er's patches and solitary
glands of the bowel enlarge, become reddish and are somewhat raised. These
go on and ulcerate until the blood vessels may be eaten into and bleeding
sometimes results, it eats through the bowel, then there is perforation
and peritonitis. The spleen is enlarged, the liver shows changes, the
kidney functions are also deranged.

Symptoms.--The symptoms are variable. The following gives the symptoms in
a typical case:

Incubation.--The period of incubation lasts from eight to fourteen and
sometimes to twenty-three days. During the period the patient feels weak,
is almost unable to work, has chilly feelings, headache and tiring dreams,
does not know what is the matter with him, constipation or diarrhea, has
no appetite, may have some pain in the abdomen which is occasionally
localized in the right lower side. Soreness on deep pressure is often
found there. In some cases there is nosebleed.

First Week.--After the patient is obliged to take to his bed: During the
first week there is in some cases a steady rise in the fever each evening
showing a degree or degree and one-half higher than the preceding evening,
reaching 103 to 104, and each morning showing higher fever than the
preceding morning. The pulse is characteristically low in proportion to
the temperature, being about 100 to 110, full of low tension, often having
double beat. The tongue is coated; there is constipation or diarrhea; the
abdomen is somewhat distended and a little tender to the touch in the
lower right portion. There may be some mental confusion at night.
Bronchitis is often present. The spleen becomes enlarged between the
seventh and tenth day and the eruption usually appears during this period
on the stomach and abdomen.

Second week.--All the symptoms are intensified in the second week, the
fever is always high and the weakening type; the pulse is more frequent;
the headache is replaced by dullness; the bowel symptoms increase and we
have the "pea soup" discharge if there is diarrhea; there is a listless,
dull expression on the face; the tongue is coated in the center, red along
the edges and the tip, becomes dry and sometimes cracked and almost
useless. It is hard to put it out of the mouth, it sticks to the teeth or
lips and curls there, and sometimes the patient allows it to remain partly
out of the mouth. There may be bleeding from the bowels and perforation of
the bowel, producing peritonitis.

[INFECTIOUS DISEASES 1