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5. The duration of attack varies considerably in different instances. The
average of twelve cases observed by me has been over 66 days. The longest has been
already 170 days on the sick list and looks pretty well still; the shortest' of these cases
was 17 days. Thus the disease may vary in duration from six months to one month,
the period of incubation and of presence of the disease before diagnosis being allowed
for. We have seen that it is difficult to fix the exact commencement of any but
experimental cases, and we have shown why this is so. Generally life flickers for some
time before it is extinguished, the reserve stores of fat become exhausted and the
animal falls in consequence of being unable longer to support his own weight. He
remains for days apparently more dead than alive, and, at length, after becoming very
cold and breathing with difficulty, dies quietly; or else, towards the end of a
protracted illness, the patient becomes excessively weak, dull, and heavy, with dropsy
of the eyelids, pendulous lower lip, extreme labor in breathing, looking the very picture
of misery. He falls, and for some time is delirious and struggles severely, especially
when touched, and finally " dies hard " with a high temperature and parasites in the
blood up to the last. In my most acute case I found the patient carried off while in
good condition, with a plentiful reserve of nutritive matter in the way of internal and
external fat, after a very short illness characterised by acute dropsy. The tempera-
ture ran up to the almost unprecedented reading 110° Fahrenheit just before the fatal
result and the animal died directly from fever, his life being " burnt out" as it were.
6. The immediate cause of death varies from a yielding to the excessive height of
the fever to the complete wearing out of the animal and exhaustion as a culmination
of anæmia; not unfrequently the animal succumbs to complications rather than the
disease; in others sequelæ are responsible for the fatality. Of these latter, two demand
special notice in consequence of their frequency—embolism and perforation of the
stomach. The latter takes place without the peritoneum being involved in appreciable
inflammation and the rent through it is often extremely small; of the emboli, some
are of long standing and others recently formed. In one case a blood-clot of some
considerable firmness and consistency was carried in the round of the circulation until
it became caught in passing into the pulmonary artery, where it became surrounded
by a fresh clot. Fatty heart and enlarged liver especially weaken the animal and lessen
his power of resisting the attack; thus, of all cases of fatality in this disease, the
majority depend on failure of the heart's action due to fatty degeneration.
7. POST-MORTEM APPEARANCES.—In marked contrast with the almost complete
absence of definite lesions found post mortem in the Trans-Indus cases are the condi-
tions noted in Burma, which are numerous, varied, and sometimes extremely marked.
The carcass of an animal which has succumbed to this disorder presents normal rigor
mortis; it is generally extremely emaciated and seems that of a very old individual.
Gelatinous extravasations into the areolar tissue are often found; some of these are
subcutaneous, their special seat being below the sternum, although not infrequently they
are found elsewhere. They seem to be quite distinct from the somewhat similar lesions
associated with bruises of the skin, such as result from.the injuries inflicted by the
animal during his delirious struggles and which may be so violent as to cause complete
perforation of the integument. Favorite seats of gelatinous effusion are above the
popliteal space, along the course of the sciatic nerve, and between the muscles of the
thigh. The lymphatic glands are generally swollen and (edematous, especially those of
the femoral space ; sometimes there is a little dropsy of the belly ; occasionally serous
fluid has accumulated in excess in the pericardial sac ; almost always there is a little
liquor pleurae above the normal. In cases of long standing the liquid contents of the
stomach may have escaped into the peritoneal sac as a result of gastric perforation. I
have noticed in most cases of relapsing fever a larger amount of yellow watery fluid in
the stomach and small intestine than is usual in health, and that the contents of the
large intestine are usually somewhat dry, although in advanced cases they may be found
pultaceous, reddish in color, and most foul-smelling. The lining membrane of the
small intestines is the seat of circumscribed local congestions, which may invade the
mucous covering of Peyer's patches and be most marked in that situation, but Peyer's
glands are not diseased. In acute cases I have seen the mucous congestion continuous
throughout the anterior two-thirds of the bowel, but ulceration is never present. The
usual parasites (Strongylus armatus, Oxyuris, and so on) are found in the alimentary
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