Symptoms and Course of the Disease.— The duration is usually from three to four weeks in adults in cases of recovery, though the patient may be sick many days beyond the 28th, owing to diarrhcea, loss of muscular tone, flabby heart, etc. Death may occur in the first and even the fourth week, or later, but usually takes place in the second or third week. It may result from a peritonitis set up by perfora tion of an ulcerated spot, from intestinal hem orrhage, even after all the leading symptoms are gone, from diarrhoea, pneumonia, nephritis, embolism, thromboSis, etc. The period of in cubation, which is not definitely known, is vari ously stated to be from 7 to 21 days. It is diffi cult to determine the exact time of exposure to the poison, and the onset of the attack is usually insidious.
First The disease begins with more or less fever, lassitude and aching "in the and sometimes a chill, more often a chilly feeling, especially when the hands are put into cold water or the person is exposed to cold air. Headache, pains in the back and limbs, alternations of chilliness and heat, and some times vomiting, nosebleed, diarrhoea and ten derness of the abdomen supervene. The pulse rarely exceeds 85 or 90; the tongue is moist, but covered with athin coating; the fever gradually increases, remission occurring in the morning. Toward the end of the first week the tongue becomes dry, delirium is likely to occur, weak ness is marked, consciousness is numbed and diarrhcea may increase. Toward the end of this week a rash sometimes appears, consisting of small pink spots, most abundant on the abdo men and chest, then on the back and rarely on the face and extremities. The spots continue to come out as long as the fever continues, do not coalesce, disappear under pressure, and do not become hemorrhagic.
Second The tongue is very dry; if there has been diarrhoea it increases, or may appear for the first time, and is attended by gurgling, the discharges having a peculiar "pea soup" appearance. There is more or less'ten derness over the ileo-ciecal region, due to the inflammation of Peyer's patches, and some tumidity of the abdomen. Delirium increases; temperature rises at night to 102°, 104°, F., or more with sharp declines in the morning (steeple-like rises, as shown on temperature chart) ; the pulse is frequent-100 to 120.
Third Gradually the patient passes into the third week, and symptoms slowly abate; or he grows worse; then the tongue cracks and bleeds; sordes appear on the lips, teeth and tongue; he has low muttering delirium; tym panitis is considerable; fever continues. He may recover even now, but there is the possible danger'of hemorrhage, perforation or a serious depression of the vital forces, at any stage of the disease, but chiefly in the second and third weeks. As recovery sets in the greatest care is
necessary that the patient may not overeat nor exert himself unduly, lest a relapse should occur or a serious complication be induced.
Treatment. treatment consists of rest in bed from the outset, diet, hydrotherapy and medicines. The food through most of the sick Qess should be largely liquid — milk, peptonoids, e ., and predigested material, but always ada ed to the patient's powers of digestion. If curds undigested food be seen in the stools, all food s uld be suspended for a considerable time, or gien of another kind and in small quantity evethree or four hours. Later, i bread and mil milk pudding, with rice or tap- ioca, eggs lightl boiled, poached or shirred and cocoa may be given. The patient may drink freely of water at any time, and may have fruit-juices. Wheii, the temperature has been normal for several, days he may have fish, chicken, broths, soup may carefully and gradually resume ordinary food. Sponging with tepid or cold water,' vinegar and water, or alcohol and water, and eke use of wet packs as frequently as they can\ be used with appar ently good results are often more serviceable than drugs. Yet medicinal measures are often necessary. Coaltar derivaties should never be used except to lower the teIerature, and then very carefully. as calomel and intestinal antiseptics, as useful. Ace tozone, or benzolyl-acetyl-pero ide, is now used internally as a germicide with benefit in many cases. Stimulants should only be used when there are signs of heart-failu and then in moderate quantity—brandy, hiskY, cham pagne, ether and camphor. Opium, carefully used in excessive diarrhoea or in peritonitis; ice internally, and applied to the abdomen in intes tinal hemorrhage; ergotine hypodermically; bromide of sodium, etc., produciing necessary quiet or sleep, are all of value; buit the disease cannot be shortened in its course to? any extent, though its severity may be modified. Skilful nursing, therefore, is necessary. 'The preven tion of bed-sores and the keeping the mouth clean add much to the patient's comfort and help him to recover.
Typhoid fever in children is more common than was at one time believed. It is the °re mittent* fever of childhood, the °infantile hec tic* fever, etc., and seldom occurs under one year of age. It does not conform closely to the type of typhoid in adults and differs as to distinct stages and well-defined temperature changes. It runs its course in from 10 to 20 days, and is characterized by gastrointestinal catarrh, fever, prostration, wasting, nervous symptoms and scanty isolated eruption. Sec PATHOLOGY.