PATHOLOGY— DOUBLE CONTINUED FEVER 1463 



Pathology. — ^Nothing is known as to the pathology of the disease. 

 Morbid Anatomy. — ^There is nothing characteristic to be seen in 

 an autopsy. 



Symptomatology. — ^The illness begins with a mild fever which 

 looks like a typical malarial attack, the temperature falling after 

 the ordinary sweating stage, though no malarial parasites appear 

 in the blood. The next day the temperature is almost normal, and 

 no anxiety is felt about the patient. But on the third day the 

 temperature begins to rise, and 

 reaches 104° to 107° F., at which 

 it will remain if only drugs are 

 used; but if cool bathing is 

 resorted to, the temperature will 

 fall temporarily, rising in due 

 course until cool bathing is again 

 performed. This struggle con- 

 tinues, despite any medical treat- 

 ment that may be employed, 

 until, at the end of six to seven 

 days, the cool bathing ceases to 

 have its effect, and the tempera- 

 ture goes on until 110° F. is 

 reached about the eighth day, 

 and the patient, after having 675.— Bodies found in a Case 



been delirious, becomes comatose of Hyperpyrexial Fever. 

 and dies; or, in about 50 per 



cent, of Thompstone and Bennett's cases, the temperature remains 

 at about 105° F. for three weeks, and then gradually falls to normal 

 about the sixth week. 



The spleen, liver, abdominal organs, urine, and blood, appear 

 quite normal, except that coagulation is said to be quick. The 

 conjunctivae are injected, and the mind is clear until the terminal 

 delirium sets in. The aetiology is quite unknown. 



Treatment. — Cool sponging, cool baths, and cool packs, are the 

 only useful treatment. 



DOUBLE CONTINUED FEVER. 



This disease, which closely resembles enteric fever, was first met with by 

 Manson, and subsequently by Thorpe and Rousseau in China. 



The disease begins insidiously, the temperature rising to 104° F., and 

 remitting about 3° F. per diem, with slow pulse, a moist red tongue, and 

 constipation. The spleen is slightly enlarged, and all the other organs are 

 normal. After ten to fifteen days the temperature falls gradually by lysis to 

 normal, at which it remains for two to seven days, when a second paroxysm 

 of fever sets in of the same type as the first, only lasting some ten days, after 

 which the patient becomes convalescent. There is, however, a considerable 

 amount of anaemia, and it is a long time before the strength is regained. There 

 are no complications or sequelae. 



Treatment must be symptomatic ; quinine is useless . 



