l88 TROPICAL MEDICINE AND HYGIENE 



symptom is due to catarrhal inflammation of the stomach, 

 partly also to active congestion of the liver and spleen. 



While the constipation of the early period of relapsing 

 fever is constant enough to be of some diagnostic value, 

 severe diarrhoea not infrequently occurs at the crisis, 

 the stools sometimes containing blood. 



Occasionally there is actual dysentery, depending prob- 

 ably upon previous infection. 



Pain and tenderness of the liver and spleen are 

 early symptoms. Both organs are enlarged, the spleen 

 especially, and both rapidly diminish in size after the 

 crisis. 



Frequently associated with enlargement and tender- 

 ness of the liver is jaundice, though this symptom is 

 more common in some epidemics than in others. It 

 usually commences about the fifth day of the initial 

 attack, disappearing a few days after the crisis. Its 

 intensity varies greatly, but while usually slight and 

 transient it may sometimes be very intense. 



The urine is dark and scanty during the febrile stages 

 of relapsing fever, and also during the early part of the 

 apyrexial period. It is of rather low specific gravity 

 (IOTO to 1015), and contains an excess of urea. A small 

 amount of albumin may occur, and granular casts may 

 be found ; blood is uncommon. When jaundice is 

 present the urine contains biliary pigments. 



Mention has been made of the hot, dry skin of the 

 febrile stage and of the sweating at the crisis of relapsing 

 fever. The skin, though dry, does not feel as hot as might 

 be expected from the bodily temperature, thus differing 

 from the condition observed in certain other acute febrile 

 diseases, pneumonia for example. 



The critical sweats are usually very profuse, even more 

 so than in malaria, and may saturate the clothes and 

 bedding. 



Night sweats sometimes occur after the crisis, and 

 during relapses the skin may often be moist. 



While there is usually no rash in relapsing fever, facial 



