APPENDIX K. 



TRENCH FEVER. 



Trench fever has been recognised as a distinct disease only 

 during the present war, and . quite recently it has been shown to 

 be a louse-borne infection. Though not a fatal malady, it has 

 been responsible, owing to its wide prevalence, for a serious 

 amount of temporary disablement in the armies, while the after- 

 effects, which occur in a certain proportion of cases, have been 

 the cause of much chronic ill-health. The onset of the disease 

 is usually sudden, and, along with pyrexia, the chief symptoms 

 are headache, giddiness, and pains in the legs, in the back, and 

 behind the eyes. The face is flushed and the conjunctivae are 

 often congested ; free perspiration is present, also polyuria and a 

 tendency to constipation. There is moderate leucocytosis during 

 the pyrexia, punctate basophilia of the red corpuscles is a 

 common feature, and the spleen is often found to be swollen. 

 No other distinct morbid changes have been found. The 

 temperature curve is on the whole somewhat irregular, though 

 it sometimes assumes a regular relapsing character. The initial 

 attack of marked fever, which may show fluctuations, lasts 

 usually three to six days ; thereafter the temperature falls to nor- 

 mal and the symptoms subside. In many cases there occurs three 

 or four days later a distinct relapse of shorter duration and less 

 severity than the original attack, or there may be slight irregular 

 pyrexia. In other cases, constituting a minority, a regular 

 relapsing type of fever supervenes, the temperature rising some- 

 times to 104° C. and falling to normal again within two days; 

 whilst there are intervals of about five to seven days between the 

 attacks, during which fever and other symptoms are absent. This 

 type of fever may occur at the beginning of the disease, or, on the 

 other hand, may develop weeks after the primary attack. Whilst 

 in the majority of cases complete recovery occurs within a com- 

 paratively short time, patients who have had trench fever may 

 suffer at a later stage from myalgia and rheumatic pains, irregu- 



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