ADDITIONS TO THE REVISED EDITION OF 1880. 74-1 



or defective drainage. Typhoid is relatively rare during pregnancy, 

 but doubts are rising against the old view that it hardly ever occurs 

 in the puerperal state. 



The period of incubation probably varies, but seems to average 

 about fourteen days. 



The parenchymatous degeneration of the muscles of the heart 

 may result in passive dilatation ; the feeble action following the de- 

 generation may induce disturbances of the circulation, especially 

 emboli, particularly if the weakened contractions favor coagulations 

 in the heart, and particles from these coagula pass from the right 

 heart into the lungs or from the left into the aorta, and reach the 

 spleen, kidneys, etc., causing haemorrhagic infarctions and possibly 

 abscesses. Venous thrombosis, especially of the crural vein, not 

 unfrequently follows the impairment of circulation. 



Among the nervous symptoms, besides the febrile delirium or 

 stupor, there may be others referrible to cerebral redema or haemor- 

 rhage, meningitis or embolism ; mental disturbances, which usually 

 recover ; paralyses of the facial, ocular, or vocal muscles, or para- 

 plegia. If these paralyses cannot be attributed to severe changes 

 in the nervous centres, they usually recover. 



Besides the albuminuria, which disappears with the disease, 

 there are sometimes haemorrhagic infarctions or even diffuse ne- 

 phritis. 



In severe cases of typhoid, bed-sores are not uncommon in spite 

 of the greatest care, and as a sequel of the disease there may be 

 numerous furuncles. 



According to Liebermeister, from 7 P. M. to 8 A. M. is the best 

 time for baths ; this being the natural period for remission, if the 

 patient can be kept for several hours at a temperature approach- 

 ing normal, he may better stand a brief increase of temperature. 

 Another good time for the bath is about noon, at which time also 

 most patients show a tendency to remission. 



Menstruation, which usually comes in typhoid at its regular time, 

 is customarily regarded as a centra-indication to baths ; but in severe 

 cases they may be continued, as they may with almost any of the 

 complications, such as diarrhoaa, meteorism, etc. Even in threaten- 

 ing paralysis of the heart, some stimulant may be given, and fol- 

 lowed by short tepid baths. 



