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 197]

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.