insidious; it begins with an "out of sorts" feeling, aching pains in the limbs, headache, loss of appetite and chilliness. For many days the sufferer is able to go about and think there is not much the matter. Sometimes there is diarrhœa. Then the pulse is quicker, the skin hot, and the tongue red and dry. At the end of the first week or later he is feverish, has no appetite, is thirsty, and the bowels are generally relaxed. The urine is scanty and high-coloured; there is still more restlessness at night. Between the seventh and twelfth day an eruption, consisting of a few slightly-raised, rose-coloured spots, makes its appearance. They are generally situated on the abdomen and chest, but they may occur over the whole body. These disappear in 2 or 3 days, but fresh crops come in their place. Pain may be experienced, and gurgling felt on pressing over the right side of the abdomen. About the middle of the second week delirium comes on. The tongue is dry, red and glazed, and often cracked. As the disease advances the patient loses flesh and strength; he lies prostrate and perhaps unconscious of what is going on around, and, if it is to end fatally, he will become quite insensible, have a high temperature, and fumble at the bed-clothes. If the disease progress favourably the symptoms abate during the fourth week, the temperature gradually falls to normal, and the patient slowly recovers.
Complications.—Diarrhœa may be profuse and exhaust the patient. Bleeding from the nose may occur, but is not often a bad symptom; bleeding from the bowel is common and, if large in amount, is of serious import. Perforation of the bowel may occur from an error in diet; it is attended by collapse and is very dangerous. Inflammation of the peritoneum adds greatly to the danger. Bronchitis and pneumonia may supervene and increase the mischief.
Treatment—Place the patient in a well-ventilated room. Remove all curtains, carpets and bed-hangings. Prevent exertion on the part of the patient. The greatest cleanliness must be observed, and all excreta removed at once, perchloride of mercury, carbolic acid, Sanitas, or chloride of lime being mixed with them. The diarrhœa need not be checked unless excessive, and then a little starch injection may be made. The diet must be very light, and no solid food should be taken under six weeks or two months, because in consequence of the ulceration of the bowels the coats are very thin and liable to burst. Absolutely nothing should be given to the patient beyond what has been ordered by the medical attendant. Milk must form the main article of diet, and then an egg or two may be beaten up in it, or a custard may be given and beef-tea. If there is much intestinal distension hot flannels sprinkled with turpentine will be useful.
Typhus Fever.—This is a highly infectious fever which occurs in epidemic form, generally in periods of famine and destitution. For it was often confused with typhoid fever, and the difference between the two has only been recognized within the last fifty years.
