he lymphatic
glands of the intestines and in the spleen.

The following are its anatomical symptoms: With the beginning of the
disease the lymphatic glands of the mucous membrane of the intestines
begin to swell; they are constantly growing during the course of the
disease and attain the size of a pea; extended over the level of the
mucous membrane they feel firm, hard and tough. In favourable cases the
swelling may go down at this stage, but generally the formation of
matter begins through the dying of the cells, caused by insufficient
nourishment. This is gradually thrown off, and a loss of substance
remains--the typhoid ulcer. This varies in size and in depth. Light
bleeding in no great quantity ensues. If the ulcer has gone very deep,
the intestines may be perforated and then the faeces and part of the
food enter the abdominal cavity. The result is purulent and ichorous
peritonitis. As a rule, however, the ulcers are purified and heal by
cicatrization. Usually the spleen is enormously enlarged (through a
rapid increase in the number of its cells). The swelling of the spleen
can easily be detected by external touch.

_(C) Symptoms and Course._

During what is termed the earlier stage, which as a rule last about two
weeks and precedes the breaking out of the disease proper, the patient
still feels comparatively well, or only begins to complain of headache,
tired feeling, prostration in all the limbs, dizziness, lack of
appetite. It is thus absolutely impossible to fix a definite date for
its development. In most cases the patient complains of a chill,
followed by feverishness,--symptoms which confine him to bed,--although
no actual shivering takes place. It is expedient, although quite
arbitrary and subject to many modifications, to divide the course of the
illness into three periods:--

(1) The stage of development.

(2) The climax.

(3) The stage of healing.

During the stage of development, which usually lasts about a week, the
symptoms of the disease rapidly increase. The patient gets extremely
weak and faint, has severe headaches and absolutely no appetite. In
consequence of the high fever, he complains of thirst; the skin is dry,
the lips chapped, the tongue coated; the pulse is rapid and full; the
bowels are constipated, but the abdomen is practically not inflated nor
sensitive to pressure. In most cases the spleen is evidently enlarged.

Before the end of the first week the climax is reached. This