28 CLINICAL OBSERVATIONS 



The blood pressure in a series of 23 cases on which daily 

 determinations were made during their period in our wards was 

 in most cases abnormally low. Systolic pressures under 80 and 

 diastolic pressures under 50 occurred in several cases. The 

 pressures from day to day changed little, but in most there was 

 a slight rise with defervescence often followed by a slight de- 

 pression in early convalescence. Our observations did not tend 

 to confirm the theory that low blood pressure is an important 

 factor in unfavorable prognosis, since in the three fatal cases in 

 this series the blood pressure was higher than the average in all. 

 The number of cases, however, is too small to warrant general 

 conclusions. 



The respiration curve showed less irregularity of rate than 

 the pulse curve. Most cases showed moderate to marked ac- 

 celeration through the febrile period. The graphic curve, how- 

 ever, fails to show the true state of the respiration. Many cases 

 of uncomplicated typhus would breathe rapidly with gentle 

 shallow respiratory movements, without dyspnoea or discom- 

 fort. When, however, bronchopneumonia supervened the 

 dyspnoea rapidly became urgent although the rate as recorded 

 on the chart showed no such conspicuous change as was evident 

 from looking at the patient. 



The duration of fever in cases that recovered, according to 

 the best information that we could obtain as to time elapsed 

 before admission, was commonly about two weeks. We esti- 

 mated that defervescence occurred by days of disease as fol- 

 lows: 9th day, 1 case; 10th day, 5 cases; llth day, 12 cases; 

 12th day, 13 cases; 13th day, 25 cases; 14th day, 42 cases; 15th 

 day, 27 cases; 16th day, 14 cases; 17th day, 10 cases; 18th day, 

 3 cases; 19th day, 2 cases; 20th, 21st, and 22d days, 1 case each. 

 Error in histories may account for some of these variations, but 

 in general the early defervescences occurred in mild cases, 

 particularly in younger patients, while the long courses were 

 commonly severe ones. 



Deaths occurred on days of disease as follows: 7th day, 1; 

 8th day, 2; 10th day, 1; llth day, 5; 12th day, 3; 13th day, 1; 

 14th day, 3; 15th day, 2; 16th, 17th, 18th, 21st, 24th, and 27th 



