38 Symptomatology. 



totally lacking. But no change is found in the digestive 

 tract. Not infrequently a patient in an advanced case 

 continues eating even when it can no longer stand on 

 its feet. 



The peristaltic action of the intestine is usually 

 normal, but sometimes it is a little accelerated. The 

 faeces are normal, but near the fatal termination they 

 are softened or sometimes coated with a slimy mucus. 

 By the time this stage is reached the anus is relaxed 

 in many cases and temperature reading is thus rendered 

 impossible. 



Spleen.— The swelling of the spleen is a constant 

 phenomenon during the febrile attacks, as can be detect- 

 ed by rectal examination. In chronic cases or inter- 

 febrile periods, the swelling varies in degree. In the 

 cases of extreme anemia, the spleen is swollen very 

 little or not at all. 



Urogenital system. — The oedema of the scrotum 

 and prepuce and the petechiae of the vaginal mucous 

 membrane are usually found. Increased frequency of 

 micturition and also increase of urine in quantity are 

 constant symptoms. The urine is light yellow or brow- 

 nish yellow, thin and turbid. Its reaction is alkaline in 

 most cases. Its specific gravity is normal (1.028-1.045). 

 Albumin is always present during febrile attacks, the 

 maximum being 10.5 9^. During interfebrile periods and 

 in chronic cases, no albumin is found. The solid con- 

 stituent usually decreases. 



General character of blood.— The patient's blood is 

 thin, and poor in coagulatings power. The plasma and 

 corpuscles are quickly separated. The separation of 

 serum is not so good as normal. This is especially the 

 case with the chronic or severe form of the illness, in 

 which coagulation does not take place after several days' 



