24 CLINICAL OBSERVATIONS 



results which are tabulated (Table VII, pp. 37, 38, and 39) cprro- 

 borate the estimate of other workers in regard to the certainty 

 and value of this test. 



11. CLINICAL COURSE 



In the progress of the cases in our wards after admission the 

 two outstanding symptoms aside from the usual manifesta- 

 tions of continued fever were delirium and cough. Delirium 

 was a marked feature in 86 cases, and undoubtedly existed 

 though in a less demonstrable form in more cases than could be 

 recognized, since not a few patients who had been quiet and 

 apparently rational through their illness later had no memory 

 of having been in our wards. In general the delirium was of a 

 peculiarly active type, noisy and violent, with constant at- 

 tempts to get out of bed and with violent resistance to all 

 nursing ministrations. It seemed to increase in severity from 

 the time of admission early in the eruptive stage until the be- 

 ginning of defervescence when in favorable cases it diminished 

 rapidly, and in certain unfavorable cases it gradually passed 

 into a partial or almost complete coma to be described later. 



Cough was troublesome and exhausting in 69 cases. Except 

 in the earlier stages it was accompanied by profuse mucopuru- 

 lent expectoration. Hoarseness or aphonia was frequent. As 

 the disease progressed the musical rales present in a large pro- 

 portion on first examination tended to disappear, while crepit- 

 ant rales especially at the bases became commoner. At some 

 time in the disease these coarse moist rales were present at one 

 or both bases in 144 cases, and often were more or less widely 

 distributed through both lungs. Local signs of consolidation, 

 dullness with bronchovesicular or bronchial breathing and 

 whisper, occurred in 16 of the cases that recovered. These are 

 believed to have had confluent bronchopneumonias with the 

 exception of one who developed a typical lobar pneumonia im- 

 mediately after the defervescence of a severe typhus. Terminal 

 bronchopneumonic symptoms, with or without demonstrable 

 consolidation, occurred in 18 fatal cases. 



In severe cases of typhus fever the delirium of the earlier 



