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vomited bilious matter twice this morning, and his bowels were moved twice after
calomel and jalap. Skin hot and dry ; breath fœtid; a peculiar earthy smell from the
person on turning down the bed clothes ; tongue furred in the centre, clean and red at
the tip and edges. Tongue large, rather dry, and teeth—indented. Fur thin, whitish,
even layer, as if moist putty had been smeared over the dorsum of the tongue and
adhered to it. No eruptions or wounds discovered. Liver and spleen not felt.
Heart and lungs normal. Abdomen flaccid, bladder not distended. Extremities
burning hot. No delirium at present, but he has been wandering and muttering
during the night, and slept very little, if at all. A bubo is seen and felt in the right
femoral region ; almond size, exquisitely tender, isolatable, horizontal in situation.
Skin over bubo hot and burning. Pulse now 110 to 120, full and bounding. Feels
giddy when he tries to sit up, against which he has been warned. Put on full
doses of mercury solution. At 5 p.m. the same day, temperature 104° F. ; pulse
120, respiration 36. Delirium and stupor and jactitation marked. 50 minims of
liq. hydrargyri injected below inflamed gland.
At 7 a.m. on 17th April, temperature 103.2° F.; pulse 120; respiration 26.
Tongue with light white fur on dorsum, increasing towards pharynx and fungiform
papillæ showing. Gephalalgia less. Passed six bad-smelling, greenish motions after
calomel and jalap purge, vomited four times. No sleep during the night but no
delirium ; voice low and weak. Feels prostrate, irritable, and depressed; tosses his
limbs about, looks weary, groans, sighs and answers questions with difficulty, and
appears to be deaf. Bubo tender, and œdema over it obscures its outlines. At
4 to 6 p.m. 17th, tamperature 104° F. ; pulse 132 ; respiration 26. Jactita-
tion and " typhoid state " marked. Eyes closed, muttering delirium, picking
and fumbling at the bed-clothes.
Conscious for a short time when roused,
but soon lapses into delirium and incoherence. Breath and body odour fœtid.
Heart sounds normal but accentuated. Slight dry cough, pain and tenderness
in right flank, signs of hypostatic congestion discovered at both bases. Turpentine
stupes and free stimulation ordered. Bowels constipated, urine small in quantity
with 1\10th albumen. Vomits frequently, headache complained of, on enquiry. Body
hot, tongue furred, does not evince interest in anything when awake.
On 18th, temperature 102.6° F.; pulse 108, weak and compressible ; respiration
36, sighing and irregular. Headache gone. Slept not more than one hour during the
night. Bubo not painful, but tender, and size of almond, surrounding œdema greater.
Tongue yellowish white, furred, and drier. No sordes on lips or teeth. Noisy ; busy
delirium during the day. Not so restless. Giddiness, thirst and weakness complained
of when roused to answer questions. Causing the patient to sit up with support made
his pulse 130 to 140 and weak and irregular, rapid and compressible.
On 19th, temperature 102° F. ; pulse 144 ; respiration. 48. Eyes half open and
seldom closed; stupid, dull, apathetic. Tongue cleaner, but drier. Sordes on lips and
teeth. Headache less. Slept towards morning with the aid of camphorodyne and
bromides. Less restless, Delirious at times. Prostration increased. Bubo harder
and larger, measuring 1½" X 1" and very tender.
On 20th, temperature 101.6° F. ; pulse 108, very weak, almost thready ;
respiration 36. Breath sounds at bases obscured by mucous rales in parts. Tongue,
clean at sides, but fur thicker in centre of dorsum. Skin clammy, extre-
mities cold. Expression stricken. Weary and disinclined to talk. Drowsy,
with dorsal decubitus. Bubo larger and more oblique and very tender. Slept
very little. Delirious on and off the whole clay. Bowels constipated, urine
passed naturally at 4 p. m.