123 
4n°c.) in extremely severe ones. In very virulent and practically 
fatal cases, the temperature may rise even higher. The pulse may 
have diminished ten or more beats. 
Although the vomiting has ceased there may be more tenderness 
over the epigastrium and sensations of burning or pain are felt. The 
thirst still continues. The skin is less moist. The cephalalgia and 
pains in the back and limbs are acute. The urine is probably free 
from albumin and still scanty in amount. 
By the end of the second day the pulse begins to fall to ioo, go or 
So, and the temperature has remitted one or two degrees. The 
tongue is still coated, the injection of the mucous membranes persists 
but is lessened. The congested appearance of the head is less 
marked, the eyes are less suffused, the headache and the pains in the 
loins and limbs are ameliorated. 1 he patient feels better, 
urine probably contains a little albumin, which gradually increases in 
amount. 
During the next twenty-four hours the temperature commences 
to fall, dropping as much as one to two degrees, the pulse decreases 
but at the same time it becomes irregular and without tone, 
albumin increases slightly; jaundice is usually apparent. e 
general symptoms of the patient improve, and, if it is a mi 
of the disease, the temperature and pulse will gradua y a 
normal or subnormal by the fifth or sixth day, all the symptom 
decreasing by degrees. In a more severe type defervescence 
so rapid; there may be epistax.s, some oozing from *e gnms 
the albumin in the urine may have increased from to to 3 0 gra 
per litre. These symptoms only persist foi a short time 
temperature and pulse usually remain subnormal for six o 0 
days. Bradycardia is common, and a pulse of 40 or 35 is no 
If you recollect the microscopical appearance of the organs 01 a 
fourth day case, you will remember that up to this time ^ 
have only shown congestion and slight cloudy swe mg ,* of the 
periglomerulitis, swelling and desquamation of t e epi ^ ^ the 
tubules with congestion of the small vesse s in 1 t ^ e third 
kidney. The liver exhibits greater changes, an , eve " n , there 
day, the hepatic cells will show vacuoles in spaces 
will be an infiltration of small round tel s 
