ease, shows itself in a large proportion of cases. One day a knee is hot, swollen, and tender; next day this joint may be well, but another joint is affected; and so this metastatic, rheumatic like condition may go on until nearly all the joints of the body have been involved one after the other. The patient may suffer also from neuralgia in different nerves intercostal, sciatic, and so on. Orchitis is an occasional complication. In some cases these complications are severe and characteristic; in others they may be mild, or absent altogether. In this respect the same infinite variety exists as in other specific fevers.
Perhaps the most characteristic feature of undulant fever is the peculiar behaviour of the temperature. In a mild case there may be a gradual ladder-like rise through a week or ten days to 103° or 104° F., and then, through another week or so, a gradual ladder-like fall to normal, the fever, which is of a continued or slightly remitting type, leaving for good without complication of any sort in about three weeks. Such mild cases are the exception. Usually, after a few days of apyrexia, absolute or relative, the fever wakes up again and runs a similar course, the relapse being in its turn followed by an interval of apyrexia, which is again followed by another relapse; and so 011 during several months. This is the "undulant" type from which Hughes derived the name he suggested for the disease -febris undulans.
In another class of cases a continued fever persists for one, two, or more months, with or without the usual rheumatic, sudoral, and other concomitants the " continued " type of Hughes.
Generally remittent or nearly continued in type, in a proportion of instances the fever exhibits distinct daily intermissions, the swinging temperature chart suggesting some septic invasion or a malarial fever. But there is no local evidence of suppuration to be found; neither, if we examine the blood, is the malaria parasite to be discovered; nor is the quotidian rise of temperature accompanied by any ague-like rigor, or at most only by a feeling
