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XIII] stomach; similar passive hæmorrhages may take place from almost any part of the body from eyes, ears, nose, mouth, bladder, uterus, and so on.

Death may occur during the early acute stage, being preceded by a rapid rise of temperature.

In mild cases the "period of calm," which sets in after the subsidence of the initial fever, may last for several days before convalescence is established. In such, recovery once begun is usually very rapid; in a week from the beginning of the disease the patient may be about again. In severe cases, however, the period of calm is followed by a third stage, the stage of reaction, in which the temperature again rises, though not to so high a point as in the initial fever, and a sort of remitting fever of an adynamic type keeps on for several days or weeks. This secondary fever is more prolonged if there is any complication, such as abscess, boils, parotitis, buboes, hepatitis, and so forth. The icterus is now very pronounced; black vomit may recur, or appear for the first time; perhaps a profuse diarrhræ ends in collapse; or the urine may be suppressed, stupor, coma, and other nervous symptoms ensuing, and very often ending in death. In other instances the secondary fever terminates in a crisis of sweating and a prolonged convalescence. Relapse may occur at any time up to two or three weeks after the subsidence of the initial fever. It is specially prone to occur if the patient has been guilty of any dietetic imprudence during the period of calm —a period at which the appetite may return to some extent. Relapses are very dangerous. 'Prognosis and mortality.— Prolonged initial rigors, algidity, convulsions, suppression of urine, coma, hæmorrhages, are all unfavourable symptoms. The prognosis is good if the temperature during the initial fever does not exceed 103° to 105° F. It is better for women (although, if pregnant, abortion is almost invariable) and children than for men; better for old residents than for new-comers; worst of all for the intemperate. According to a table given by Sternberg, of 269 carefully observed cases