delirium. This brief preliminary stage rapidly culminates in coma, complete unconsciousness, and high fever, quickly passing into hyperpyrexia.
Wood thus describes the symptoms of the developed attack: "Total insensibility was always present, with, in rare instances, delirium of the talkative form, and still more rarely the capability of being roused by shaking or shouting. The breathing was always affected, sometimes rapid, sometimes deep and laboured, often stertorous, and not rarely accompanied by the rattle of mucus in the trachea. The face was often deeply suffused, sometimes with the whole face deeply cyanosed. The conjunctiva was often injected, the pupils various—sometimes dilated, sometimes nearly normal, sometimes contracted. The skin was always intensely hot, and generally, but not always, dry; when not dry it was bathed in a profuse perspiration. The intense burning heat of the skin, both as felt by the hand and measured by the thermometer, was one of the most marked features of the cases. The degree of heat reached during life was, in my cases, mostly 108°-109° F. The pulse was always exceedingly rapid, and early in the disease often wanting in force and volume; later it became irregular, intermittent, and thready. The motor nervous system was profoundly affected. Subsultus tendinum was a very common symptom; great restlessness was also very often present, and sometimes partial spasms or even violent general convulsions. The latter were at times epileptiform, occurring spontaneously; or they were tetanoid, and excited by the slightest irritation. Sometimes the spinal cord appeared to be paralysed, the patient absolutely not moving."
The pupils, unless immediately before death, when along with the other sphincters they relax, are contracted. The reflexes are partially or wholly in abeyance. There may also be, especially in the graver cases, free watery purging, the dejecta, as well as the skin of the patient, emitting a peculiar and distinctive mousy odour. The scanty urine may contain blood corpuscles, albumin, and casts.
