2i8 DISEASES DUE TO BACTERIA 



The bacilli are not so numerous in the peripheral circulation, but 

 more plentiful in the spleen, fasces, urine {33 per cent, of cases), and 

 rose spots. 



Liver and gall-bladder symptoms may set in. 



B.P. diminished, dicrotism perhaps has disappeared. 



Cold extremities. Vomiting rare. 



The typhoid state may set in, lips and teeth being covered ^ith 

 dark brown scales (sordes), tongue dry, furred, fissured, pharynx 

 inflamed or ulcerated. More or less meteorism always present, and 

 may be very troublesome. Reduction in red cells, Hb. and leucocytes 

 shown, but the mononuclear leucocytes are increased. Coagulability 

 of blood reduced. 



Third Week : — 



Temperature falls by lysis to normal about the twenty-first day, and 

 with this symptoms may subside and convalescence begin. In some 

 cases profound symptoms may appear. The heart is weak and rapid. 

 The lungs congested, fatal. Epistaxis possible. Perforation not 

 uncommon (3 per cent, of cases). Subsiltus tendinum often present. 

 Emaciation increases. Liver dulness encroached upon by the tym- 

 panites and breathing becomes thoracic. LTrine may be suppressed. 

 Peritonitis or collapse may cause death. 



Fourth Week : — 



Temperature becomes normal; convalescence begins. 



Watch for relapses. 



In severe cases the status typhosus may continue; the heart may 

 fail, for the myocarditis is considerable. 



The varieties are according to^ the severity of the symptoms, am- 

 bulatory, abortive, mild, typical, severe and masked. H^emorrhagic 

 cases have been known, when there has been bleeding from the mucous 

 membrane, tongue, gums, bladder and intestines, also purpuric 

 eruptions. 



In Ceylon the disease caused by B. paratyphosus, viz.. Paratyphoid 

 fever, is indistinguishable from Typhoid fever, though it generally 

 runs a milder course. The intestinal ulcers are identical with those of 

 typhoid. Cases of mixed infection are not rare. 



COMPLICATIONS. 



Malaria very important. 



Haemorrhage from bowel, nose and mucous surfaces. 



Perforation mav occur in mild cases. 



Peritonitis, with or without perforation. 



