slightly marked the eruption may fade in twenty-four hours.
The patients during the height of the fever are flushed, and at night, it may be, delirious. They complain incessantly, probably on account of a general hyperæsthesia of skin and muscles. Deafness is also a feature.
As the disease advances, the symptoms become more urgent; the conjunctivitis is intensified, the cough becomes incessant, the tongue dries, the lips crack and bleed, and there may be from time to time profuse perspiration. By the end of the second week— sooner or later according to the severity of the case— the fever begins to remit, the tongue to clean, and, after a few days, temperature falls to normal, and the patient speedily convalesces. Ashburn and Craig have noted a well-marked leucopenia. The red cells are normal. Diarrhoæ or diuresis may occur during the decline of the fever. The circular, sharp-edged, deep ulcer left after the separation of the primary eschar— an event which usually takes place during the second week now begins to heal, and the enlargement of the glands gradually to subside.
Such is the course of a moderately severe case. In some instances, however, the. constitutional disturbance is very slight, although the primary eschar may be well marked and perhaps extensive. On the other hand, the fever may be much more violent, and complications such as parotitis, melæna, coma, mania, cardiac failure, or œdema of the lungs may end in death. Similarly, the duration of the disease varies according to severity from one to four weeks, three weeks being about the average.
Pregnant women contracting shima mushi mostly abort and die.
The mortality in those attacked is approximately about 27 per cent.
Pathological anatomy.— Beyond evidences of bronchial catarrh, hypostatic pneumonia, enlarged spleen, perisplenitis, patchy reddening of the intestine near the ileo-cæcal valve, injection of the peritoneum,
