646 ACUTE INFECTIOUS DISEASES. 



DF seventh week, or even later, of this slow form of typhoid. Ju other 

 cases the diarrhoea ceases, the intestinal ulcers heal ; but the bed-sores 

 nduce fatal exhaustion ; at least, we not unfrequently find deep de- 

 struction of the soft parts and exposure of the bones, and recently- 

 healed intestinal ulcers, as the only post-mortem appearances in cases 

 that have proved fatal late in the disease. The pneumonias, pleurisies, 

 suppurations of the parotid, diphtheritic inflammations of the intestines, 

 nephritis, and other sequelae of typhoid above mentioned, show them- 

 selves, just as in other debilitated persons, by objective rather than by 

 subjective symptoms. Chills, and renewed increase of the bodily tem- 

 perature, should excite the suspicion of one of these consecutive diseases 

 and induce a more careful examination. Repeated chills, very high 

 temperature, quick collapse, generally depend on pyaemia, induced by 

 absorption of ichor from the bed-sores. The occurrence of severe pain 

 in the larynx, hoarseness, aphonia, and the signs of acute laryngeal 

 obstruction, indicate perichondritis laryngea, which is caused by ty- 

 phous laryngeal ulcers penetrating deeply, but also occurs indepen- 

 dently of this as a sequel of typhus. 



Lastly, we must mention that in some cases perforation of the in- 

 testine occurs in the fifth or sixth week, not only while the patient is 

 debilitated by the fever, induced by sluggish ulcers, but even while 

 convalescence is going on perfectly well. Far more rarely haemor- 

 rhages occur at this time, from slowly-healing ulcers. 



Recovery is the most frequent termination of typhoid fever ; it 

 takes place in about three-fourths of all cases ; but some epidemics are 

 far more malignant, while in others the mortality is much less. In 

 most fatal cases death occurs in the second or third week of the dis- 

 ease, that is, at its height ; but we have already stated that, where 

 the course is very rapid, the disease may prove fatal in the first week, 

 and, in protracted cases, not till the fifth or sixth week, or even later. 

 The different causes of death have been sufficiently described when 

 speaking of the symptoms and course. 



Sometimes typhoid ends in incomplete recovery ; sequelae, such as 

 disturbances of innervation, neuralgias, partial paralyses, partial anaes- 

 thesias, or mental disturbances, remain ; occasionally typhus leaves a 

 tabes and a lasting anaemia and hydraemia, which are not thoroughly 

 understood. The material changes on which these disturbances of in 

 nervation depend have not been discovered on post-mortem examina- 

 tion. The supposition, that the remaining sickness and the deficient 

 formation of blood depend on destruction of the intestinal glands and 

 impermeability of the mesenteric glands, is incorrect. Pulmonary con- 

 sumption not unfrequently develops during convalescence from severe 

 typhoid fever. 



