TYPHuID FEVER. (333 



phoid fever do not correspond to any marked clinical stages, so as to 

 enable us accurately to distinguish the symptoms corresponding to the 

 stages of congestion, typhus infiltration, sloughing, and ulceration, and 

 to give the symptoms of these different phases of the intestinal dis- 

 ease. Nor does the time that has elapsed since the first chill give any 

 definite clew to the pathologico-anatomical stage of the bowel affec- 

 tion ; but, on the other hand, we may suppose that, at the end of the 

 third, or, at latest, at the end of the fourth week, the true typhus pro- 

 cess has terminated, and that any existing morbid symptoms are only 

 its remains, and belong to the secondary diseases of the blood and of 

 different organs, induced by the typhus infection. Therefore Hamer- 

 nik makes " a first and second period of the typhus blood-crasis ; " in 

 his communications from the Pfeufer's clinic, Vogel speaks of two 

 groups of symptoms, the " intoxication " and the " reaction " symp- 

 toms ; Griesinger makes a " first and second period of the disease." 

 We also shall divide the symptoms into two classes, and shall speak 

 first of the symptoms of the disease itself, afterward of the symptoms 

 of the sequelae. As we mentioned above, the former occur in the first 

 three or four weeks of the disease, the latter later in its subsequent 

 course. 



Even during the first week the patient becomes very weak and 

 much prostrated ; but few can leave their beds during the first days ; 

 at the same time they complain of headache, which is chiefly in the 

 forehead ; of vague pains in the extremities, of buzzing in the ears, 

 flashes before the eyes ; of dizziness, which is particularly severe when 

 they rise in bed, or attempt to walk. The sleep is restless and broken 

 by dreams, in which the patients often speak single words, or whole 

 sentences, in a loud voice. During the first week, while awake, the 

 patient is usually perfectly conscious, but shows little interest in 

 things around, and answers slowly and unwillingly to questions. 

 There is great thirst, no appetite ; there is a slimy or bitter taste in 

 the mouth ; many patients ask for an emetic, because their stomach 

 is out of order. Occasionally there is diarrhoea, but at first the 

 bowels are usually constipated, and it is not till the end of the week 

 that the patient has several pulpy or even fluid stools daily ; in still 

 other cases, the bowels remain constipated throughout the week, and 

 induce imprudent physicians to prescribe laxatives. If these or an 

 emetic be given at the commencement of the disease, they almost al- 

 ways induce severe diarrhoea, which it is difficult to arrest. The pas- 

 sages are rarely accompanied by much pain. During the first week 

 of typhoid, there is often repeated epistaxis, which is not apt to be 

 abundant, and which relieves the headache. In most, but not in all 

 sases, cough and mucous expectoration betray the bronchial catarrh, 



