SYMPTOM A TOLOGY—VA RIETIES—COMPLICA TIONS 1359 



the large proportion of cases, is on the head or upper extremity, 

 becomes red and swollen, and an ulcer forms, while the regional 

 lymph glands become enlarged. The temperature now rises (103° 

 to 105° F.), the pulse becomes small and rapid, and there may be 

 sensations of chilliness, while an eruption of purple spots, which 

 often resembles erythema polymorphum, appears on the body, and 

 the patient feels very ill, with pains in the muscles and joints, and 

 perhaps delirium. In a few days the temperature declines and the 

 patient feels well. 



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Fig. 656.— Rat-Bite Fever. 



Fig. 657. — Rat-Bite Fever. 



Relapse. — After a few days or a couple of weeks of apyrexia, how- 

 ever, the attack is repeated, and these intervals of apyrexia and 

 attacks of fever may be repeated for months or years. The relapses 

 may be fairly regular, at five days' intervals, for months, and may be 

 preceded by premonitory symptoms. Thus Hora's case had about 

 ten relapses a year for a period of seventeen years. The blood may 

 show eosinophilia. During the fever red cells are about four millions 

 and the leucocytes about six to twelve thousand. In the interval 

 there may be only four thousand leucocytes. Death may occur in 

 old people from exhaustion, or in others from complications. 



Varieties. — ^Three different types of the disease are described : a 

 febrile type with a marked eruption, a febrile iy^Q with nervous 

 symptoms, and an abortive type; but the first is most common. 



Complications. — Sloughing and gangrene at the site of the bite 

 and nephritis may occur. 



Diagnosis. — ^The presence of a relapsing fever associated with a 



