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of typhoid fever take the following course.

The patient feels depressed and moody—a condition which grows rapidly worse until it amounts to acute despondency. At the same time he is overpowered by physical weariness, not only of the muscles and sinews, but also of the organic functions, in particular of the digestion—so that the stomach refuses food. There is a great desire for sleep, but even in conditions of extreme fatigue the sleep is restless and superficial and not refreshing. There is pain in the head, the brain feels dull and confused, and there are spells of giddiness. An indefinite ache is felt in all the bones. There is blood from the nose now and then, without apparent cause.—This is the onset.

Then comes a violent chill which seizes the whole body and makes the teeth chatter; the fever sets in, and is immediately at its height. Little red spots appear on the breast and abdomen, about the size of a lentil. They go away when pressed by the finger, but return at once. The pulse is unsteady; there are about a hundred pulsations to the minute. The temperature goes up to 104°. Thus passes the first week.

In the second week the patient is free from pain in the head and limbs; but the giddiness is distinctly worse, and there is so much humming in the ears that he is practically deaf. The facial expression becomes dull, the mouth stands open, the eyes are without life. The consciousness is blurred, desire for sleep takes entire possession of the patient, and he often sinks, not into actual sleep, but into a leaden lethargy. At other intervals there are the loud and excited ravings of delirium. The patient’s helplessness is complete,

RV 351 (351)