RELAPSING FEVER. 661 



temperature. I should like to know if such a rapid defervescence of 

 the fever is seen in cases where, instead of sweating, there is critical 

 diarrhoea. 



In the days following the crisis, the bodily temperature, which had 

 almost always fallen below the normal, rises one to two degrees. 

 The pulse varies from 48 to 50 beats a minute, the appetite returns, 

 the tongue cleans off, the muscular pains subside, the patients feel 

 stronger, and many of them wish to leave their beds. 



But only in rare cases, where the disease is incorrectly termed re- 

 lapsing, does this very agreeable condition (which, to the uninitiated, 

 must seem a commencing convalescence) actually form the beginning 

 of recovery. In most cases, in from six to eight days, rarely less, or 

 from twelve to fourteen, there is a new attack, closely resembling the 

 first. This second attack also usually begins with a chill of variable 

 duration and intensity ; the subsequent feeling of heat, debility, de- 

 pression, and thirst, attains about the same degree as in the first stage 

 of the disease. The muscular pains also recur, but are less severe ; 

 the tongue, which had cleared off, is again coated, the appetite is 

 lessened. The spleen and liver, which during the interval had some- 

 what decreased in size, again swell, and occasionally become even 

 larger than in the first attack. During this second paroxysm, the 

 bodily temperature rises just as high as, in many cases higher than, 

 in the first, but the pulse is usually less frequent. 



The second attack is commonly shorter than the first, lasting only 

 three or four days. The crisis terminating it has about the same symp- 

 toms as that closing the first attack. The disease generally ends with 

 the second attack. Far more rarely it is followed by a third, fourth, 

 or even fifth, which have essentially the same symptoms. 



By far the most common termination is in recovery; the very 

 slight mortality, which in most epidemics is only two or three per 

 cent., and rarely higher than six or eight per cent., is in great con- 

 trast to the severity of the symptoms, especially to the temperature. 

 If the disease prove fatal, death results either during the attack, from 

 collapse and general paralysis, or more rarely during the interval, from 

 exhaustion, or lastly as a result of secondary diseases and complications, 

 among which pneumonia is the most important. 



Pastau, as well as Obermejer, has given us valuable investigations 

 as to the weight of the body in relapsing fever. These show that 

 during the disease the body loses from a tenth to a fifth of its weight, 

 and that this cannot be solely referred to the diminished supply of 

 nutriment. Exact investigations prove again the correctness of the 

 doctrine that increased transformation of the constituents of the body 

 plays the most important part in the elevation of temperature during 



