TYPHOID FEVER. (537- 



patients, who are just as insensitive to the external world, who denude 

 themselves without any modesty, do not answer questions, and scarcely 

 react to the strongest irritants, show by their whole manner that they 

 are living in an excited dream ; they are constantly agitated, throw 

 off the bed-covers as fast as they are replaced ; thrust first one foot, 

 then the other, out of bed, attempt to stand up or run away, talk loud 

 or disjointed words, gesticulate, speak unknown tongues, and become 

 morose and angry when they are held or in any way restrained 

 (febris nervosa versatilis). It is astonishing what energy and persist- 

 ence such patients often show in attempting to carry out their morbid 

 impulses. Occasionally, during the entire disease, a certain circle of 

 hallucinations recurs ; the patients pursue any object that they can- 

 not attain, are grieved by any sorrow that they are constantly combat- 

 ing, etc. ; in other cases the phantasms alternate confusedly with 

 others having apparently no connection with them. Occasionally this 

 alternation is so great that during the day the case appears to be a 

 febris nervosa stupida, while during the night it seems to be a febris 

 nervosa versatilis. In some cases the patients are constipated, even 

 during the second week of typhoid fever ; but, as a rule at this time, 

 there are several watery evacuations daily. They vary in number 

 from three to six, or even to twenty or more in twenty-four hours, but 

 we cannot, from their frequence, decide the number and extent of the 

 typhus ulcers, as the diarrhoea does not depend on them, but on the 

 catarrh accompanying them ; it is exceptional for the stools to be ex- 

 cessively frequent, and it is most common to have only three or foui 

 passages daily. The dejections have the color and appearance of 

 badly-cooked pea-soup, in which the meal is not thoroughly mixed, 

 but has sunk to the bottom. They have an alkaline reaction, contain 

 uniy traces of albumen, and have no microscopic elements or chemical 

 constituents peculiar to typhus. The upper watery layer contains 

 chiefly salts, and owes its alkaline reaction to the large amount of car- 

 bonate of ammonia in it. The lower stratum consists of remains of 

 food, detritus, epithelium, mucous corpuscles, numerous crystals of triple 

 phosphates, and small yellow flocculi and globules, of whose origin and 

 character we know nothing definite. Respiration is hastened and 

 superficial. In some cases, in spite of the extensive catarrh, there is 

 neither cough nor expectoration ; in other cases the patients cough a 

 good deal, and expectorate quantities of tough mucus. The objective 

 symptoms also have changed to some extent in the second week. The 

 cheeks are now more brownish red or bluish, the eyelids are half- 

 closed, there is dried mucus at their corners, the conjunctiva is injected, 

 the nostrils smoky-looking. A brown, tough mucous, fuliginous coating 

 clings to the teeth and gums, and the tongue is covered with a browr 



