Bronchitis of this character was a source of serious annoyance to many patients. In several cases there was impaired resonance at the lower margins of the lungs posteriorly, with imperfect bronchial respiration, but without the symptoms of fully-developed pneumonia. Such conditions were regarded as due to hypostatic congestion, and proved amenable to treatment. Pneumonia occurred in eleven cases out of 200 recorded with reference to this complication. It will be more fully discussed under the head of Complications. It was attended with the usual physical signs, and gave rise to extremely rapid and labored breathing, especially when associated with painful enlargement of the liver and spleen. In a case of double pneumonia, with enlarged and ruptured spleen, the respirations were from 80 to 90 for two days, the pulse being 130 to 136. It was a very fatal complication, death resulting in all but two instances.
Leyden16 has shown that though the percentage of carbonic acid in the air expired during the pyrexia is diminished, the total quantity exhaled is increased, the proportion being as 1.5 to 1 in the non-febrile state.
16 "U. d. Resp. in Fieber," Deutsch. Arch. f. klin. Med., 1870, 536, quoted by Murchison.
Elaborate investigations have been made of the condition of the urine in relapsing fever by numerous observers, and in the Philadelphia epidemic of 1870 we had the great advantage of being assisted by the distinguished chemist, the late Horace B. Hare, who conducted an extensive series of analyses in our cases. In a number of cases quantitative analyses were continued daily throughout the entire course of the disease.
As a rule, the quantity of the urine is comparatively free during the febrile periods, very scanty at the time of crisis, except in the cases where critical discharges of urine occur, and excessive for some days after the crisis.
Still, there were not rare exceptions, especially to the first of these statements. Thus on four successive days of the relapse of a severe case with delirium, but without albumen, and which ultimately recovered, the analysis gave—
| Temperature. | Amount in ccm. | Sp. gr. | Urea in Grm. | Na. Cl. |
| 103 | 400 | 1024 | 23.8 | 2.64 |
| 105 | 300 | 1025 | 15.27 | 1.95 |
| 106 | 500 | 1024 | 24.7 | 4.3 |
| 106 to 97 | 850 | 1021 | 24.735 | 5.525 |
And in another severe case, also resulting in recovery, the analysis was, for two days preceding the crisis of the initial paroxysm—
| Amount. | Sp. gr. | Urea. | Na. Cl. | |
| 500 | 1014 | 12.9 | Traces of albumen. | |
| 650 | 1014 | 15.85 | 1.365 | |
| After the crisis: | ||||
| 2250 | 1004 | 18.9 | 15.75 | No albumen. |
And again, in another case at the height of the initial paroxysm, within twenty-four hours of the crisis, no vomiting, purging, or epistaxis being present; temperature 105°; only 500 ccm. was passed of dark reddish colored urine, non-albuminous, and with sp. gr. 1011.