﻿142 ASHBUKN AND CRAIG. 



central coat, with a red tip and edges. It remains moist throughout and 

 shows no tendency to fissure. The breath is heavy and at times foul, 

 especially in cases showing constipation. 



The appetite is practically always impaired or absent for the first few 

 days. By the third or fourth day most of our patients were very hungry 

 and asked for full diet, which all but two or three of them relished. 



Xausea and vomiting occurred in a few cases, as did diarrhoea. This 

 last was profuse and watery, but Ave never saw either mucus or blood in 

 the stools, though both are said to occur at times. The vomiting and 

 diarrhoea which we observed always occurred at the onset of the disease, 

 and not as manifestations of the crisis. 



As a rule, slight constipation is present, necessitating the administra- 

 tion of laxatives. As our patients were all soldiers leading active lives 

 and taking much exercise, it is not improbable that the inaction of 

 hospital confinement had as much influence as the disease in producing 

 the constipation. 



Nervous symptoms. — The most constant of these, the pains, have 

 already been discussed. In three eases we have had delirium, that in one 

 was very mild, in another slightly more marked, and in the third at- 

 tended with marked hysterical symptoms and hallucinations. In all 

 three cases the delirium was observed only at night, and in two it occurred 

 as the patient was falling to sleep and may have been merely the manifes- 

 tation of troubled dreams. The other case, Case 10, was as severe a one 

 as we saw, but even in it the symptoms pointed rather to hysteria than 

 to meningitis, and we afterwards learned that the patient had for several 

 years, been subject to nervous attacks, beginning when he was a small 

 boy and continuing until about two years ago. He also had an attack, 

 similar to the one he showed during his fever, a short time after 

 his return to duty. In this attack he got out of bed, ran about the 

 room, shouted, wept and talked to his mother, who was of course not 

 present. He was quieted, and the next day was impressed with the folly 

 of his conduct and the necessity for maintaining self-control. Since that 

 time, now nearly three months, he has had no trouble, and has performed 

 his full duty. 



We have not seen the ''meningeal type" of the disease as it has been 

 described by others, nor have we heard of any such cases occurring 

 during this epidemic. We have not seen peripheral neuritis, unless some 

 of the pains were due to such lesions, in which case the neuritis did 

 not outlast the other symptoms and must have been trifling. 



Insomnia was frequently observed while the fever was high and the 

 pain severe. It was so evidently dependent on these causes and dis- 

 appeared so soon that it did not require treatment. 



Disturbances of the circulatory apparatus should probably be considered 

 here. A considerable minority of patients complained of pain or dis- 



