AND IN EPIDEMICS. 67 



is usually ushered in by nausea, followed by vomiting, 

 which at irregular intervals recurs, until the close of the 

 case in death or convalescence, a period usually of from 

 four or five to ten days. In the first stage of the attack, 

 the sufferer complains of severe pains in the limbs, but 

 chiefly in the calves of the legs, and sometimes at the 

 nape of the neck. A headache is a common event. Even 

 before the open attack, during the incubative period, con- 

 stipation is observed, and a very obstinate torpidity of the 

 bowels is a marked feature during the whole case. The 

 abdomen is commonly enlarged, and doughy, and presents 

 a very singular, diffused pulsation, most conspicuous to the 

 right- of the navel. In some cases there is gastric or ab- 

 dominal pain and tenderness, in others, even the prolonged 

 vomiting does not cause pain; but usually there is per- 

 ceived a curious and intense sense of heat at the epigas- 

 trium, which produces a desire for cool drinks, independ- 

 ently of a sense of thirst. 



As in most intense fevers, the pulse is often in this one, 

 even natural, or, while the face is flushed, the extremities 

 become frightfully cold, and the pulse falls to preternatu- 

 ral slowness or is accelerated to one hundred and ten or 

 one hundred and twenty per minute. (Buck.) In some 

 cases no sensorial disturbance is perceived, in others there 

 is intense nervousness, extending sometimes to delirium, 

 vigilance, coma. Such cases commonly prove fatal, after 

 the occurrence of singultus, subsultus, a hurried irregular 

 pulse, cold extremities and a sunken countenance.* There 

 is, according to every detailed account, a singular fetidity 

 of the breath, not like any smell known to the describers; 



* Sometimes the hair, cuticle and nails drop off. (Lea.) 

 M. Roulin tells us that in Colombia, the maize is liable to a kind of 

 fungus or ergot, which occasions the loss of nails and hair. 



