RELAPSING FEVER 189 



herpes is not uncommon. In certain cases small rose- 

 coloured spots, something like those of enteric fever, but 

 smaller, are met with. They come out in crops, which, 

 commencing near the crisis of fever, may continue into 

 the apyrexial period. These papules are most common 

 on the front and sides of the chest and abdomen. They 

 are never very numerous, last only a few days, and 

 disappear on pressure without leaving a stain. 



Sudamina are common, and in rare cases petechiae are 

 met with. 



Desquamation, except in the form of minute branny 

 scales following sudamina, is uncommon. 



Complications. The more important complications of 

 relapsing fever are pneumonia, severe diarrhoea, or dysen- 

 tery, and have already been dealt with. 



Mention may here be made of the liability of a small 

 proportion of cases to haemorrhages. Epistaxis at the 

 acme of fever is the most common example. Haemat- 

 emesis may also occur, and more rarely cerebral 

 haemorrhage, always fatal, has been observed. 



Swelling and inflammation of the parotid gland and of 

 lymphatic glands, most commonly those of the inguinal 

 regions, have been observed occasionally. This is of 

 importance in connection with the differentiation of the 

 disease from plague. 



Inflammatory affections of the eye and ear sometimes 

 occur, but are rarely serious in the Indian variety. 



Inflammation of serous membranes are rare, but slight 

 painful swelling of some of the joints, most commonly 

 those of the upper limb, are not uncommon. 



Pregnant women always abort ; the abortion is gener- 

 ally followed by recovery. 



The co-existence of relapsing fever, with malaria, small- 

 pox, measles, plague, and diphtheria has been noticed, 

 and in certain epidemics, following famines, with scurvy. 



There are no special sequelae of relapsing fever, though 

 mental and bodily weakness frequently persist for some 

 time. A certain degree of immunity is conferred by an 



