28 PRACTICE OF MEDICINE. 



.the diarrhoea ; the dusky hue of the countenance ; the epistaxis ; 

 the gurgling in the right iliac fossa ; the tympanitis ; the rose- 

 coloured eruption ; the stupor or delirium ; the appearance of the 

 tongue ; and lastly, by the duration of the disease, and the peculiar 

 musty smell when the skin is dry, and acid smell when it is moist. 



Prognosis. — Not even the mildest cases can be looked upon as 

 free from danger, and on the other hand there is no condition so low, 

 no symptom so fatal, that death should be considered inevitable. 

 Among the unfavourable symptoms, are constant delirium, a belief 

 on the part of the patient that nothing ails him, a sudden shifting of 

 position on the elbows, deep coma, stertorous respiration, great sub- 

 sultus, rigidity of the limbs, profuse diarrhoea, or hemorrhage from 

 the bowels, great prostration and frequency of the pulse, and exces- 

 sive tympanitis. The favourable symptoms have been already 

 mentioned. 



Treatme7it. — This should usually be commenced by some mild 

 laxative, such as a small dose of sulphate of magnesia, castor oil, 

 rhubarb and magnesia, or a seidlitz powder, according to the nature 

 of the case. The practitioner should always bear in mind the diar- 

 rhoea, or the tendency to it, and avoid all irritating and drastic 

 cathartics. The next thing is to obviate febrile symptoms. This 

 may be done by venesection, when the pulse is full and strong, and 

 there is sanguineous determination to the brain. The protracted 

 duration of the disease, must also here be borne in mind, and no 

 blood drawn unless imperatively demanded. Leeches, or cups to 

 the head, and to the right iliac fossa, may be advantageously em- 

 ployed, where there are evidences of congestion in the first, or of in- 

 flammation, as evinced by pain and tenderness, in the second locality. 

 Diaphoretics are useful throughout the whole course of the disease. 



TYPHUS FEVER. 



Syn, — Typhus gravior. — Spotted fever. — Jail, camp^ and ship 

 fever. — Petechial fever. — Putrid fever. 



Sympjtorns. — Before the attack the patient often exhibits certain 

 premonitory symptoms. He is low-spirited and languid ; loses his 

 appetite, and he feels ill without knowing why. There are 

 usually at the same time sharp pains in the head, back, loins, and 

 loM'er extremities. Violent shivering is often the immediate precursor 

 of the disease ; sometimes, however, the cold stage is so slight as 

 scarcely to be noticed. 



The febrile condition, when fairly established, is generally well 

 marked. The skin is hot and dry, and of the heat of that pungent, 

 biting character called calor Tnordax. The pulse is full, frequent, 

 and possessed of some degree of strength, but is easily compressed. 

 The tongue is moist, and covered with a yellowish-white fur. Some- 



