660 ACUTE INFECTIOUS DISEASES. 



has others which enable a certain diagnosis, even in the first at- 

 tack. 



From the observations of Obermejer, who has taken accurate meas- 

 urements of temperature during the chill, with which the later at- 

 tacks also usually begin, we may assume that the bodily tempera- 

 ture is elevated even during the initial chill, and that this is even 

 preceded by a slight elevation of temperature. The bodily tempera- 

 ture attained is very unusual ; it is not at all rare for it to reach 

 107.3, and in some cases 109, or an elevation that never occurs in 

 other diseases, and at which many regard the continuance of life as 

 impossible. This, like typhoid fever, has a remittent type. The daily 

 variation is usually about one degree, the greatest differences being in 

 the morning and evening. The pulse also is more frequent in relapsing 

 fever than in almost any other disease. In nearly every case it rises 

 to 110 or 120, not unfrequently to 120 or 130 and even to 150 beats 

 per minute, without being in itself of very evil import. The frequency 

 of the pulse corresponds far less than in other diseases to the bodily 

 temperature. As a rule, the pulse is at first hard and tense, later, from 

 paresis of the muscular coats of the vessels, it becomes soft, undulat- 

 ing, and not unfrequently dicrotic. With slight modifications the dis- 

 ease goes on thus for from five to seven, rarely longer than eleven or 

 twelve days ; then there is a sudden change. After a transient increase 

 of all the symptoms, in which the bodily temperature reaches its 

 highest point, the peripheral arteries pulsate strongly, and abundant 

 epistaxis often occurs ; the previously-dry skin breaks into a copious 

 perspiration, and there is an alleviation of all the symptoms. Accord- 

 ding to Obermejer, the duration of defervescence is usually eight or 

 nine hours, during which time the body cools off about 9, so that, if 

 before the crisis the temperature was 106.4, afterward it will be 

 96.8, or less than normal. I have no doubt that the excessive loss 

 of warmth, caused by the evaporation of the perspiration, contributes 

 materially to this rapid fall of temperature. During a critical sweat, 

 the active flow of blood from the interior of the body to the surface 

 will almost equalize over the body the loss of warmth that is induced 

 by evaporation of the perspiration. Such a sweating must induce 

 cooling, such as could not be attained in the same length of time by 

 any hydropathic procedure. It does not lessen the loss of heat by 

 conduction and radiation ; and to this is added the great loss due to 

 evaporation of the perspiration. I would call attention to the im- 

 mense amount of heat withdrawn by evaporation of the abundant 

 perspiration during a Turkish bath ; for there, in spite of the sur- 

 rounding air being 40 or more warmer than the body, and the con- 

 tinued heating from within, there is no considerable elevation of its 





