TYPHUS FEVER. 29 



times there is nausea and vomiting. The bowels are costive, and 

 no stools are procured without medicine. The aspect of the patient 

 is peculiar ,* the countenance is of a dusky hue, with injection of the 

 eyes ; the features are fixed and inexpressive, or expressive only of 

 apathy and indifference. 



As the disease advances the symptoms augment in violence ; the 

 heat of skin increases, the pulse rises in frequency, and diminishes 

 in force, ranging generally from 120 to 150, or 160. The respira- 

 tion is frequent, and, according to Gerhard, feeble and imperfect at 

 the back and lower part of the chest, which is also dull on percus- 

 sion. At a period ranging from the fourth to the eighth day, a 

 peculiar eruption appears upon the surface, not confined, however, 

 to any particular locality. It varies in colour from a dusky reddish- 

 brown to purple or black. It is not elevated above the surface, 

 neither does it disappear upon pressure. It is petechial in character. 

 Sudamina are rare in this disease. The tongue becomes dry, brown 

 and cracked ; the urine scanty and highly coloured ; the dejections, 

 when procured, black and offensive ; a peculiar ammoniacal odour is 

 exhaled from thebody ; the nervous symptoms become more prominent, 

 there is dizziness, confused vision, tinnitus aurium, and sometimes 

 deep stupor, which becomes characteristically more profound as the 

 disease advances. Sometimes violent delirium (typhomania) takes 

 the place of stupor ; the patient is sleepless or restless, with the sen- 

 sation of utter prostration and helplessness. Should no improvement 

 take place the disease passes on to the last stage, that of prostration. 

 The patient lies insensible, or in a muttering delirium, with subsultus 

 tendinum, floccitation, hiccough, involuntary evacuations, and extreme 

 insensibility of the surface, till at length death approaches silently 

 and without violence. 



Sometimes a critical discharge takes place from some organ and 

 the patient begins to convalesce, which is generally, however, by 

 slow degrees, and under the influence of supporting remedies. 



The duratio7i of the disease varies, sometimes, in mild cases, ter- 

 minating on the seventh day, sometimes running out to three weeks 

 or more. Death rarely occurs before the second week. 



Anatomical characters. — There is only one constant lesion, (and 

 it is questionable whether it can be considered entirely characteristic,) 

 that is, the want of coagulability in the blood, and the petechial erup- 

 tion ; all the other lesions may be considered incidental. No disease 

 is discovered in the glands of Peyer, unless in some few cases, in 

 which there is a complication with typhoid fever. A very fatal form 

 of typhus fever prevailed among the black' population of Philadelphia, 

 in the fall of 1847. Many died at the onset of the disease. A num- 

 ber of post-mortem examinations were made but the results were 

 uniform in but few particulars. The blood was fluid and uncoagu- 

 lated, resembling the settlings from claret wine. Petechise were not 



3* 



