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In a recent study1 of convalescence from acute brucellosis the findings strongly supported the view that delay or failure in symptomatic recovery from that disorder is critically dependent upon the emotional state or attitude of the person. While no objective clinical or laboratory findings differentiated those persons who recovered quickly and completely from those who retained symptoms for a long period of time (chronic brucellosis), there were striking differences between these two groups in terms of psychological adjustment and life situation concurrent with the acute phase of the infection. The evidence pointed to the importance of depression particularly in retarding symptomatic recovery from the illness.The study of convalescence of patients with brucellosis was done retrospectively in that the persons were investigated medically and psychologically some time after the acute illness had been contracted. We felt reasonably assured that certain features of the study enabled us to differentiate between

Psychologic measures of mood, distress and psychologic vulnerability were obtained from young male volunteers participating in experimental tularemia studies before exposure, during incubation of disease and during the acute and convalescent illness periods. Daily temperature and fever records were maintained. It was found that the onset of negative mood feelings was prodromal to fever in the majority of subjects. Psychologically vulnerable subjects tended to react to a greater degree and to show more severe illness as measured by the duration of fever than did the nonvulnerable subjects.

INFECTION does not always result in disease or illness. Only a proportion of infected persons become sick following many epidemic and endemic infections. Social, economic, racial, and other factors obviously influence the frequency of infection and disease in a population, affecting the degree of exposure to the microorganisms and natural resistance. The impact of psychological factors upon the frequency of infection and infectious disease, however, has not been previously evaluated.The onset or exacerbation of disease during a chronic infection, such as tuberculosis, may be partly dependent upon antecedent emotional stresses.1 Development of illness with acute infection, however, has not been related to psychological factors. The severity of acute infection as measured, for example, by the height and duration of fever, has not been shown to be influenced by emotional factors,2,3 but psychological stresses might magnify the symptoms of illness.Delayed recovery from symptoms associated with infection

Brucellosis is usually a self-limited disease. Complications, such as suppurative or granulomatous lesions, may, however, occur. In addition, some patients remain disabled after the acute infection because of persistent symptoms in the absence of any demonstrable physical abnormalities and are commonly said to have "chronic brucellosis." The present study was done to investigate the role of psychologic factors in the pathogenesis of this delayed convalescence."Chronic brucellosis" is clinically similar to neurosis in that nonspecific symptoms, such as fatigue, headache, myalgia, arthralgia, "nervousness," and depression, occur in the absence of abnormal physical findings. This similarity could be attributed to factors discussed below, which may be important determinants in delayed convalescence from any illness.Although similar to emotional illness, "chronic brucellosis" might be unrelated to psychologic factors and be attributed to enduring infection. The coexistence of neurosis and "chronic brucellosis" then would be no more than expected from chance alone.It

Four clinical types of brucellosis were described by Hughes in his classical monograph on "Mediterranean, Malta, or Undulant Fever." 1 These were characterized as malignant, undulatory, mild or intermittent, and irregular or mixed, depending largely upon the severity, duration, and course of the infection. Although brucellosis, as studied by Hughes, was probably due almost exclusively to Brucella melitensis, his classification and description of the disease became widely accepted regardless of the species of Brucella causing infection. Cases were included in Hughes' studies only if the evidence was sufficient to "prove" the diagnosis. Hughes' classification of brucellosis has been criticized in that he did not describe cases of chronic disability.2 Bassett-Smith, in 1903,3 however, described patients with "chronic brucellosis" who had persistent ill health, with fatigability and inability to carry on normal activities even in the face of a declining or negative agglutinin titer and without physical abnormalities. Acute