RELAPSING FEVER. 659 



(I have already stated that, of two patients with equal bodily temper- 

 ature, the one whose skin is moist is the more feverish.) There is 

 great thirst, but no appetite, although the patients do not obstinately 

 refuse food. The tongue is broad, rounded anteriorly, and bears the 

 imprint of the teeth along its sides ; it has a thick, white coating, the 

 edges and point are red. Even where the fever is high the tongue 

 usually remains moist, and is scarcely ever covered by the dry, black 

 coating visible on the small pointed tongue, and on the teeth, and 

 gums, in typhoid fever. 



The pharynx also is affected by catarrh, usually mild, but some- 

 times very intense, characterized by more or less injection of the mu- 

 cous membrane and secretion of a tough mucus. In some cases bil- 

 ious vomiting occurs at the commencement. As a rule, there is con- 

 stipation ; far more rarely, diarrhoea, perhaps from excessive drinking. 

 The respirations are increased in proportion to the fever, and, without 

 any complication of the lungs or bronchial tubes, may attain to thirty 

 or forty, or even more, in a minute. There may be symptoms of bron- 

 chial catarrh or not. The abdomen is neither distended nor depressed ; 

 the regions of the liver and spleen are sensitive to pressure, and some- 

 times spontaneously painful. Physical examination early shows con- 

 siderable enlargement of the liver and spleen. Not unfrequently the 

 former extends almost to the navel and far into the left hypochon- 

 drium. The latter is also perceptible to the touch when it extends 

 beyond the angles of the ribs. 



According to the careful researches of Obermejer, in most cases 

 the urine shows the peculiarities of parenchymatous nephritis. Be- 

 sides more or less albumen, blood-corpuscles and dark epithelial cyl- 

 inders were found in about two-thirds of his patients ; later in the 

 course of the disease the cylinders were covered with granular epi- 

 thelial detritus, and finally perfectly pale*cylinders were passed. As 

 a rule, during the fever the amount of urine passed is diminished ; its 

 specific gravity is 1012 to 1020. 



A slight degree of icterus, sometimes accompanying the above 

 symptoms and depending on catarrh of the ductus choledochus, is 

 readily recognized to be hepatogenous by the diminished color of the 

 fasces and the discovery of bile-acids in the urine, and is to be distin- 

 guished from the icterus hereafter described, which is probably haema- 

 togenous and renders the disease malignant. 



From the above description it is evident that, apart from the se- 

 vere muscular pains, the patient's symptoms resemble those accompa- 

 nying intense fever ; and iri fact we may regard the fever as the most 

 prominent and characteristic symptom of this disease. This fever shows 

 not only the peculiarities to which the disease owes its name, but it 



