97]

Third week.--The temperature is lower in the morning with a gradual fall;
the emaciation and weakness are marked. Perforation of the bowel or
bleeding may occur. Unfavorable symptoms now include low muttering,
delirium, shakings of the muscles, twitching of the tendons, grasping at
imaginary things, lung complications and heart weakness.

Fourth week.--In a favorable case: The fever gradually falls to normal,
the other symptoms disappear. Death may occur at any time after the second
week from the disease or complications. The convalescence is very gradual
and the appetite is very great.

Special symptoms and variations.--It may come on with a chill sometimes it
is observed by nervous symptoms only.

Walking type.--In this type the patient is able to be around and can walk.
The temperature is as high, but some of the other symptoms are not so
violent. This is a dangerous kind because the patient is able to walk and
thinks it foolish to remain quiet in bed. Walking and being around are
likely to injure the bowels, and there is then more danger of bleeding
from the bowels. A typhoid fever patient should always go to bed and
remain there until he has fully recovered.

Digestive Symptoms.--The tongue is coated, white and moist at first, and
in the second week it becomes red at the tip, and at the edges. Later it
is dry, brown and cracked. The teeth and lips are covered with a brown
material, called sordes.

Diarrhea.--In some cases constipation is prominent, in others diarrhea is
a prominent symptom. Bloating is frequent, and an unfavorable symptom,
when it is excessive. Bleeding from the bowel occurs usually between the
end of the second and the beginning of the fourth week. A sudden feeling
of collapse, and rapid fall of the temperature mark it. It is not always
fatal.

Perforation of the bowel is usually shown by a sudden sharp pain coming in
paroxysms generally localized in the right lower side. The death rate
varies very much; in hospitals it is seven to eight per cent. Unfavorable
symptoms are continued high fever, delirium and hemorrhage. Persons who
are hard drinkers do badly and very many of them die.

TREATMENT. Prevention. Sanitary Care.--Do away with the causes. Keep your
cellars clean; do not have them damp, filthy, and filled with decaying
matter, as these all tend to weaken the system and make you more
susceptible to the poison. In the country, no drainings should come near
the wells or springs.