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XX] be nausea and vomiting; in some instances there is diarrhœa. Stage of fever.— The stage of invasion may last for a day or two without a serious rise of temperature occurring. Usually it is of much shorter duration; or it may be altogether wanting, the disease developing abruptly without definite rigor or other warning, the thermometer rising rapidly to 103° or 104°, or even to 107° F, with a corresponding acceleration of pulse and respiration. The rise of temperature is more gradual than is usual in malarial fevers. The skin is now dry and burning, the face is bloated, the eyes are still more injected, sunken and fixed, the hearing is dulled. The tongue is swollen and covered with a creamy fur, which rapidly dries and becomes brown or almost black; sordes form on the teeth and about the lips and nostrils. Thirst is intense, prostration extreme, the patient from utter weakness being hardly able to make himself heard. Sometimes the patient becomes delirious; more generally he sinks into a state of typhoid stupor and prostration, perhaps picking the bedclothes or trying to catch imaginary objects. The delirium is sometimes wildly furious, sometimes fatuous, sometimes of a low muttering type. Coma, convulsions— sometimes of a tetanic character— retention of urine, subsultus tendinum, and other nervous phenomena may occur. Vomiting is in certain cases very frequent: some are constipated, others have diarrhœa. The spleen and liver are usually both enlarged. Urine is scanty, but rarely contains more than a trace of albumin. The pulse, at first full and bounding, in the majority of cases rapidly loses tone, becoming small, frequent, fluttering, dicrotic, intermittent. In the later stages the heart may be dilated, the first sound being feeble or absent. In many cases, as death approaches, there may be some cyanosis.

Stage of adenitis.— In from about two-thirds to nine-tenths of the cases, some time between the first few hours and the fifth day, generally within twenty-four hours, the characteristic bubo or buboes develop. Usually (in 70 per cent.) the bubo forms in the groin,