RELAPSING FEVER 187 



which, however, is quickly relieved with the fall of 

 temperature. 



A frequent and serious complication of relapsing fever 

 is pneumonia, which may be either of the lobar type or 

 more commonly lobular. 



The relation of the two conditions is liable to be over- 

 looked, for while on the one hand the indications of 

 serious pulmonary inflammation may be so slight as to 

 be only discovered after death, on the other hand pneu- 

 monia may be the most prominent feature of the illness 

 and may modify the crisis or obscure the onset of a 

 relapse. The onset of pneumonia is most common 

 towards the end of the initial attack, but may be earlier, 

 or not until the commencement of a relapse. It may 

 sometimes be indicated by a diminution in the severity 

 of the general symptoms shortly before the crisis is due. 

 The temperature and pulse-rate fall, breathing becoming 

 more frequent, and working of the alae nasi may be 

 observed. The headache and bodily pains diminish and 

 there is less epigastric discomfort. Examination of the 

 chest will reveal the ordinary physical signs of pneumonia. 

 There is, however, less tendency to involvement of the 

 bases of the lungs than in primary pneumonia. It is 

 always accompanied by pleurisy. 



Reference has been made to the thirst, vomiting, and 

 epigastric discomfort of relapsing fever. The severity of 

 the thirst is often a striking symptom. It is associated 

 with a dry tongue, which quickly becomes coated with 

 brown fur, except at the tips and edges. Following the 

 crisis the tongue soon becomes clean and the thirst 

 diminishes. 



Vomiting is a variable symptom. It is usually not 

 serious, but the irritability of the stomach may render 

 feeding difficult and aggravate the thirst. 



The vomited matter is usually greenish, a mixture of 

 bile and mucus, occasionally containing streaks of 

 blood. In rare instances " black vomit " has been 

 observed. 



The epigastric discomfort which is so common a 



