Relapsing Fever.

This disease occurs comparatively rarely in this country, but is a
familiar visitor in Europe and in Asia. The cases that are seen in the
United States are generally importations from abroad. Like typhus
fever, it occurs especially in overcrowded districts and houses, and
is a so frequent accompaniment of famine in Ireland that it has
been called “ famine fever. “

The onset of the disease is usually abrupt; there appears to be
no stage of incubation. The patient, previously in good health,
suddenly experiences a chill, followed at once by intense fever.
Nausea and vomiting are frequently present, and the patient is occa­
sionally jaundiced. The extreme prostration and the abdominal
symptoms characteristic of typhoid and typhus fever are absent; so,
too, the mental disturbances usual in these other diseases are not
observed.

The most marked feature of this disease is the one indicated
by its name—the relapses. The fever lasts at first from five to
seven days, at the end of which time the patient apparently
recovers, and may even resume his avocation. At the end of
another seven days, however, a second attack follows, identical in
all essentials with the first; sometimes after another interval of free­
dom from fever, a third attack similar to the preceding occurs.
The features of the disease may vary somewhat; the duration of the
febrile stage may vary from three to ten days, and the intermission
between the febrile attacks may likewise vary. It may also happen
that the interval between the attacks is not a perfect cessation of
the fever, but merely a fever of diminished intensity.

Cause*—In every case of this disease which has been carefully
investigated, whether in Europe or in India, there has been found a
microscopic organism of spiral form, and exhibiting active move­
ment. These organisms—technically called bacteria, a species of
vegetable — are found in immense numbers in the blood of these
patients during the febrile attack. It is all but established that the
disease is due to the presence of these organisms in the patient’s
blood.

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