:iOID FEVER. 549 



would in most cases be able to tell you if it were typ! r from v 



patient suffered. In well-marked simple cases of typhoi.l, tin- ntiro duration of 

 the fever is from three to four weeks. This time may be eamnit'ntly dividitl into 

 four periods which we shall speak of as weeks, but each of which may vary in 

 duration from five to ten days. 



During the. first week the fever gradually and steadily increases in inten- 



During the second week, it is constant or stationary that is to say, 

 successive morning and successive evening temperatures are almost identical 



During the third week the fever remits, that is, the successive evening 

 temperatures remain the same, but every morning the temperature is a little lower 

 than it was at the same hour on the previous day. 



During the fourth week there is a gradual fall in both morning and evening 

 temperature until at last the patient is feverish only in the evening. . 



The accompanying chart serves to illustrate these facts. It is not taken from 

 any individual cases, but gives the average course of the temperature in a large 

 number of cases, and is, therefore, to some extent diogramatic. For the sake of 

 simplicity only the morning and evening temperatures are given ; but, practically, 

 the thermometer should be employed every four hours. 



During the first week the temperature may rise from 98 '6 to 104 Fahr. or 

 more. In the third week the morning temperature may be from 4 to 6 lower 

 than the evening. Any marked alteration in the temperature is an indication tlmt 

 some change of importance either for the better or the worse has occurred. ' Often 

 in this way something is discovered which would otherwise have escaped notice. 



The temperature affords valuable information in the diagnosis of typhoid f 

 An illness is probably not typhoid fever, (1) if the temperature on the first three 

 evenings, or on two of them only, is the same ; (2) if on two of the first three 

 mornings the temperature is alike ; or, (3) if the temperature on the first two days 

 rises as high as 104. 



As we have already indicated, all cases of typhoid do not run a uniform 

 course. It frequently happens that the attack is so mild that its very existence is 

 recognised with difficulty. It is probable that in these cases a very small qua 

 of the poison has entered the system, or else that the patient is in some way we 

 do not quite understand protected, or partially protected, from its influence. It 

 would be useless to attempt to describe these slighter forms, as they present very 

 great diversity in their course. 



The complications and sequela of typhoid fever are very numerous, more 

 numerous, in fact, than in almost any other disease. In typhoid fever tin 

 inflammation, and generally ulceration of a certain portion of the bowel. This 

 condition may give rise to bleeding, and blood may be found in the stools. 

 Sometimes the motions are only just streaked with the blood, but sometimes it is 

 passed in large quantities. When the blood is not passed at once, but is ret 

 for a time in the bowel, it colours the motions black. A considerable loss of blood 

 nearly always causes a sudden fall in the temperature, and the use of the 

 thermometer will often tell us what has happened, and indicate the necessity for 

 prompt treatment, before any blood makes its appearance in the stools. 



