A short description of the tsutsugamushi disease is given, followed by a note on the conditions under which it occurs in Sumatra and the Malay States. Abandoned agricultural land which has grown up in weeds is particularly dangerous. Small rodents are the reservoirs of the virus which is carried from them to man by larval mites. Trombicula akamushi is the carrier in Japan, and T. deliensis in Sumatra. The disease has been conveyed to monkeys by inoculation and also by the bites of infected mites. A description is given of four mites which are commonly found in the ears of rats in the Malay States, and a method for the examination of the mites is described. Black rats, to the number of 130, were examined. Sixteen were trapped in an abandoned portion of an oil-palm estate where three Europeans became infected with the tsutsugamushi disease, and T. deliensis, the Sumatran carrier, was found on ten of them. Thirty rats were caught in other parts of the estate, and T. deliensis was found on nine. Thirty rats were caught in other rural districts, where the disease was not known, and T. deliensis was found on only one. Fifty-four rats caught in the town of Kuala Lumpur were examined, with the result that T. deliensis was found in none. The conclusion is reached that T. deliensis is probably the carrier in the Malay States, as it is in Sumatra.
Eight caaes of this condition are described, the patients being four Ceylonese, three Indians, and one Chinese, all males except one. Symptoms consisted of breathlessness and cough, sputum being sometimes purulent and occasionally blood-stained. Six of the patients complained of loss of weight, and in one, a Ceylonese schoolboy, this was the only presenting symptom. The authors found the most troublesome complaint to be a paroxysmal cough which was always worst at night. On clinical examination rhonchi were heard scattered throughout both lung fields in five cases, the lungs being clear in the other three. X-ray examination showed characteristic mottling of both lungs in four cases and of one lung in one case; another showed increased vascular markings, while in two the lungs were clear. Sputum was examined for tubercle bacilli and mites but none were found. The technique used for searching for mites is not described. A marked eosinophilia was found in all cases, the highest count recorded being 33, 264 eosinophils per cmm.Treatment consisted of arsenic, given in the form of neoarsphenamine, six injections of 0.3 gm. in six cases, and stovarsol 4 grains t.d.s. for seven and ten days respectively in the other two. Four of the patients were cured, three were improved, while one was showing a favourable response although treatment had not been completed.The author emphasizes the importance of performing repeated blood counts in order to avoid missing this condition. Out of the eight cases which he describes, one had been wrongly diagnosed as pulmonary tuberculosis and three as bronchial asthma. One of the latter had an initial eosinophil count of 4, 092 which rose to 17, 700 three weeks later. H. T. H. Wilson