TYPHOID FEVER. 27 



leaving the raw surface exposed, and the teeth are covered with 

 sordes. The pulse becomes more feeble and frequent, there is a low 

 muttering delirium, and sometimes twitching or spasm of the muscles. 

 As the patient becomes more feeble he slips down to the foot of the 

 bed ; there are involuntary evacuations, hemorrhage from the bowels 

 or other mucous surfaces, with petechia? and vibices upon the skin. 

 This is the usual course of the disease when it terminates unfavour- 

 ably. If the disease is to terminate favourably, the symptoms abate, 

 the countenance brightens, the tongue cleans, the pulse lessens in 

 frequency, and the evacuations become more healthy. It often 

 happens that at this time the emaciation becomes more evident than 

 it was before. 



Sometimes in the course of the second week, the patient is seized 

 with intense pains in the abdomen, vomiting of green, bilious matters, 

 a small fluttering pulse, syncope, constipation, and coldness of the 

 extremities. The cause of these symptoms is perforation of the in- 

 testine, and escape of its contents into the cavity of the peritoneum, 

 producing inflammation. It occurs most frequently in the mild forms 

 of the disease, and is almost uniformly fatal. 



Anatomical characters.— -There is scarcely an organ of the body 

 that may not be the seat of some anatomical lesion. Those which 

 are considered characteristic of this fever, however, are thickening, 

 hardening, sqfteni?ig, and ulceration of the glands of Peyer ; the 

 condition varying with the stage of the disease. Enlargement, soft- 

 ening, and idceration of the ^nesenteric ganglia, more especially 

 those corresponding with the morbid patches in the intestine, and, 

 according to some writers, ulceration of the solitary mucous follicles 

 of the ileum. 



Other lesions met with are, ulceration of the pharynx and epiglottic 

 cartilage; softening of the spleen, sometimes of the liver and kidneys; 

 hepatisation of the lungs; softening of the heart ; and sometimes in- 

 flammation of the meninges of the brain with eflM.ision. The blood 

 drawn in this disease is generally deficient in fibrine, and is said by 

 some authors to contain an excess of blood-corpuscles ; this is doubtful. 



Cause.—On this point little is definitely known. It attacks all 

 classes, rich and poor, though it is often generated where a number 

 of persons are crowded together, with unwholesome, or insufficient 

 food, and confined and vitiated air. It cannot be said either to be 

 contagious, since it is very seldom if ever communicated in isolated 

 cases. 



Age is a predisposing cause. It rarely attacks those beyond 

 thirty. Strangers are more liable than long residents, and males 

 than females. It may occur at any season, but most commonly in 

 the autumn and winter. It rarely occurs more than once, hence, 

 perhaps, its comparative infrequency in the aged. 



Diagnosis. — By the slowness and insidiousness of the attack ; by 



