

TYPHUS FEVER. 



wiiile awake have a muttering delirium. Ot tiers are excited and rest- 

 less, have anxious, wild fantasies, and can scarcely be kept in bed. 

 At my first visit I found one of the patients, sent to me from jail with 

 exanthematic typhus, in a strait-jacket. Besides these symptoms 

 of disturbed innervation, there are almost always signs of intense 

 catarrh during the invading stage ; the eyes shun the light, and are 

 red ; there is an increased flow of tears ; the nose is dry and stopped 

 up, or its secretion is at first fluid, afterward more tenacious, and dries 

 to crusts ; the act of swallowing also is often difficult and painful, the 

 tongue has a white coating, the taste is slimy ; occasionally there are 

 nausea and vomiting, and not unfrequently some diarrhoea. These 

 symptoms are absent, or only slight, in some cases ; a more constant 

 one is a painful, hoarse cough, which brings up a tough mucus, occa- 

 sionally mixed with blood. On auscultation we hear numerous ronchi. 

 We have but few exact observations as to the grade and course of the 

 fever ; these are especially due to Wunderlich. According to these, 

 even at first the temperature rises to 104 to 106 ; the pulse is usually 

 large, full, soft, rarely double, and beats about 100 in a minute. From 

 the great loss of water from the body of the patient, induced by the 

 increased perspiration due to the high temperature, the thirst is great, 

 the urine scanty and of high specific gravity. Even in this stage, en- 

 largement of the spleen may usually be discovered by percussion. 



With the first appearance of the roseola spots, which occurs in the 

 second half of the first week, usually between the third and fifth, rarely 

 on the seventh day of the disease, the stadium eruptionis et florescetir 

 tice begins (if we keep up the analogy between exanthematic typhus 

 and the acute exanthemata, which, however, only exists at first, and is 

 subsequently lost). At first the spots are few in number and only 

 appear on the trunk, but they soon multiply and spread toward the 

 neck and extremities, till finally the entire body, except the face, is 

 covered with them ; at some places they are more numerous than at 

 others ; the eruption is only exceptionally scanty ; but even in these 

 cases it is more extensive than the roseola eruption in abdominal 

 typhus. The exanthema lasts longer than it does in measles or scar- 

 latina ; the roseola spots do not disappear till toward the end of the 

 second week, when the fever defervesces and the other symptoms sub- 

 side. The longer the roseola spots last, the more their bright-red color 

 changes to a livid hue ; they then disappear imperfectly under the 

 oressure of the finger ; part of them often change to petechias. The 

 general symptoms do not improve with the outbreak of the eruption. 

 It is true the patients complain less of pain in the head and limbs, 

 but this is only because their mind is more affected ; they can no 

 longer think clearly, give slow and incomplete answers to questions, 



