Page:Tropical Diseases.djvu/410

368 Symptoms.— Undulant fever begins generally with lassitude and malaise, such as we associate with he incubation of many specific fevers, particularly typhoid. There are headache, boneache, anorexia, and so forth. At first the patient may go about his work as usual. Gradually the daily task becomes increasingly irksome, and he takes to bed. Headache may now become intense, and, in addition, the patient will suffer from thirst and constipation. At the commencement the symptoms, except that there is very rarely diarrhœa, resemble those of typhoid. There are no rose spots, however, then or at any subsequent period. There is evidence in the coated tongue, the congested pharynx, the anorexia, and the epigastric tenderness, of gastric catarrh; and the occasional cough and harsh, unsatisfactory breathing at the bases of the lungs indicate some degree of bronchitis or of pulmonary congestion. There may also be delirium at night. The fever is usually of a remittent type, the thermometer rising towards evening and falling during the night, the patient becoming bathed in a profuse perspiration towards morning. The spleen and the liver, but especially the former, are somewhat enlarged and, perhaps, tender. Lumbar pain may be urgent.

After a week or two of this type of fever, specially distinguished by pains and perspirations, the tongue begins to clean, and the appetite to revive; but, notwithstanding these signs of amendment, the patient still remains listless and liable to headache and constipation. He continues feverish and at times perspires profusely. Gradually, however, although the patient is anæmic and weak, subjective symptoms become less urgent; he sleeps well now, he has no delirium at night, and he can take his food, and this although the body temperature may still range slightly above the normal. Then once more, and perhaps over and over again, fever with all the former symptoms gradually returns; and now, if it has not declared itself before, the peculiar fleeting rheumatic-like affection of the joints or fasciæ, so characteristic of the dis-