632 AFFECTIONS OF THE INTESTINAL CANAL. 



pillow, while it is occasionally relieved by binding a towel firmly 

 around the head. The patient does not sleep at all, or is disturbed by 

 dreams. The symptoms of disease of the stomach or intestines vary. 

 Usually the appetite is lost, the tongue coated, the taste slimy or bit- 

 ter, the breath is bad, the patients complain of a feeling of pressure and 

 fulness in the epigastrium, and are sensitive to pressure there. There 

 is also eructation of gases and fluids, usually acid products of abnor- 

 mal gastric digestion. Occasionally there is repeated vomiting. At 

 first there is usually constipation ; but later, particularly when the dis- 

 ease is protracted, there is diarrhoea, preceded by more or less colicky 

 pain ; the stools are fluid, and colored green by bile, and are sometimes 

 mucous. 



Occasionally these symptoms pass off quickly, and the patient, who 

 is one day in a sad plight, feels quite well the next (ephemera). At 

 the same time herpetic vesicles not unfrequently come on the lips. 

 We should not consider this a distinct disease, a febri's herpetica. 

 Herpes labialis accompanies gastric fever as often or perhaps oftener 

 than it does pneumonic or intermittent fever, and has the same sig^- 

 nificance in the former disease as in the latter. But the disease does 

 not by any means always terminate in one day ; it often continues 

 several days, but rarely longer than a week. In persons who do not 

 bear well the feverish increase of temperature, or the consumption 

 caused by the increased development of heat (we have frequently said 

 that individual peculiarities vary greatly in regard to this), there is 

 great depression, the mind is affected ; instead of dreams, the patient 

 has delirium ; and, if at the same time the tongue become dry, the 

 similarity with typhus is very great. It often happens that the true 

 nature of the case is only explained at the sixth or eighth day, by the 

 sudden improvement and the rapid convalescence. 



In consideration of the difficulty of diagnosticating gastric fever 

 from a commencing typhus, it is advisable to be very guarded in diag- 

 nosis and prognosis during the first week. It would be very danger- 

 ous for the reputation of the physician, if, after he has pronounced the 

 disease to be gastric fever, and promised improvement from day to 

 day, it should develop with all its terrors in the second or third week. 

 But it will compromise the doctor just as much if the supposed nervous 

 fever terminate in cure at the end of the first week, and the patient 

 be able to walk out a few days later. Even the laity no longer believe 

 that under certain circumstances " gastric fever " may become " gas- 

 tric nervous," and this again develop into "nervous fever." They 

 know that these two diseases are of different nature from the first. 

 In making a differential diagnosis during the first week, great atten- 

 tion should be given to the etiology. If there have been injurious 



