TYPHOID FEVER. 641 



*:ant modifications of its course, and the severest and most dangerous 

 accidents that present themselves. 



First, there are many cases which are not characterized by any re- 

 markable lack of intensity of the symptoms, or by any other peculiari 

 ties during the first week ; but in the second week the symptoms do 

 not grow worse and prove dangerous, as in " normal " typhus, but 

 they decrease, and toward the end of the second or third week have 

 all disappeared. Lebert has proposed the name abortive typhus for 

 these cases, and it seems to me preferable to other names, such as 

 " febricula," " febris typhoides," etc., because it better expresses the 

 fact that these cases are only modified, benign, brief forms of typhoid, 

 and not a peculiar variety of disease. After what we have said, it 

 would be a useless repetition to give a description of the course of 

 abortive typhoid during the first week ; so we shall only remark, that 

 many of the cases which former writers call " gastric fever " or " mu- 

 cous fever " are to be regarded as abortive typhus. The old customary 

 precaution, of waiting till the ninth day of the disease before saying 

 whether the case was " one of gastric or nervous fever," was and still 

 is very justifiable. The designations " gastric fever " and " nervous 

 fever," in common use, exactly correspond to what modern physicians 

 mean by " abortive typhus " and " normal typhoid," and since the laity 

 do not understand precise scientific terms, it would be well to keep up 

 this old custom. As in the first week the thermometer is the most 

 certain means of distinguishing typhoid from a genuine febrile gastric 

 and intestinal catarrh (Yol. I.), so in the second week it is the most 

 certain means of deciding whether the disease will be an abortive ty- 

 phus or not ; the other symptoms are far more deceptive. If we find 

 thv-t on the eighth or ninth day of the disease the temperature ceases 

 to rise, but gradually falls, and especially if we find decided morning 

 remissions at this time, we may be almost certain that the case is 

 one of abortive typhus. Cases where the temperature rises again 



exacerbations ; late occurrence of the daily remissions ; and very high temperature at 

 any time. 



In the third week, in mild cases, there are great morning remissions, so that the 

 morning temperature may be three to three and a half degrees lower than the even- 

 ! ng temperature, and may become normal toward the end of the week. And from 

 the middle of the week the evening temperature also decreases. In severe cases, on 

 the other hand, the temperature sinks but little during the third week, or else it 

 maintains the same height, or even rises. In the latter case, we may almost posi- 

 tively expect a severe fourth week, and not look for a decided decrease of the fever 

 before the fifth week. 



"We. may look for the approach of death, if the temperature remain for some timo 

 at 107 J ; if it suddenly rise to 107.5 or 108, or when it suddenly falls very low, say 

 to 94. We must not expect perfect convalescence till the temperature is normal in 

 the evening also. 



