1442 



UNDULANT FEVER 



Course. — All these symptoms continue for about a couple of weeks, 

 the temperature remaining high — 103° to 105° F.— but at the end 

 of this period the fever declines, and the temperature may become 

 normal, while the patient feels much better. In a day or so, 

 however, a relapse occurs with much the same symptoms as the 

 attack. This relapse subsides, and another follows, relapses and 

 intermissions recurring for months. 



The temperature now becomes undulating, with a marked rise 

 at night and fall in the morning, while the patient becomes more 

 and more ansemic, weak, and wasted. The alimentary canal is 

 irritated, as is shown by the dyspepsia and the constipation or 

 diarrhoea. The throat may be sore, the gums spongy, and bleed 

 on pressure; the spleen is often enlarged and painful, and the 



Fig. 672. — Temperature Chart of Undulant Fever. 



lungs may show signs of bronchitis, and occasionally lobular 

 pneumonia, v/hile the heart is easily excited, and hsemic murmurs 

 are heard. The patient shows signs of prostration and head- 

 ache, and pains all over the body are felt. Insomnia and hysterical 

 emotions are not uncommon, but actual delirium is not usual, and 

 the memory may be impaired, while neuritis — e.g., sciatica — may 

 occur. The skin is pale but damp, due to local or general perspira- 

 tion, which is very common, and occurs with each remission of the 

 temperature, the sweat being of a peculiar disagreeable odour. 

 Sudamina is not uncommon after the third week. Desquamation 

 may occur, as well as prickly heat, boils, bedsores, subcutaneous 

 abscesses, or haemorrhages. 



The joints may become swollen and very painful, but the skin over 



