never delayed beyond the fourteenth day. In the artificially inoculated, symptoms show themselves in from two to six days.
Symptoms.— European and Indian type.— The onset is generally abrupt, being marked by chilliness or rigor, giddiness, vomiting, and intense headache. In the young there may be convulsions. Temperature rises rapidly to 104° or 105° F., sometimes even to 108°. The pulse is rapid, 110 to 130. Should fever run high there may be delirium. The skin is dry, although, especially during the first day, occasional sweats may break out. A slight icteric tinting of the conjunctiva is usual; not infrequently jaundice is marked. The spleen is invariably enlarged and tender. The tongue is coated and moist except in bad cases, in which it may become dry and brown. The bowels, as a rule, are confined. Occasionally herpes labialis is noted, and in certain epidemics a rash of rose-coloured spots on the trunk and limbs has been observed. Some authors describe petechise. A slight bronchitis is not uncommon. The urine, not appreciably diminished in amount, is very high-coloured. This, the primary fever, lasts for from five to seven days. At first the morning is usually lower than the evening temperature, but on or about the third day the evening temperature rarely rises above that of the morning. On the fourth, fifth, or sixth day there is again a rise of temperature, sometimes with delirium, ending in crisis of profuse sweating and diarrhoea. The temperature now falls rapidly to normal or subnormal, sometimes dropping in the course of a few hours as much as 10° F. in the latter event, especially in elderly or delicate patients, there may be dangerous collapse.
The initial pyrexia, called first paroxysm, is followed by a first period of apyrexia during which the patient recovers so rapidly that after four or five days it may be difficult to keep him in hospital. But from seven to nine days after the crisis, that is about the fourteenth from the commencement of the attack, rigor again occurs, followed by a second attack of fever first relapse. This may be more severe than the
