I3I2 



THE RELAPSING FEVERS 



complication than a feature of the disease. The liver is enlarged 

 and tender, and so is the spleen, which may reach a considerable 

 size. The heart sounds are normal, but the pulse-rate is quick, 

 reaching 120 to 140, or even more, per minute; but it is not dicrotic. 

 The erythrocytes and the haemoglobin are reduced in amount, while 

 a polymorphonuclear leucocytosis may be present. Spirochsetes can 

 be found in the blood, and occasionally can be seen engulfed by 

 leucocytes. There is generally a troublesome cough, with scanty 

 bronchitic expectoration, and rales, which can be heard over the 

 chest and trachea. The respirations follow the pulse-rate, being 

 increased to 48 to 50 per minute if the temperature is high. The 

 pains in the muscles and joints continue, and sleeplessness may 

 result, while a noisy delirium is not rare, but stupor is uncommon. 

 The urine is febrile, and may contain a little albumen. About the 

 sixth or seventh day the crisis, sometimes ushered in by a rigor, 

 intervenes, with violent perspiration, or diarrhoea, with or without 

 epistaxis, and with a sudden rapid fall of temperature, while the 

 pulse and respirations also return to normal, and the patient falls 

 into a deep sleep, and awakens much better. 



The Intermission. — ^The intermission now begins, during which the 

 temperature returns to normal. The spleen often remains enlarged, 

 the temperature chart may show small rises, and the patient's 

 strength slowly improves. 



The Relapse. — ^The disease may now end; but this is exceptional, 

 and more usually, about the fourteenth day from the first commence- 

 ment of the illness, the relapse occurs, beginning with a rigor and 

 symptoms resembling the attack, but often more severe, and, after 

 lasting three or four days, terminating in a crisis, which generally 

 ends the illness. Very rarely is there a second relapse, in which case 

 the same symptoms occur, but much less severely, a.nda.third relapse 

 is most uncommon. Convalescence is sometimes slow. 



Complications. — ^The complications are numerous, affecting the 

 lungs in the form of bronchitis and pneumonia, or the alimentary 

 canal as dysentery, diarrhoea, and haematemesis; while cerebral 

 haemorrhage, conjunctival haemorrhage, iritis, and corneal ulcers, 

 have all been recorded. 



Abortion often complicates the first relapse in pregnant 

 women. 



Diagnosis. — In the first instance, before the relapsing character 

 has appeared, the disease requires to be diagnosed from malaria, 

 typhus, typhoid fever, yellow fever, and seven days' fever. The 

 principal positive signs indicating relapsing fever are: — (i) Presence 

 of the spirochaetes in the blood; (2) agglutination or Lowenthal's 

 reaction, which consists of taking a drop of blood from the suspected 

 case and adding it to another drop of blood containing spirochaetes 

 taken from a patient, mixing the two drops together, and covering 

 with a cover-glass, which is then sealed and placed in an incubator 

 at 37° C. for half an hour. A positive reaction is indicated by the 

 clumping of the spirochaetes into non-motile masses. 



