This fever often commences very suddenly, frequently rendering the patient prostrate within an hour. There is a continuous and urgent suffering from febrile anxiety, restlessness, fever, great headache. It begins, for the most part, with shivering, the pulse rising sometimes to 140 to 150 beats in a minute. The tongue is covered with a thick, moist, whitish fur. Pain in the region of the stomach, with tenderness, nausea and vomiting are common among the early symptoms; with pains in the limbs and joints. In many cases, probably in one-fourth of the whole number, yellowness of the skin occurs, amounting to Jaundice, with vomiting of matters looking like coffee grounds, and sometimes as black as ink. Circumscribed petechial spots, never elevated, are observable on the skin in a large proportion of these patients. It often departs rather suddenly after a free sweating, between the fourth and seventh days, most frequently on the fifth; the patient becoming so much better as to be able to leave his bed, or even to walk out of doors, and occasionally to travel to some distance. This is succeeded by an abrupt relapse, ushered in with severe shivering, taking place usually about the fourteenth day from the commencement of the attack, and not to be averted by any precautionary management; and is finally carried off by a second abrupt sweating crisis on the third day of the relapse, leaving the patient greatly prostrate, and with a slow convalescence to pass through, but without any vestige of fever after the expiry of the few brief hours of critical sweating.

The second convalescence is generally permanent. The relapse or repetition of the symptoms may, however, happen three, or even four times.

Dr. Christison says: "It is far from being a deadly fever; but it causes great suffering, and debility so lasting that it makes a working man unfit for labour for two months, first and last. Strange to say, in this city (Edinburgh) at least, where it has been better studied than anywhere else, it is never seen but as an epidemic. I have known four such visitations of it, in 181V, 1827-8, 1841-2, and 1847-8; but I never saw it in the intervals, nor have any of my medical brethren. Hence, at every fresh appearance it is at first taken for a new fever. It is met with in the labouring population alone; never in the easy ranks of society, unless through very decided exposure to infection.

In the year 1847 a great outbreak of relapsing fever took place in Manchester; evidently, says Dr. Tweedie, the consequence of a sudden large importation of Irish emigrants. Dr. Ormerod has given us a sketch of this kind of fever as it fell under his observation in the same year in the wards of St. Bartholomew's Hospital. The subjects of this also were chiefly Irish persons newly arrived in London. Drs. G. B. Wood and M. Clymer recognized relapsing fever among some emigrants in Philadelphia in 1844; and Dr. Dubois in New York, in 1847-8. Its presence has not been distinctly noted since that time in the United States until 1870. During the summer of that year, hundreds of cases occurred in New York and Philadelphia, in local "nests" of unsanitary conditions. The rate of mortality in this species of fever is low: and death usually takes place, if at all, before the seventh day of the disease. In the fatal cases, Jaundice has been observed to be a frequent, but not a constant symptom; the surface becomes cold and livid, the pulse very feeble as well as very frequent, a low form of delirium arises, with drowsiness, which deepens into unconsciousness, which ends in death.

It is stated by Dr. Wardell that in pregnant women affected with this fever, abortion is sure to happen, whatever may be the period of gestation.

Neither early and extreme frequency of the pulse, nor sudden and great variations in its rate of beating, are of themselves, prognostic of danger. In this respect, therefore, the disease differs remarkably from both Typhus and Typhoid fevers, in either of which a pulse of 130 or 140, and in the former of which rapid fluctuation of the pulse always indicate great danger. In relapsing fever it may mount to 150, or even higher, and upon the breaking out of perspiration it may drop, in the course of two or three hours, to half that number of beats, without warranting any alarm for the patient's safety.

Typhoid fever is generally known as a one-and-twenty-day fever; Typhus, as a fourteen-day fever; and in like manner the Relapsing fever was called in Ireland the five-day fever; although, as it has its crisis very often on the seventh day, it might properly enough be called the seven-day fever.

The average mortality in the three species of fever as deduced from tabular statements compiled on a large scale by Dr. Murchison is in Typhus one in 5 or 6; in Typhoid one in 6; in Relapsing fever very much less. In one epidemic it has been computed at one in 25, in another at one in 50.

Dr. Hartshorne says: "Of Relapsing fever, in Philadelphia in 1870, the mortality among white persons was about one in 20; among negroes one in 4.

Relapsing fever, like Typhus, attacks all ages; but the proportion of the young to the aged is greater than in Typhus.

Dr. Welch, in his account of Relapsing fever as it was seen in Queensbury House, in Edinburgh, which was opened for the sole use of fever patients during the prevalence in that city of the epidemic of 1817-1819, has the following statement;

"In this Hospital, since it was opened (which was the year before the time when Dr. Welch was writing), my friends Messrs. Stephenson and Christison, the matron, two Apothecaries in succession, the shopboy, washerwomen, and thirty-eight nurses have been infected, and four of the nurses have died. With the exception of but two or three nurses, who have been but a short time in the Hospital, I am now the only person who has not caught the disease, either here or at the infirmary, within the last eight or ten months."

Although the fever was highly contagious, it was observed that bodies of persons collected together, but fenced about by barriers which precluded intercourse between them and places infected with the fever, remained exempt from it; children in charity schools, soldiers in barracks, and even prisoners in jails. In a report made to a Committee of the House of Commons in England, respecting epidemic fever in Ireland, is a letter from Dr. McDonald, who had established a fever Hospital at Belfast, which Hospital alone, at one period contained 190 cases of the disease. Very near the Hospital was a school, containing 700 or 800 young persons; a poorhouse with 300 inmates; and a barrack with 1000 soldiers. These places were never more free from fever than at that time.

Persons seldom take Typhus or Typhoid fever a second time, but Dr. Christison had three separate attacks of Relapsing fever within fifteen months.

In Ireland and Germany this disease is known by the names of Famine fever, and Hungerpest.

Dr. Guy says that "filth is rather the nurse than the parent of fever; in extreme cases fever may be bred of filth."

Treatment

At the commencement, if the bowels are not relaxed a mild purgative should be given, which may be repeated in two or three days, if necessary. Probably a warm bath or putting the feet and legs in warm water would be beneficial. The Fever Mixture, No. 9, may be taken three or four times a day; or the following:

Solution of Acetate of Ammonia............One Ounce.

Sweet Spirit of Nitre..........................Half an Ounce.

Tincture of Henbane..........................Three Drams.

Water sufficient to make Half a Pint.

A tablespoonful three or four times a day.

Cold may be applied to the head if there is much heat or delirium; and the Bromide of Potash may be taken if there is sleeplessness. With regard to diet, caution must be observed. While the fever lasts the diet must be light and unstimulating; and during convalescence care must be taken to avoid exposure to cold.

In addition to the Mixture given above; the patient may take twenty or twenty-five grains of Chlorate of Potash, three times a day, dissolved in a little water.