Pains in the back and limbs, varying in intensity, are experienced in a large proportion of cases. Pain fid sensations and hyperresthesia in the feet are often noticed. Neuralgia,' especially of the trigeminal nerve, occurs in some cases.
Delirium is one of the most frequent nervous symptoms. Its severity is not always in proportion to the severity of the disease, but depends, to some extent, on the individual. When, however, the delirium is active and uncontrollable, the prognosis is usually grave. It does not generally begin until the middle of the second week and ceases in the stage of convalescence. Sometimes it occurs only in the night, or for a few hours after waking, but it is usually continuous. In rare cases it is one of the earliest symp toms, and it occasionally lasts for three or four weeks after defervescence. The delirium is generally of a low, mutter ing character. The patient will try to get out of bed, but is easily induced to return. Sometimes the delirium is active and almost maniacal. A suicidal mania may develop, and, on that account, as well as to prevent injury, a patient in typhoid delirium should never be left alone. In some rare instances the same delusions are noticed from day to day throughout the disease. The writer had once a case in which the delusions of grandeur were manifested continuously. The patient was extremely happy, paying out enormous sums of money and making handsome presents to all his friends.
In many cases where delirium is not present the patient will answer questions in a rather incoherent manner, and even when nothing can be noticed which would indicate mental aberration. He will not afterward remember anything which has occurred during the course of the disease.
In a few cases the delirium is of an hysterical character, and the differentia tion between it and hysterical mania is made by the comparatively-mild type of the former.
In the third week, when the disease is severe, the patient may pass from delir ium into an unconscious condition, which is marked by muscular tremor, carpho logia, and subsultus tendinum. The urine and farces are passed involuntarily.
The patient has a strange expression, and, although the eyes arc wide open and the patient seems to follow the move ments of his attendants, he is quite conscious: a condition to which the term coma vigil has been given.
Convulsions are rare and occur most frequently in children. They may, in adults, follow thrombosis of the arteries or veins of the brain, when they take place late in the disease.
Neuritis occurs in a small number of cases. It is sometimes general, but, as a rule, the lower extremities are affected, causing a paraplegia. llemiplegia is a rare occurrence.
Poliomyelitis, varying in severity, may follow typhoid fever.
Study of the tendon-reflexes in ty phoid fever. In 32 cases out of 100 these are exaggerated; in 22 out of 100 they undergo no change: they are dimin ished in 17 eases out of 100, and abol ished in 29 out of 100. The preservation of the normal reflexes are noted espe cially in the benign cases and those with pronounced gastric symptoms. Daring the course of convalescence a marked tendency to exaggeration of the reflexes was observed. The epileptoid trembling of the feet was found in 20 cases out of 100, but it was less frequent than the exaggeration of the patellar reflex. This tremulousness was observed espe cially after repeated percussion of the patellar tendon. This condition does not seem to manifest itself at the drop of the temperature, but often coincides with profuse sweats and polyuria and appears to deserve notice as a true crit ical phenomenon. The percussion of the tendon of Achilles sometimes provokes in typhoid fever an epileptoid trembling of the foot. The epileptoid trembling of the knee is not unusual in typhoid fever. P. Item linger (Revue de Med.. Jan. 10, 1901).
The Skin.—A peculiar capillary injec tion of the skin is frequently noticed. This is of a bright-red or dark-red color and of an erythematous character. When present, it is usually found during the first week.
The odor of typhoid fever is of such a distinctive character that by means of it a diagnosis can sometimes be made. Cases have been reported in which a peculiarly distinctive odor was noticed, which was the forerunner of death. In one instance the other symptoms were not, at the time, of an alarming char Deter.