64-2 ACUTE INFECTIOUS DISEASES. 



toward the end of the second week, and the subsequent course of the 

 disease is as above described, are rare. Even in abortive typhus, 

 the sleep is restless and disturbed by dreams, and patients talk in 

 their sleep during the second week ; but when awake their mind is 

 clear, and only a more or less marked apathy reminds us of the coma 

 vigil of severe cases. The bronchitic symptoms are moderate; the 

 daily evacuations are few in number, or there is no diarrhoea. The 

 patient looks pale and worried rather than blue and sodden. The 

 tongue is inclined to dryness, but is not covered with a firm crust. 

 There is either no deafness, or else it is only slight, like the oral and 

 pharyngeal catarrh. The abdomen is soft and only moderately promi- 

 nent. Frequently there is no ileo-caecal gurgling or sensitiveness of 

 the abdomen to pressure. The spleen-dulness is but little increased. 

 Only exceptionally a few roseola spots occur on the epigastrium. 

 During the morning, and while the patient remains in bed, the pulse 

 is only moderately hastened. In the third week, or toward the end 

 of the second, the temperature is usually normal, and is only elevated 

 moderately toward evening ; the tongue remains moist, and the patient 

 begins to have some appetite. The morbid symptoms of the thoracic 

 and abdominal organs have disappeared, particularly the diarrhoea. 

 Many patients are anxious to get up ; but, on attempting to rise or 

 move about the room, are usually surprised at their feebleness, of 

 which they were not aware while in bed. The strength returns slowly, 

 and this tardy convalescence shows the severity of the disease that 

 the patient has had. The conjecture above advanced, that in abortive 

 typhus there is no sloughing of the diseased intestinal glands, is not 

 founded on post-mortem examination, for which the favorable course 

 Df the disease gives no opportunity, but on the early cessation of the 

 diarrhoea, and the absence of the sequelae, so common in severe and 

 tedious cases of typhus, especially of those depending on retarded cica- 

 trization of the intestinal ulcers, and on the ulceration occurring in 

 their place. 



There is a second modification of typhus which differs materially 

 from that above described ; it is usually termed typhus ambulatorius. 

 It is not very rare for persons who have only suffered from a slight 

 amount of weariness and depression, loss of appetite and slight diar- 

 rhoea, but have still been able to attend to business, or go on a jour- 

 ney, to die suddenly of perforation of the bowel or intestinal haemor- 

 rhage. On autopsy of such cases, we may find numerous intestinal 

 ulcers along with sloughing patches and medullary infiltration of the 

 mesenteric glands ; in short, the anatomical changes of advanced ty- 

 phous disease of the intestines. It is difficult to explain this peculiar 

 form of disease, except on the supposition that, under some circum- 



