Medical and surgical report of the Presbyterian Hospital in the City of New York . admission, the temperature was ° F.; pulse, 100; respira-tion, 26. He was a poorly nourished boy; very much prostrated andintensely apathetic. Respiration was a little rapid but not was moderate pectus carinatum. The tongue was dry, brown,cracked, and heavily coated. The teeth were covered with sordes;the lips dry, cracked, bleeding; the gums soft, red, with several aphthouspatches. The pharynx and tonsils were dry and red. All of the superficiallymph-nodes were palpable. The heart was normal
Medical and surgical report of the Presbyterian Hospital in the City of New York . admission, the temperature was ° F.; pulse, 100; respira-tion, 26. He was a poorly nourished boy; very much prostrated andintensely apathetic. Respiration was a little rapid but not was moderate pectus carinatum. The tongue was dry, brown,cracked, and heavily coated. The teeth were covered with sordes;the lips dry, cracked, bleeding; the gums soft, red, with several aphthouspatches. The pharynx and tonsils were dry and red. All of the superficiallymph-nodes were palpable. The heart was normal and acting pulse regular and slightly dicrotic. Percussion of the splenic areashowed it to be enlarged, and though he held the abdomen rather tensethe edge of the spleen was felt at the costal arch. Scattered over thesurface of the thorax, abdomen, and shoulders were many small,faint, very shghtly elevated, pink, erythematous spots. The urine was of a specific gravity of 1028; contained a very fainttrace of albumin, without casts. There were decided diazo and indican. A HOUSE EPIDEMIC OF PARATYPHOID FEVER. 261 reactions. The Widal reaction was negative. The leucocytes num-bered 9,700. His course in the hospital was uneventful. Under careful nursingthe tongue cleared up almost at once. The temperature fell steadily,reaching subnormal and remaining below 100° on the ninth day inthe hospital, the nineteenth day after he first complained of malaise,or the seventeenth day after going to bed. The bowels were inclinedto constipation, requiring a daily enema. The Widal reaction wastested fourteen times with negative result. The spleen could be pal-pated until the thirtieth day, the temperature having been normalfor thirteen days. The spots rapidly faded and there was no secondcrop. Case III.—James F.; school-boy; aged ten; admitted to the serviceof Dr. W. Oilman Thompson, October 14, 1903. The patients previous history was negative, except for a slight attackof chorea eigh
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