548 THE TREATMENT OF DISEASES. 



said they were comfortable, now begin to complain of pain, and awake to a sense of 

 their weakness and utter prostration. The face is pale and very thin and sunken, 

 but still it wears a more natural expression. The tongue becomes moister and more 

 movable, the motions are firmer and less frequent, and the appetite slowly returns 

 After the thirtieth day, in the majority of cases, 110 more spots appear, and the fever 

 is over. 



Thus the patient slowly passes into a state of convalescence, but his recovery is 

 often hindered by complications, or even relapses. The fever may be readily revived 

 by causes in themselves apparently trifling, such, for instance, as getting out of bed 

 too soon, too early indulgence in solid food, or mental or physical exertion of all 

 kinds. In hospitals patients convalescent for typhoid often have a return of the 

 fever on the evening of the visiting-day if their friends have been to see them. It 

 is to be feared that it is too often due to the surreptitious introduction of articles of 

 food, but in some cases it may arise purely from excitement. The appetite soon 

 returns, and the patient may be ravenously hungry. The first meal of solid food 

 often causes a temporary rise in the temperature. If food is given too early it may 

 produce a rupture of the bowel, and this may occur even after convalescence seems 

 firmly established, particularly if any serious error in diet has been committed. The 

 patient rapidly increases in weight, but it is often very long before he gets well 

 again. Even in uncomplicated cases many months may elapse before the mental 

 and bodily functions are completely restored to their natural condition. It has been 

 laid down as a rule that no man can be considered fit for work for three or four 

 months after a severe attack of typhoid. 



We have already mentioned incidentally the elevation of temperature in this 

 disease ; but it is necessary that we should enter a little more fully into detail on 

 tnis point. The course of the temperature is of the greatest value in determining 

 not only the nature of the case, but its probable termination, the existence of 

 complications, and the line of treatment, both medicinal and dietetic, to be adopted. 

 Liebermeister, a very eminent German physician, says : " The great practical 

 importance of the determination of the temperature is more evident in typhoid fever 

 than in any other febrile disease. It may well be asserted that a rational treatment 

 of typhoid fever, without following the temperature, is not possible ; and that any 

 physician who does not make two or more observations of the temperature every 

 day neglects his duty. The common remark, that such observations are applicable 

 to hospital but not to private practice, has been found to be erroneous. To .measure 

 the temperature in the rectum, or even in the axilla (armpit), requires so little time 

 that a physician who does not have the requisite leisure can hardly treat such a 

 patient at all. Besides this, nurses sufficiently intelligent to use the thermometer 

 are requisite for any proper treatment of these patients. A physician can really 

 treat his patient better if he only sees him once a day, but has a good ther- 

 mometrical record kept by the nurse, than if he makes several visits and does not 

 employ the thermometer." 



The nature of the disease can in typhoid fever be determined by the temperature 

 alone, although, of course, the fact does not justify us in neglecting other symptoms. 

 If you were to show a physician the chart of the temperature taken twice a day, he 



