Sequelae and Complications.—It should be borne in mind that while not serious from a standpoint of mortality this disease is to be dreaded by reason of the possibility of invalidism. The neuralgic pains, insomnia and mental depression render patients liable to the morphine habit. In pregnant women there is a tendency to abortion. In rare cases we may have intestinal haemorrhages with asthenic manifestations. Bassett-Smith has reported a case with extensive purpura. The same author in paramelitensis cases has noted the susceptibility to secondary streptococcal infections.
Symptoms in Detail
Temperature Chart.—Except in the malignant form of the disease, when the temperature may be rather continuous, the fever course is a step-like ascent with daily remissions for about ten days and then a similar descent. Following an evening rise of temperature night sweats may be noted.
It is the wave-like succession of such courses of fever, separated by afebrile intervals, that suggests the name undulant fever.
Circulatory System.—The disease shows rather a toxic effect on the heart as shown by palpitation and irregularity and rapidity of pulse rate.
In the beginning of the fever, however, the pulse rate is not very fast. Anaemia is a rather marked feature.
Respiratory System.—A slight bronchitis with cough tends to suggest phthisis in those cases which show rather marked night sweats.
Nervous System.—The organism seems to have a selective action on the nervous system as shown by headache, various neuralgias, insomnia, apathy and neurasthenia. Sciatica is probably the most common peripheral nerve involvement.
Joint Symptoms.—Very characteristic are the sudden and painful swellings of various joints, especially hip, shoulder, ankle and knee. Not rarely the costo-sternal articulations may be involved. The acute symptoms subside in a few hours and the joints become normal in a few days.