Filatow states that the mortality of children varies between 3 and 10 per cent. against 17 to 25 per cent. in adults, yet severe epidemics occur, for instance one reported by Guinon in Paris with a mortality of 17.5 per cent.
Moreover, the course of the disease is shorter in children, the dura tion of the several stages being less and symptoms which later are highly dangerous, as intestinal hfemorrhages and perforation, are exceedingly rare, there being no ulceration, or only rarely and this only in older children. The onset as a rule is unnoticed, showing itself in different ways, disposition to sleep at an un usual hour, restlessness at night, loss of appetite, mild disturbances of digestion such as eructations, mod erate vomiting, and constipation; thus inconspicuously, the disease is slowly ushered in until the fever with its somewhat characteristic steps is present. The latter may be divided properly into three stages—a period of gradual ascent of temperature (called stadium in crementi by Filatow), continuous fever, and defervescence. The first period exhibits an evening ex acerbation of temperature each morning higher than the preceeding morning and then a steady rise of fever. In the second stages the difference between morning and evening temperature is only slight, .5 to 1.5° C. (1° to 4° F.), and in the third stage the temperature descends to the normal in the morning while in the evening there is a slight increase, and this gradually diminishes. The aggregate duration of the fever in light and medium cases is 2; to 3 weeks, of which 3 to 5 days may be allotted to the first stage and as ninny days to the third stage, while the period of continuous fever lasts 10 to 14 clays.
As a matter of course, there are numerous deviations from the type just described. There may be a longer duration of the fever (up to 40 days and more), the so-called "formes prolongees" of Cadet de Gassicourt, as well as a shorter or abortive course; sudden onset with sharply rising temperature, observed especially in quite young children: a critical fall of the fever; the so-called inverted type, in which the morning tem perature is higher than the evening. For the most part the fever remains at a mean height in the first years of life not exceeding 39° to 39.5° C. (102°-103° F.), but occasionally there are considerable elevations of temperature up to 41°-42° C. (106°-107.6° F.), which are usually well borne by the youthful patients as is fever generally. A sudden drop of the temperature, with simultaneous bad appearance of the patient, whose face becomes pale and pointed, is as a rule indicative of intestinal lieinorrhage or perforation and is, therefore, a sign of had omen.
The frequency of the pulse increases slowly and not excessively, so that the rate closely corresponds to the fever or is even slower. Only in case of the occurrence of some dangerous complications, in cardiac weakness and in the death agony does the pulse become thready and hardly perceptible. Dicrotism is frequently present, but on account of the smallness of the arterial tube it cannot be easily detected by the pal pating finger. During the period of convalescence, the pulse frequently becomes slower and at times irregular.
Concerning the blood pressure we have investigations made by Carriere and Doncourt, from which we learn that at the beginning of the affection the arterial tension drops from 13 or 14 to S or 7, but during the second phase slowly rises from 9 to 2S. During the period of defervescence and convalescence, comes a second decrease of pressure. followed slowly by a return t.o normal conditions. Increase of blood pressure may occasion intestinal haemorrhages, pulmonary congestion, delirium, etc. Myocarditis is not always accompanied by a decrease of the blood pressure.
The younger the child, the less the accompanying nervous symptoms, which for the most part are confined to apathy and restlessness at night. The typhoid state which is so characteristic in the adult with highly flushed or pale cheeks, injected conjunctivre, dull expression, etc., is rare. At most a hyper-excitability prevails, such as tossing about in bed, tremor of the hands, hyperwinia of the face, uncanny lustre of the eyes or finally even convulsions. A furibund delirium, alternating with deep stupor, points to a cerebral disturbance especially when rigidity of the neck and back muscles, picking of the bed clothes, deep sighing, grinding of the teeth, and other symptoms characteristic of meningitis set in. During convalescence aphasia may occur as I have seen in a case observed jointly by Escherich and me, which presented also symptoms of idiocy. Similar cases have been reported. In another case under my observation after defervescence, there occurred an eclamptic attack lasting a day and a half with resulting imbecility. Delirium from inan ition, melancholic depression, transitory paralysis of various muscles, etc., are by no means rare sequelte of grave typhoid and all of these point to a severe intoxication.