5th. Eight ounces of blood which were drawn not sizy; crassamentum
loose; pain of head not at all relieved; sense of weight distressing; no
sleep; much restlessness; heat over the scalp pungent; pulse 104; tongue
more dry; tenderness of abdomen the same; six stools.
6th. Pain of head still severe; mind more confused; passed a more
restless night; pulse 116.
10th. Pain of head undiminished; eyes more suffused; extremely restless
night, during which delirium came on; this morning muscular tremor has
appeared; pulse 124.
12th. Pain of head entirely gone; scarcely at all sensible; constant
muttering delirium; muscular tremor with subsultus tendinum; two stools
passed in bed; pulse 124; abdomen still painful on firm pressure, and
has become swollen and tense.
13th. Insensibility and delirium increased; constant incoherent
muttering; extreme prostration; erysipelas has appeared on the forehead,
and is spreading to the scalp: pulse 128; two stools passed in bed.
14th. Died.
II. TYPHUS MITIOR, WITH THORACIC AFFECTION.
Prominent thoracic affection, as we have seen, is not infrequent in
synochus; in typhus it is more constant; and the signs which denote its
existence are more obvious, but they are not precisely the same. The
pain in the chest is less severe; it is more often absent altogether;
while the sense of stricture and the dyspnœa are more urgent. The cough
is more constantly attended with mucous rattle; the respiration is
shorter and more hurried. The skin in general is cooler, and it is
always more dusky. The dark colour of the skin, in severe cases,
becoming quite livid, is one of the most characteristic marks of intense
thoracic affection. The colour of the cheek is at first of a deep and
vivid red; as the disease advances it becomes of a purple tinge, and at
length it is quite livid. In these cases it is not uncommon for the
respiration to be from forty to fifty in a minute. The pulse is
invariably rapid and weak. The cerebral affection is equally peculiar
and characteristic; it never consists of intense excitement; it is never
accompanied with violent delirium; it is indicated by confusion and
stupor passing rapidly into coma; and is attended with low muttering
incoherence or disjointed rambling, the trains of ideas that pass
through the mind being extremely faint, and linked together by no
distinguishable affinity. We know that one of the most essential
conditions to the due exercise of the sensorial faculties is the due
supply of the brain with arterial blood; but in this state of the system
arterial blood does not and cannot circulate through the brain, because
it is not formed in the lung: the patient is in a state approaching to
asphyxia, and in very severe cases he remains for several days in as
perfect a state of asphyxia as seems to be compatible with life. Why
debility should, in these cases, be carried to the utmost possible
extent; why such cases should form the most exquisite specimens of the
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