RELAPSING FEVER. 



Often also there is bronchial catarrh of variable intensity; and gen- 

 erally from the fourth to the sixth day of the disease, after the liver 

 and spleen have swollen considerably, and become painful, there is 

 severe icterus without discoloration of the faeces. About this time the 

 prostration of the patients is very great ; they are perfectly apathetic 

 and somnolent or delirious. The tongue is dry and crusted, pulse 

 slow, the hot skin loses its turgescence ; and, in this state, many die 

 with the symptoms of sudden collapse. 



In others, at about the same time as in simple recurrent fever, 

 there is a more or less complete crisis, followed by a rapid improve- 

 ment of all the symptoms. The patients seem to be convalescing, 

 tiL a relapse occurs with the former symptoms, and they generally 

 soon succumb. 



Finally, in other cases there is no crisis, and in the second week, 

 except for the intense icterus, we are reminded of severe and protracted 

 cases of other forms of typhus. According to Griesinger*s description, 

 this period of the disease is characterized by more or less profound 

 sopor, delirium, great sensitiveness of the abdomen, involuntary pas- 

 sages of dark, thin faeces, or markedly dysenteric dejections, or occa- 

 sional large evacuations of clotted blood, difficulty of swallowing, 

 croupous coating on the pharynx, bronchitis, extensive lobular pneu- 

 monia, occasional pericarditis, petechia and miliaria of the skin, and 

 irregular chills. It almost always terminates with slight convulsions, 

 sometimes by sudden collapse, internal haemorrhages (rupture of the 

 spleen), or secondary disease of the thoracic organs. Barely, the 

 patient recovers either with a rapid change, or slowly and irregularly 

 the latter is especially the case if there has been extensive disease 

 of the thoracic or abdominal organs, such as pneumonic infiltration or 

 dysentery. 



TREATMENT. The prophylactic rules for preventing the spread 

 of or protecting one's self against relapsing fever appear at once from 

 what we have said of its etiology. Improvement of the condition of 

 poor people, care for healthy nourishment, and roomy dwellings, ne- 

 cessary as they are for prophylaxis, will probably never be fully car- 

 ried out, as it is so much easier to separate the healthy from the sick, 

 as is required by the contagiousness of the malady. 



The slight mortality contraindicates an energetic treatment of the 

 disease. Thus far attempts to cut short the process and prevent 

 relapses by quinine have failed. In the same way digitalis did no 

 especial good in the Berlin epidemic. 



By cold baths, in recurrent fever also, we may almost always lower 

 the temperature from one to five degrees ; but this usually continues 

 only a short time, the bodily temperature soon rising again to its 

 92 



