The blood has recently been studied by Thayer, who found that the red corpus cles gradually diminished after the first week, and that the anaemia after con valescence is extreme and requires very careful treatment.
The leucocytes diminish in number throughout the disease, reaching the lowest point toward defervescence. This is an important diagnostic point, as in many inflammations the lencocytes are ranch increased.
The amount of haemoglobin is less ened in greater proportion than the red corpuscles, and its return during con valescence is slow.
The Respiratory System.—The breath ing is little affected in mild cases, but when the disease is severe the respira tions become frequent and shallow.
Catarrhal laryngitis is occasionally present, causing greater or less hoarse ness. (Edema of the larynx sometimes occurs. A sudden attack of dyspnoea may arise from inflammation and oedema. Bronchitis is so often present that it can scarcely be called a complication. It is usually mild in character. Dry and moist rifles are heard in different parts of the chest.
Epistaxis is a frequent and early symp tom. The amount of haemorrhage is usually slight, but in some cases the bleeding is so great that it is necessary to plug the posterior nares to control it. This severe form of haemorrhage occurs, as a rule, in the later stages of the dis ease.
The Urinary Systenz.—A small amount of albumin is often found in the urine of severe cases. It is of the ordinary febrile character, and is not an impor tant symptom. In the renal type min may appear at the earliest stage in large quantities and continue until the temperature falls.
In 346 cases of typhoid fever in von Leube's clinic, albuminuria was noted in 205, or in 59.2 per cent. In 37 of these 205 cases there were, besides the albumi nuria, signs of nephritis present, namely: hyaline and epithelial casts. In every case of nephritis which might be classed as idiopathic, but which has a high temperature, the urine should be exam ined for typhoid bacilli and the blood tested for W'idal's reaction. Rostoski (Munch. med. Woch., Feb. 14, '99).
Sometimes retention is noticed early in the disease, and a catheter requires to be used throughout. Incontinence occurs late in some cases.
As a rule, the amount of urine is less ened during the first week, the specific gravity increased. The reaction, which is at first acid, afterward becomes line. Toward the end of the attack and during convalescence the quantity of urine is increased and the specific gravity is lessened. uric acid is always increased in the earlier part of the disease, and the chlorides are greatly diminished.
During convalescence uric acid is dimin ished and the chlorides are increased. The toxicity of the urine is greatly in creased, especially when the cold-bath treatment is adopted. Pus is not infre quently found in the urine of typhoid patients. It may arise from cystitis or pyelitis.
The Osseous System.—In childhood and adolescence inflammation of the bone is not an uncommon feature of typhoid. The symptoms may appear during the course of the disease, but more frequently in the stage of convalescence.
[In 237 cases collected by Keen, peri ostitis occurred in 110, necrosis in 85, and caries in 13. Bacteriological exami nations were made in 51 cases. Typhoid bacilli were found in 38 and pyogenic organisms in 31. J. E. GRAHAM.] Indolence, chronicity, and a remark able tendency to recur are, perhaps, the most striking features of typhoid bone lesions. (Osler.) Complications and Sequelm.—Inflarn mation of the larynx, with stenosis or destruction of the cartilage, is an sional complication. The patient comes hoarse, and may have some diffi culty in breathing. Sudden and fatal dyspncea may take place in very weak patients, when the premonitory hoarse ness is referred to weakness rather than to local disease.
The pulmonary inflammations are the most frequent complications of typhoid fever.
In a large proportion of cases more or less hypostatic congestion is present in the posterior portions of the lungs, withstanding the care taken by the nurses to prevent it. In many this terminates in consolidation, and a true broncho pneumonia exists. This is shown by diminished resonance: fine, moist riles; and bronchial breathing heard over the affected part. Bronchopneumonia may also arise from the presence of foreign bodies (deglutition pneumonia).