen. No immediate reaction followed.In the eveniing of the twentieth day the temperature had risen to 1031, land the pulse again appeared low at 80. She felt better, and vomiting ceased. The next day improvement was considerable. The terhperature was normal. The woundl was less painful. From this time she improved in every way. The ulcer became cleaner and swelling lessened with a great diminution of the pain. She was able to get up on the twenty-eighth day. The site of the bite was still discharging a slightly purulent fluid. It is to lie noted that throu...
