Such are the most characteristic marks of thoracic affection in typhus; as an illustration of which, as it occurs, perhaps, in the severest form ever witnessed in this country, the following case may be cited.
Case XIV.
Alexander Crombie, æt. 19, seaman.
The mate of his vessel states that, notwithstanding some previous indisposition, three days ago he was on duty; that while on watch, about eleven o’clock at night, he became too ill to remain at his post, and that, since that time, he has scarcely spoken a word. At present he is incapable of giving any account of himself. He is dull, stupid, and, when roused, is scarcely able to answer coherently; he does not speak, but he is constantly picking at the bed-clothes; there is extreme restlessness; the countenance is heavy and inexpressive; the features in general are swollen, the lips especially, which are also extremely parched. The entire skin is dusky, but the cheeks are of a deep red colour, approaching to a purple hue; the integuments of the eye are dark; the conjunctiva injected; the tongue brown and quite dry; the lips and teeth sordid; respiration oppressed; occasional cough; pulse from 130 to 140; small and thrilling; skin, especially over the scalp, hot; tenderness of abdomen on full pressure.
4th. Cerebral symptoms the same; cough frequent, difficult; respiration short and hurried; pupils dilated, not contracting on exposure to light; conjunctiva injected; pulse small, hurried, irregular; all the stools passed in bed; pressure over the abdomen induces cough and apparently excites pain. Died in the evening. See pathology.
III. Typhus Mitior, with Abdominal Affection.
To the account of abdominal affection in typhus, it is necessary to add nothing to that already given of abdominal affection in synochus, excepting that, in the former, pain in the abdomen is scarcely ever felt; tenderness on pressure is less acute, and it is more common for both to be absent. On the other hand, the abdomen is more often swollen, hard, tense and tympanitic, while the stools are more early and more constantly passed involuntarily. It is in this type of fever, also, that hæmorrhage from the bowels most frequently takes, place—an event not very uncommon in the severest and the most protracted examples of the disease. The tongue, also, is less constantly red than in the abdominal affection of synochus; but it is more uniformly dry, black and cracked.
Since the full exposition of pathology requires that many examples of this affection should be detailed under that head, and since, however numerous and striking such examples may be, they can illustrate no characteristic symptom beyond what has been already stated, it is unnecessary to cite any cases of it here.
IV. Typhus Mitior, with Mixed Affection.
Whenever the brain, the lungs, and the intestines become simultaneously and prominently affected in typhus, the case no longer assumes the mild, but lapses into the severer form. We shall, therefore, speak of this complication under—