2S 



ress of the disease. There is nothing peculiar about the character of 

 the vomited matter in any but some of the grave or the fatal cases. 

 At first it may consist of food remnants or of such liquids as may 

 have been swallowed; later it consists of "a thin mucus, which soon 

 becomes bile-stained. In some grave cases, about on the third day, 

 sometimes on the second, but more commonly on the fourth or fifth, 

 streaks of red or black may be detected in the vomited matter. These 

 strea'ks are more or less altered blood and are the first signs of black 

 vomit., In some cases it does not go beyond this, but in some very 

 severe cases and in most of the fatal ones the vomited matter soon 

 becomes more or less uniformly black in color. In some fatal cases 

 black vomit does not manifest itself during life, but is found post- 

 mortem. In the severer cases there is sometimes associated with the 

 vomiting or retching more or less distressing hiccough. In the cases 

 terminating favorably the gastric irritability gradually diminishes and 

 disappears. The bowels are usually constipated. The movements are 

 at first natural in color and remain so in all but some of the grave 

 cases, in which tb^ may become dark and tarry. Some tenderness, 

 especially in the severer cases, can usually be elicited by pressure in 

 the epigastric region as early as the second day. Abdominal pains of 

 a colicky character -are occasionally complained of; sometimes they 

 are very severe and cause the patient intense suffering. 



JTrine. — In mild cases and in those of moderate severitv the urine 

 may show but slight alteration in character as regards quantity and 

 density. In severer cases it becomes reduced in volume and somewhat 

 in specific gravity. Complete suppression is not a rare occurrence in 

 fatal cases. The suppression may, however, only be apparent and due 

 to retention, as may be demonstrated by catheterization. 



In -all but the mildest cases albumin appears in the urine at some 

 time in the course of the disease. It may appear within 24 hours 

 after the onset, though usually not until the end of 48 hours; or 

 it may delay its appearance until after the subsidence of the fever. 

 At first it appears only in small amounts — a slight trace, perhaps — 

 which in some cases is not increased, while in others it rapidly aug- 

 ments in volume up to 80 to 90 per cent. In favorable cases the ' 

 amount begins to diminish almost at once or very soon after the 

 maximum has been recorded, and will be found to have disappeared 

 in from three or four days to two or three weeks from the time it first 

 appeared. In some cases, however, the albuminuria is very transitory 

 and, may not be detected unless every specimen of urine passed be 

 examined. When jaundice is present, biliary pigment appears in the 

 urine, as may frequently be noted when making the nitric-acid test 

 for albumin. Albertini and Guiteras a report the absence of the diazo 



a Guiteras, 1904b, p. 594. 



