SYMPTOM A TOLOGY 



1385 



rate, or by a slight drop in the temperature. In sudden severe cases 

 of haemorrhage the facies alters, becoming pinched and pallid; 

 the pulse increases in frequency, and the temperature drops perhaps 

 quite suddenly. In very severe cases a sudden fatal collapse may 

 take place before any sign of blood has been visible in the motions. 



More or less meteorism is always present during this week, and 

 at times this becomes a great trouble to the patient, and very 

 rarely may reach to such a degree that it embarrasses the heart's 

 action. It is dangerous in that it favours perforation, which may 

 occur in this week, but is more commonly met with in the third week, 

 under which heading it will be described. 



Usually the spleen is distinctly enlarged during this week, and 

 the blood shows an anaemia due to the reduction of red blood cells, 

 while the haemoglobin and the leucocytes are also reduced. The 

 leucopenia is due to a reduction of the polymorphonuclear leuco- 

 cytes and eosinophiles, while the mononuclear leucocytes are usually 

 increased in numbers. The presence of a marked leucocytosis 



Fig. 659c. — Temperature Chart of a Case of Paratyphoid B Fever. 

 (Chart made by Major Archibald.) 



would indicate the occurrence of some complication. The coagula- 

 bility of the blood is reduced. 



Pain and tenderness may occur in the right hypochondrium over 

 the area of the gall-bladder, and is often due to a slight attack of 

 cholecystitis, which may also be indicated by slight enlargement of 

 the liver, slight jaundice, and rigidity of the abdominal muscles. 



The lungs should be carefully watched during this period, as lobar 

 pneumonia may occur, and as the symptoms are not marked, and 

 rusty sputum is rare, it may be overlooked. 



Rarer symptoms during this week are local neuritis, tetany, eye 

 troubles, and ear complications; but muscular cramp is by no 

 means rare, and may cause great inconvenience to the patient. 



The urine is febrile, and may contain albumen. The diazo- 

 reaction may appear before the rash, or may be deferred as late as 

 the end of the third week. Bacilluria is found in about one-third 

 of the cases, while urobilin and indicanuria are also fairly frequently 

 met with. Acetone and diacetic acid occur, but may be due to the 



