Nervous symptoms are not always marked. In severe cases there may be delirium, stupor, twitching of the muscles, picking at the bed-clothes, and coma.
The face is dull and listless. The tongue is coated and tremulous. In severe cases it becomes dry, brown, and fissured, and sordes tend to collect upon the teeth.
Relapses are common. In some cases they are due to the too early use of solid food, to excitement, or to overexertion.
When typhoid fever is prevalent, the most reliable preventive measures consist in thorough boiling of all water and milk used for drinking purposes and the avoidance of uncooked vegetables, oysters, and shell-fish.
Management.—Unless otherwise directed take temperature, respiration, and pulse every three hours, in mouth or axilla, as desired. If for any reason a change is made in taking temperature, it should be noted on the chart. Note the effect of sponging or of bathing upon temperature and pulse. Note the character of pulse, and effect, if any, which stimulants have had upon it. Note the amount of cough, and the character and quantity of the expectoration; also any pain that may occur in the chest.
Note the amount of flatulence and the number and character of the stools; especially be on the lookout for blood or undigested food in the discharges.
Note carefully any abdominal pain, any increase in the distention, as these symptoms, with or without a rather abrupt fall in temperature, chills, and pinched features, are suggestive of perforation.
Treatment for Hemorrhage.—Stop all orders immediately, including diet. Elevate the foot of the bed. Give morphin sulphate, gr. ¼ (gm. 0.015), hypodermically, and apply an ice coil or iced compresses to the abdomen until the physician arrives.
Note the occurrence of vomiting and the character of vomit.
Be on the lookout for retention of urine, which is quite common. Note the amount of urine passed in a day and any abnormalities connected with its appearance.