194 DISEASES DUE TO BACTERIA 



The temperature goes up somewhat ladder-like to about 103° F., 

 pulse 80-90. 



Tongue coated, edges red, sliglitly congested fauces. 



Some bronchial catarrh, tender epigastrium and enlarged spleen. 



This continues for about two weeks, the temperature remaining 

 between io3°-io5° F. and then declines with general improvement. In 

 about two davs a relapse occurs. This subsides and another follows 

 and these relapses and remissions may last months, during which the 

 temperature is undulating, a marked rise in the morning and a fall in 

 the evening. 



The patient becomes more anaemic and wasted. Dyspepsia sets in, 

 constipation or diarrhoea reveals irritation of the intestines. Throat 

 sore, gums spongy, spleen painful, lung- bronchitic, heart excitable 

 with h^emic murmurs, drenching sweats, disagreeable odour, crops 

 of sudamina after the bird week, big joints painful and swollen, 

 orchitis, parotitis, a general nervous disorder shown by insomnia, 

 hysterical emotion, jDhotophobia, delirium, hallucinations are trouble- 

 some. A rapid ansemia is common. 



The red cells show 20-40 per cent, loss with some poikilocytosis, 

 Hb. low. 



Decrease of polxmorphonuclears, increase of mononuclears up to 

 80 per cent. 



Leucocyte count normal. Phagocytosis and bactericidal power of 

 blood diminished. Agglutination test; diluted i in 50 to i in 150, it 

 lasts two to seven years. Course of disease 20 to 300 days, average 90. 



Convalescence long and slow, perhaps six months. 



Many soldiers and sailors are permanently invalided. 



Mortality low, about 2 per cent. 



Symptoms arising in connection with the genital organs are not 

 unknown, such as ovarian pains, dysmenorrhoea, amenorrhoea, 

 menorrhagia, &c. The M. melitensis has been frequently known to 

 remain for long- periods in the vaginal mucous membrane and con- 

 tagion during intercourse is quite possible. Mammitis, like orchitis, 

 is a not rare complication. 



The influence of the fever upon a pregnant woman may vary very 

 much according to the period of gestation, and when the woman is 

 infected. Abortion and premature labour are favoured during the 

 fever when it is high. 



In some Mell authenticated cases it has been shown that M. meli- 

 tensis can pass through the placenta and infants born at term generally 

 show signs of infection and are weakly. 



Whether or not the infant acquires the disease by drinking the 

 'nfected milk of a nursing mother is a debatable point. Generally the 



