320 CHAMBERLAIN. 



War Commission where the average duration was 10.5 days (19) and 

 MeCrae's large series in America where the average was 31 days. 



The initial step-like increase of temperature characteristic of the early 

 days in typhoid fever was rarely seen, the patients usually being well 

 along the first week when they came under observation. A clearly marked 

 fastigium was the rule, being present in 71 cases, 79.7 per cent of the 

 series. For 18 persons a definite fastigium was lacking, the morning and 

 evening excursions of temperature being pronounced even at the height 

 of the disease. The maximum range of fever is shown below. 



Never up to 39° A C, 9 cases. Fever up to 40°. 5 C, 45 cases. 



Never up to 40° C, 26 eases. Never up to 41°.l C, 9 cases. 



The decline of the fever was characterized by gradually increasing 

 remissions, such as are observed in typhoid in the United States, and 

 no chart was found showing the unduly prolonged intermittent stage 

 described by Eogers in India. 



Recrudescences and relapses.— -HecT-adescences occurred in 4 cases (4.5 

 per cent) the lengths of the febrile disturbances being respectively six, 

 seven, ten, and eleven days. Eelapses occurred in 7 cases (7.9 per cent) 

 lasting nine, twelve, fifteen, sixteen, seventeen, twenty-four, and twenty- 

 five days, respectively. One patient was desperately ill during the relapse. 



Pulse rate. — That the pulse rate was slow as compared with the tem- 

 perature elevation was the almost universal experience, the disease in 

 this respect conforming to the classical type in Europe and America. 

 The low pulse rate was especially commented on by Lieutenant Dulin in 

 the Ludlow Barracks epidemic where it rarely rose above 100 and was 

 often normal at the height of the disease. 



A dicrotic pulse was recorded in 13 out of the 89 cases, (14 per cent). 



Symptoms of intestinal ongrm.— Constipation was. a marked feature in 

 this series. Diarrhoea has been credited to each patient who showed 

 abnormal frequency for the evacuations at any time during the disease 

 but there were only 21 such cases out of 89, an incidence of 23 per cent. 

 Fifty-one patients (57 per cent), were constipated and, in 13 (14 per 

 cent), the bowel movements were of normal frequency. In 4 cases there 

 was no record. The percentage with diarrhoea is slightly higher than 

 that found by McCrae in his American series (17 per cent) but consider- 

 ably lower than that met with by Rogers in India, where 63 per cent 

 showed diarrhoea at some period of the disease. Curschmann in Berlin 

 found 73 per cent to have diarrhoea at some stage of the disease. 



Since diarrhoea is considered of bad prognostic significance (3) (19) it 

 may be that its low incidence among our patients is related to the low 

 death rate of 4.5 per cent which was mot with in this series. 



Abdominal pain was noted as present in 13 of the 89 characteristic 

 non-fatal cases, (14 per cent), was absent in 2 and there was no record 

 for the remainder. Tympanites was recorded for 21 patients, (23 per 



