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RV 352 (BUDDENBROOKS) and his uncleanliness becomes repulsive. His gums, teeth, and tongue are covered with a blackish deposit which makes his breath foul. He lies motionless on his back, with distended abdomen. He has sunk down in the bed, with his knees wide apart. Pulse and breathing are rapid, jerky, superficial and laboured; the pulse is fluttering, and gallops one hundred and twenty to the minute. The eyelids are half closed, the cheeks are no longer glowing, but have assumed a bluish colour. The red spots on breast and abdomen are more numerous. The temperature reaches 105.8°.

In the third week the weakness is at its height. The patient raves no longer: who can say whether his spirit is sunk in empty night or whether it lingers, remote from the flesh, in far, deep, quiet dreams, of which he gives no sound and no sign? He lies in total insensibility. This is the crisis of the disease.

In individual cases the diagnosis is sometimes rendered more difficult; as, for example, when the early symptoms—depression, weariness, lack of appetite, headache and unquiet sleep—are nearly all present while the patient is still going about in his usual health; when they are scarcely noticeable as anything out of the common, even if they are suddenly and definitely increased. But a clever doctor, of real scientific acumen—like, for example, Dr. Langhals, the good-looking Dr. Langhals with the small, hairy hands—will still be in a position to call the case by its right name; and the appearance of the red spots on the chest and abdomen will be conclusive evidence that his diagnosis was correct. He will know what measures to take and what remedies to apply. He will arrange for a large, well-aired room, the temperature of which must not be higher than 70°. He will insist on absolute cleanliness, and by means of frequent shifting and changes of linen will keep the patient free from bedsores—if possible; in some cases it is not possible. He will have the mouth frequently cleansed with moist linen rags. As for treatment, preparations of iodine, potash, quinine,

RV 352 (352)