TYPHOID OR ENTERIC FEVER. 129
It may arise from mere extension of irritation from the bowel; from intestinal perforation; from rupture of glands or of the spleen; or from perforation of an ulcer in the gall-bladder.
Urinary Organs.—The kidneys are sometimes congested; or they may have their tubes choked up with detached epithelium. The mucous coat of the bladder may be congested or inflamed.
Blood and Organs of Circulation.—There is nothing very special here. The blood is dark and fluid and does not coagulate, if there have been typhoid symptoms before death, but these characters are rare in typhoid fever compared with typhus. The white corpuscles are increased, and disintegrating red corpuscles are sometimes seen. The heart may be a little softened.
Respiratory Organs.—There may be congestion, various forms of inflammation, œdema, or ulceration of the larynx, the last-mentioned not being due to any specific deposit. Signs of bronchitis, hypostatic pulmonary congestion or œdema, pneumonia, or pleurisy may be evident. The bronchial glands are sometimes enlarged.
Nervous System.—This presents no particular alterations. There may be excess of serum in connection with the brain and its membranes.
Symptoms.—1. Incubation-stage.—The period of incubation in typhoid fever is of doubtful duration. It most frequently extends beyond 10 days, and may be much longer than this. There are no distinctive symptoms. Sometimes the incubation-period appears to be very short if the poison is concentrated, the disease setting in with vomiting and purging, attacking a number of persons at the same time, and giving rise to a suspicion of irritant poisoning.
2. Actual attack.—It is scarcely possible to divide this affection into distinct stages, but at the same time it often presents periods in its progress, which are marked by tolerably characteristic phenomena. The invasion is ordinarily very indefinite and gradual, and the patient cannot fix the exact date of the commencement of the attack. Frontal headache, with giddiness and noises in the ears; general pains in the limbs, with a feeling of lassitude and illness; restlessness and disturbed sleep; slight, irregular chills; diarrhœa, with loss of appetite, furred tongue, and not uncommonly nausea and vomiting, are the ordinary symptoms at the outset. Sometimes there is much abdominal pain. Diarrhœa may be the only prominent symptom for some time. Occasionally repeated epistaxis occurs. Soon there are signs of pyrexia, increasing towards evening. It frequently happens that the patient does not feel sufficiently ill to take to bed for some days, but follows his occupation, and it is not an uncommon event for patients to come to the hospital after having been poorly for many days, thinking that there is not much the matter with them, while they sometimes walk about during the entire illness. Murchison has seen cases in which at first the symptoms of typhoid fever resembled those of ague.
Early stage.—The disease being established, the symptoms present during the first week or ten days are as follows:—
The general appearance does not indicate any great prostration, and although a certain degree of depression is felt, it is not very
