DBook II LENTICULAR FEVER——TVPHUS 103

against it; soon, however, the symptoms of malignant fever be—
gan to show themselves. For though, according to the nature
of fevers of this sort, a moderate temperature was felt, never—
theless a sort of internal disturbance became obvious, then
prostration of the whole body, and a lassitude such as follows
over—exertion; the patient could only lie flat on his back, the
head became heavy, the senses dulled, and in the majority of
eases, after the fourth or seventh day, the mind would wander;
the eyes became red, and the patient was garrulous; the urine
was usually observed to be at first pale, but consistent,'? but
presently red and elouded, or like pomegranate wine; the pulse
was small and slow, such as I have described above, the excre—
ment corrupt and offensive in smell. About the fourth or
seventh day, red, or often purplish—red spots broke out on the
arms, back and chest, looking like flea—bites (punctiform), though
they were often larger and in the shape of lentils, whence arose
the name of the fever. 'The patient felt little or no thirst; but
the tongue became foul. Some were sleepy, others wakeful,
while sometimes both conditions were experienced, in turn, by
the same patient. 'The disease remained stationary in some
cases till the seventh day, in others till the fourteenth, in others
still longer. In some patients there was retention of the urine,
and this was the very worst sign. Few women died of this
fever, very few old men, almost no Jews, but many young people
and children, and they were of the best families. 'This is the
contrary of what happens in true pestilent fevers, which chiefly
attack the common people, whereas these fevers seemed to
strike at the nobility especially.?* ?

Special symptoms preceded death and likewise recovery.
The following symptoms were bad: if the patient suddenly felt
that all his strength had failed him; if the administration of a&
mild purgative had been followed by an abnormally large evacua«—
tion; if, after a crisis had occurred, there was no consequent
relief; for I have often seen cases where three pounds of blood
burst from the nostrils, yet the patients died soon after.  Again,
it was a bad symptom if the urine was held back; if the lentil—
shaped spots remained suppressed, or, on the other hand, broke
out with difficulty or were livid and very purple; and if all or
several of these symptoms occurred, death was very certain to
follow; on the other hand, recovery was certain, if all or several
of the opposite symptoms appeared.