ACUTE INFECTIOUS DISEASES. 



and after their recovery they scarcely remember this period, during 

 which they are in a quiet or noisy, violent delirium, and sometimes 

 make constant attempts to jump out of bed and run away. They 

 often become very hard of hearing. The tongue is dry and covered 

 with a brownish crust; the cough has usually subsided, but the res- 

 piration is superficial and rapid ; ronchi are more numerous, and at the- 

 dependent parts of the chest the percussion-sound is often dull. In 

 some cases there is constipation, in others there is more or less diar- 

 rhoea, and the urine is often passed involuntarily. According to Wun- 

 derlich, in mild cases the fever retains till the end of the first week 

 the height that it had attained the third or fouth day of the disease, 

 or in the second half of the first week there is a slight decrease of the 

 temperature, and on the seventh or eighth day a decided remission. 

 In severe cases, on the contrary, the temperature increases during the 

 second half of the first week, and there is no remission the seventh 

 day. At this time the pulse is often very small and soft, and its fre- 

 quence corresponds to some extent with the height of the temperature, 

 so that in mild cases the pulse is about 100, in severe ones 120 or more, a 

 minute. Toward the end of the first week even, the spleen is usually 

 enlarged. In the second week, while the exanthema becomes more 

 livid, all the symptoms increase, and about the middle of this week 

 they attain their height. Then the patients lie almost constantly on 

 their back, the eyes half closed, the knees rolling outward, the hands 

 between the thighs, they are in a deep stupor from which they can 

 scarcely be awakened. From time to time they mumble unintelligi- 

 bly, make grimaces, gesticulate, pick the bedclothes, attempt to rise, 

 and to thrust the feet out of bed, and it is evident that while all sense 

 of shame and propriety is gone, and the real world is lost to the 

 patients, they still live in an imaginary world, and their minds are 

 more or less active. They do not appear thirsty, although the tongue 

 is dry, and often covered with a blackish hard crust ; but, if a glass of 

 water be placed to their lips, they show great avidity for drink ; at- 

 tempts to satisfy their thirst often fail, because the tongue trembles 

 or is stiff and immovable, and the act of swallowing is more difficult. 

 The nostrils are usually filled with a sooty crust, the teeth and gums 

 are covered with a smeary coating, whose decomposition causes a dis- 

 agreeable fetor ex ore. In many patients the skin is at this time 

 covered with petechiae and miliary vesicles ; in some there are symp- 

 toms of pneumonia and extensive atelectasis, in others those of par- 

 otitis. Not unfrequently the urine contains albumen. The abov^ 

 symptoms of severe constitutional disease and great disturbance ol 

 innervation, as well as those of pneumonia, collapse of the lung, paro 

 titis, etc., occur even m those cases of exanthematic typhus that run s 



