TYPHOID FEVER. 639 



crease of the temperature and of the pulse. The morning remissions are 

 indistinct. Fatal termination is most common in the third week , if not 

 induced by some peculiar accident, death results from cedema of the 

 lungs, after the prostration, weakness, temperature, and pulse have 

 reached the highest grade. The more the respiration is affected, the 

 sooner and more readily paralysis of the heart occurs. In favorable 

 cases there is a subsidence of the symptoms about the middle of the 

 third week. The state of deep sopor, during which the patient lives 

 a dream-life, gives place to natural sleep. While awake, the expres- 

 sion of the patient shows that he pays some attention to the things 

 about him, which, at the height of the disease, had no existence for 

 him ; he also recognizes his attendants. The first glance in which 

 affection and gratitude again appear may be regarded as an advance, 

 although the danger is not yet over, and although the hopes awakened 

 by this and other signs are often blasted. The more quiet and con- 

 tinued the sleep, the clearer the intellect usually is during the waking 

 state. The patients begin to complain of the bed-sores, and to lie on 

 the side, so as to avoid pressure on the sore parts. They no longer 

 pass their urine and faeces in bed, but call for the bed-pan when they 

 wish to have a stool, or empty the bladder. The number of respirations 

 decreases, the patients cough oftener, and more strongly, and easily 

 expectorate the mucus collecting in the bronchi, which has become 

 less tough, and is usually yellowish. The passages are less frequent, 

 and contain some consistent matter. The blue, sodden appearance of 

 the patient disappears, the face becomes paler. The tongue grows 

 moist at the edges and tip, its coating is gradually thrown off; speech 

 becomes more intelligible ; there is less difficulty in drinking. We 

 hear moist rales in the chest, the dulness along the spine disappears ; 

 even at these points the respiratory murmur becomes distinct, mete- 

 orism decreases, the spleen dulness grows less, the roseola spots dis- 

 appear. With the abatement of the other symptoms, the difference 

 between the morning and evening temperatures becomes remarkable ; 

 while the thermometer placed in the axilla still rises to 104 to 106 in 

 the evening, in the morning it is often only 101 to 103, or even less. 

 These lower degrees are not observed in the evening for some time 

 yet. As the temperature decreases, the pulse also falls, although the 

 two do not keep pace. At the same time the pulse becomes fuller, 

 and loses its rebounding character. This general improvement, which 

 often does not occur till the fourth week, while the symptoms have 

 maintained their intensity, or even increased till the end of the third 

 week, often passes directly into convalescence, and the slow recovery 

 alone shows that remains of the typhus process, especially intestinal 

 ulcers, still exist ; in other cases, the improvement is only temporary ; 



