In the second week the patient is free from pain in the head and
limbs; but the giddiness is distinctly worse, and there is so much
humming in the ears that he is practically deaf. The facial expression
becomes dull, the mouth stands open, the eyes are without life. The
consciousness is blurred, desire for sleep takes entire possession
of the patient, and he often sinks, not into actual sleep, but into
a leaden lethargy. At other intervals there are the loud and excited
ravings of delirium. The patient’s helplessness is complete, and
his uncleanliness becomes repulsive. His gums, teeth, and tongue are
covered with a blackish deposit which makes his breath foul. He lies
motionless on his back, with distended abdomen. He has sunk down in
the bed, with his knees wide apart. Pulse and breathing are rapid,
jerky, superficial and laboured; the pulse is fluttering, and gallops
one hundred and twenty to the minute. The eyelids are half-closed, the
cheeks are no longer glowing, but have assumed a bluish colour. The red
spots on breast and abdomen are more numerous. The temperature reaches
105.8°.
In the third week the weakness is at its height. The patient raves
no longer: who can say whether his spirit is sunk in empty night or
whether it lingers, remote from the flesh, in far, deep, quiet dreams,
of which he gives no sound and no sign? He lies in total insensibility.
This is the crisis of the disease.
In individual cases the diagnosis is sometimes rendered more difficult;
as, for example, when the early symptoms--depression, weariness,
lack of appetite, headache and unquiet sleep--are nearly all present
while the patient is still going about in his usual health; when they
are scarcely noticeable as anything out of the common, even if they
are suddenly and definitely increased. But a clever doctor, of real
scientific acumen--like, for example, Dr. Langhals, the good-looking
Dr. Langhals with the small, hairy hands--will still be in a position
to call the case by its right name; and the appearance of the red spots
on the chest and abdomen will be conclusive evidence that his diagnosis
was correct. He will know what measures to take and what remedies to
apply. He will arrange for a large, well-aired room, the temperature
of which must not be higher than 70°. He will insist on absolute
cleanliness, and by means of frequent shifting and changes of linen
will keep the patient free from bedsores--if possible; in some cases it
is not possible. He will have the mouth frequently cleansed with moist
linen rags. As for treatment, preparations of iodine, potash, quinine,
and antipyrin are indicated--with a diet as light and nourishing as
possible, for the patient’s stomach and bowels are profoundly attacked
by the disease. He will treat the consuming fever by means of frequent
baths, into which the patient will often be put every three hours, day
and night, cooling them gradually from the foot end of the tub, and
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