TYPHOID FEVER. 547 



illusions and hallucinations, and speak in a loud voice and gesticulate violently. 

 There is now profuse diarrhoea, there being usually from four to six motions in the 

 twenty-four hours, and often more. The stools are commonly fluid, of a yellow- 

 ochre or drab colour, and have a sickly offensive odour. In general appearance 

 they somewhat resemble pea-soup, to which they are usually compared. Ai'i. -r 

 standing for a little while they separate into two layers, the upper a turbid brownish 

 fluid, and the lower a light feathery-looking mass. These stools soon decompose, 

 and if you take a little slip of red litmus paper and drop it in, it will turn blue, 

 indicating that they are alkaline. Some medicines, such as iron, bismuth, lead, 

 silver, and copper, darken the motion, and when these have been taken the stools 

 will be of a dark greenish-brown or blackish colour. 



From the seventh to the tenth day the rash usually makes its appearance. It 

 is very slight, and unless care be taken it may be entirely overlooked. The spots 

 are about the size of a pin's head, or even smaller, and are of a pale rose colour. 

 They are few in number, usually not more than from half a dozen to a dozen bring 

 seen at once. The total number during the whole course of the disease seldom 

 exceeds fifty. They occur most frequently on the chest and abdomen, and not 

 uncommonly they first make their appearance just where the collar-bone joins the 

 breast-bone. On pressing on them with the tip of the finger they disappear for a 

 few seconds and then gradually return. They appear in successive crops, each 

 individual spot lasting for two or three days and then slowly fading away. On the 

 first day of the rash only two or three spots may be observed, and on the next, four 

 or five fresh ones, and on the following day as many more. If it is desired to 

 watch the progress of any individual spot, it may be readily identified by drawing 

 rouncj it a little circle of ink with a quill pen. It is said that the rash is occa- 

 sionally absent all through the disease, but if carefully looked for will nearly always 

 be found. Sometimes numerous small transparent spots containing fluid appear on 

 the chest and abdomen. They are known as sudamina, and are caused in most cases 

 by excessive perspiration. They are not of the slightest importance ; they occur in 

 the progress of many diseases, and must not be confounded with the characteristic 

 rash of typhoid fever. 



In the third week the symptoms continue with undiminished vigour, and even 

 increase in intensity. The patient becomes so weak that he can no longer raise 

 himself, but lies in a relaxed condition in the lowest part of the bed. The stupor 

 may reach such a degree that the greatest difficulty is experienced in arousing the 

 patient. The urine and faeces are usually passed involuntarily. Sometimes, how- 

 ever, the urine is not passed at all, the bladder becomes distended, and the use of an 

 instrument may be required. It is very necessary to watch typhoid patients to see 

 that they pass their water. 



During the fourth week there is a change for the better, the temperature falls, 

 the symptoms are alleviated, and evidences of returning interest in life appear. 

 The motions are no longer passed involuntarily, or should this occur the patient is 

 annoyed by it, and expresses his sorrow. The sleep soon becomes more natural, and 

 the patient is refreshed by it. Patients who during the whole course of the disease 

 appear to have suffered hardly at all, and who as long as they could answer always 



