of chilliness; nor is the disease amenable in any way to quinine. This is the "intermittent" type of Hughes. In other instances these types may be variously blended.
In some patients, not months merely, but years, may elapse before they are finally rid of the tendency to febrile attacks and characteristic pains and aches. According to Bassett-Smith, the average duration of the disease is four months. Many of our sailors and soldiers are permanently invalided from the services on account of prolonged or recurring attacks of undulant fever.
Sequelæ, complications, and mortality. —As a rule, by far the most serious consequences of undulant fever are the debility it entails, the emaciation, the profound anæmia, the rheumatic-like pains, the neuralgias, and such sequelæ as abscess, orchitis, mastitis, parotitis, boils, etc. It is prone to give rise to ovarian pains, dysmenorrhœa, amenorrhœa, menorrhagia, and to favour abortion and premature labour. The germ may pass into the fœtus, and children born under such circumstances are weakly.
Complications, such as splenic and hepatic enlargement, enlargement of the mesenteric glands, suppuration, phlebitis, chorea, various psychoses, arteritis, endocarditis, hæmaturia, etc., are met with occasionally during the long course of this disease. There is little risk to life; the mortality does not exceed 2.5 to 3 per cent. When death occurs it is usually from suddenly developed hyperpyrexia; occasionally it is brought about by exhaustion, by hæmorrhages and purpuric conditions, or by some pulmonary complication such as pneumonia. In a few instances the fever is of a fulminating type, rapidly ending in death from hyperpyrexia. Hughes, in his elaborate monograph, designates such cases " malignant."
Pathological anatomy and pathology.— This disease has almost no pathological anatomy. The spleen is the only viscus of which it can be said that it is distinctly diseased. In undulant fever this organ is enlarged (average 17 oz.), soft, and diffluent; on microscopical examination the lymphoid
