EUROPEAN RELAPSING FEVER ix 



There is thirst, nausea and vomiting of yellow-green matter. 



Constipation is common, but diarrhoea is rare. 



The liver and spleen are enlarged and tender. 



The pulse is 120 to 140, but not dicrotic. Respirations are 48-50. 



Red cells and Hb. are diminished. 



There is leucocytosis of the polymorphs. 



Spirocha?tes are found in the peripheral blood and engulfed in the 

 leucocytes. 



A troublesome cough is common with rales and a scanty expec- 

 toration. 



Muscle and joint pains continue and cause sleeplessness. 



Delirium is not uncommon, stupor is rare. 



The urine is febrile and often contains a little albumin. 



Sometimes herpes labialis is seen. There may be rose-coloured 

 spots on the trunk and limbs. 



Crisis. — This takes place on the sixth or seventh day, usually by 

 rigor. 



There is a violent perspiration and sometimes diarrhoea. 



Epistaxis is not uncommon. There is a sudden fall of temperature, 

 pulse-rate and respirations, then a deep sleep, followed by rapid 

 improvement. Sometimes there is a dangerous collapse at the crisis 

 with old people. 



Intermission. — All appears to be normal, but it is the exception 

 for the disease to end here. The patient usually desires to leave the 

 hospital. About the fourteenth day from the onset there is a 



Relapse, with rigor and severe symptoms as before, lasting three 

 or four days. The urine is increased, the pulse-rate goes up, and the 

 prostration is often marked. The termination is by crisis which may 

 end the illness. If there are more relapses, which is common, they 

 become gradually milder in severity. The second relapse occurs about 

 the twenty-first day from the onset, is milder, and lasts about three 

 days as a rule. 



Convalescence is sometimes slow. 



COMPLICATIONS. 



Bronchitis, pneumonia, dysentery, diarrhoea, ha^matemesis. 



Cerebral haemorrhage, conjunctival haemorrhage, iritis, irido- 

 cyclitis, corneal ulcers. 



Abortion during the tirst relapse is common. 



Nephritis, otorrhoea, neuritis, parotitis and adenitis are not un- 

 common. 



Meningism, paresis with spasticity of lower limbs. 



Recurrent myocarditis, followed always by death (van Hoof). 



