SPECIFIC INFECTIOUS FEVERS.
Relapsing Fever (Famine Fever).
Definition.—An infectious fever caused by Obermeier's spirocheta characterized by 'a febrile paroxysm of about six days' duration, followed by a remission of about equal length, and one or more relapses of both paroxysm and remission.
Symptoms and Diagnosis.—Relapsing fever has not been met with in this coun try since 1S69, when it occurred in New York and Philadelphia in epidemic form. The period of incubation is thought to be short: a week or less. The early symptoms are not characteristic: severe pain in the back and joints, chills, fever, and, particularly in young subjects, nau sea and vomiting. Convulsions are occa sionally observed in children. The pulse is rapid: 110 to 140 or more; and the temperature is high: 103° to 105° F. This parallelism is important, since it serves to differentiate relapsing fever from influenza, which disease it resem bles. An attack of malarial fever is also suggested, the spleen being more or less enlarged almost from the start and pro fuse sweating being common. But the delirium which accompanies a high tem perature, the prolonged duration of the paroxysm, the gastric symptoms, which are usually severe, serve to invalidate such a diagnosis. Typhoid fever is simu lated in many instances, especially when petechix, which are sometimes observed, are present; but the rapid decline of practically all active symptoms after a few days clearly indicates the absence of this affection. Again, intestinal symp toms, except toward the crisis, are un common. Many manifestations of vary ing nature may appear in the course of the disease: jaundice, cough, parotitis, cervical adenitis, orchitis, oedema of the feet, monarticular or polyarticular in flammations, laryngitis, and glossitis. Again, various eruptions may appear: roseola, purpura, urticaria, herpes, and the rashes of scarlet fever and measles. IRematemesis, htematuria, and epistaxis are occasionally noted. The most serious complications observed are pneumonia and acute nephritis. The intensity of the symptoms steadily increases, as a rule, until the crisis appears: from three to seven days after the onset of the access. Diarrhoea and sweating are often the first signs of the remission; a rapid decline of temperature, to the normal or below, follows, and the period of convalescence begins.
In about one-third of the cases the fever does not return; in the remainder a new attack appears after a week's com parative comfort. The previous symp toms once more prevail, and are followed, as in the former experience, by a sudden crisis, a period of repose, and a third at tack. As a rule, the disease ends here; but
two more recurrences may appear, each successive attack increasing the patient's exhaustion. In weak and aged individ uals death may thus be brought about ; but, as a rule, the fatal issue occurs dur ing or at the end of the first access. Deaths from rupture of the spleen have been reported. The fatality of the dis ease is small, being but 1.26 per cent. curing the epidemic which occurred in Moscow in 1894, but it may reach 6 per cent., as was the case in the St. Peters burg epidemic.
Ulcerative conjunctivitis, various forms of paralysis, and the various tions occurring after exanthems are oc casionally observed as sequels to the affec tion.
Etiology and Pathology.—Poverty, filth, insufficient or poor food, and other unhygienic conditions prepare the sys tem for the invasion of the organism: a spirillum, or spirocheta. This micro organism, a filamentous spiral, may read ily be recognized in the blood, during the paroxysm, by its rapid movements among the red corpuscles. It disappears with the attack, and is superseded by what is thought to be its spores.
Of 29 inoculations in the monkey, there were 5 failures, and the incuba tion period was found to vary between two and four days. with one exception, in which it was prolonged to eight days. The blood may contain spirilla in small amount for a short period before the onset of fever. At the onset of fever the polynnelear cells are noticed to be much increased in number. Contrary to Carter's opinion. a considerable int mnnity, lasting for some tune, was con ferred by one attack. Living spirilla were found to be still present in the spleen when they had disappeared from the blood, and the spleen was observed to be poorer in antibaetericidal sub stances than the -circulating blood. From these and other considerations the following theory of the relapses in the disease is enunciated; At the crisis some of the spirilla perish, but some sur vive and are protected against the full power of the antibactericidal substances, and under this protection grow and multiply in the spleen during the period of apyrexia. Toxins would then be pro duced, and in a short time so modify the blood as to diminish the antispirillar substances to such an extent as to per mit of the spirilla again living in that medium. Captain Lamb ( Scientific :Memoirs by Med. Officers of the Army of India. Part XII; Practitioner, Sept., 11)01).