At postmortem we have an enlarged, congested, soft spleen with swollen Malpighian bodies. The kidneys may show a nephritis and the mesenteric glands be swollen. The intestines fail to show the characteristic lesions of typhoid fever. There may be evidences of myocarditis. SYMPTOMATOLOGY _A Typical Case._—Following a period of incubation, varying from ten to fifteen days, headache, malaise and anorexia set in with a step-like rise of fever from day to day. The tongue is not heavily coated and is red at the tip and sides. Constipation is the rule and there is an early tenderness and enlargement of the spleen. There is much to suggest typhoid fever in the gradual ascent of the remittent fever for about ten or twelve days and the gradual descent during the succeeding ten or twelve days, but the lack of apathy and slighter evidences of toxaemia differentiate. The patient is dejected rather than apathetic. There is often a slight bronchitis, with cough, which, when associated with a profuse sweating at night, may suggest phthisis. [Illustration: FIG. 75.—Temperature chart of Malta fever. (After Scheube.)] Following the initial period of fever there is usually a short afebrile interval of a few days to be succeeded by a second, third or many of these febrile waves, thereby making one of the names, undulant fever, appropriate. Anaemia becomes marked and cardiac weakness, as shown by palpitation and rapid, irregular pulse, apparent. The symptoms which aid us most in diagnosis are joint manifestations and neuralgic pains. These may come on quite early in the course of the disease or be delayed until succeeding febrile waves set in. Swelling and pain, but without redness, of a single joint may come on rather suddenly, to have the acute symptoms subside in a few hours and to be entirely normal in three or four days. Pains in the sacro-iliac region or pains resembling those of hypertrophic arthritis of the spine may be noted. It is however the peripheral nerves, even more than the joints, for which the toxic effects of _M. melitensis_ show a preference. The sciatic nerve seems to be most often involved and sciatica may set in suddenly and acutely, to pass off in two or three days, leaving a soreness over the course of the nerve and a tendency to recurrence. Orchitis may occasionally set in. There is usually albuminuria. Insomnia is usually quite a prominent feature of the disease and there is a great tendency for nervous prostration to develop. The usual course of the disease runs for three or four months but may last almost a year.