On a New Form of Febrile Disease. 



493 



cause of the epidemic, it appeared that some of the families which 

 escaped had been supplied with milk of a very superior quality ; 

 whereas many of those who suffered from the disease deponed that 

 the milk delivered to them looked and tasted as if it had either 

 been adulterated with water or with skimmed milk. In other families 

 which escaped it was only used for cooking purposes, or the chief 

 supply of milk was obtained from other sources, or only a very small 

 quantity of cream was used. In many cases the individual members 

 of affected families who escaped were in the habit of using the milk 

 only after it had been cooked or boiled. In my own household of 

 eight, two escaped who were in the habit of using boiled milk only. 



Symptoms. — In the cases which came under my observation, I 

 noticed the following symptoms : — 



1. A well-marked rigor, with a feeling of chilliness, lasting from 

 ten to fifteen hours ; headache, pain in the back and limbs, and often 

 nausea and vomiting. 



2. Sudden rise of temperature varying from 103° to 104°, and even 

 reaching sometimes 105° F. 



3. Hot dry skin, and a pulse of 120 to 125. 



4. A feeling of uneasiness in the neck, accompanied in some cases 

 with congestion of the fauces and tonsils. 



5. Enlargement of the cervical glands lying between the angle of 

 the jaw and the anterior border of the sterno-mastoid muscle — the 

 glands of one side were usually more affected than those on the 

 other. 



6. Complete remission of the febrile symptoms for twenty-four to 

 thirty-six hours, but marked prostration during the remission. 



7. This period was followed by a return, in nearly all the cases, of 

 the high temperature, which lasted from twenty to thirty-six hours. 

 In many cases, after the second remission, there was a third relapse, 

 and in not a few cases a fourth relapse. In those cases in which a 

 relapse took place, the glands least affected during the first attack 

 were most affected during the second attack. 



8. In all cases there was a very slow recovery from the prostration. 

 Although the outbreak began on the 25th of March, some of those 

 attacked are still (13th June) suffering from sequelse, to be afterwards 

 referred to. 



Perhaps the most characteristic and constant feature of the disease 

 was the swelling of the cervical glands at the angle of the jaw. 



Further, there was an indurated condition apparently of the fibrous 

 structures in front of the sterno-mastoid, extending as far as the 

 clavicle, and sometimes upwards, so as to appear to involve the 

 parotid gland. In most cases this induration slowly disappeared, but 

 in at least three cases it has ended in suppuration. 



In many cases, after convalescence had fairly set in, there were 



