While obstruction prevails during the first week, the second week is characterized by diarrhoea of a pale and thin consistency.

When general improvement sets in, the stools gradually decrease in number, they grow more solid and finally reach the normal.  The abdomen is not very sensitive to pressure and is usually intensely inflated with gas.

In the region of the right groin a cooing sound is often heard, caused by a liquid substance in the intestines, which can be felt under pressure of the finger.

Bleeding from the intestines is not infrequent and happens during the third week of the illness.  It usually indicates a bad complication, since the result may be fatal.  The stool assumes a tar-like appearance through the mixture of the coagulated blood with the faeces.  Close attention must be given to minor hemorrhages, since they often herald others of a more intense nature.

In such extreme cases of serious complications, however, a cure has nevertheless been sometimes effected.  They are occasionally followed by the immediate beginning of convalescence.

The perforation of the intestines, which is caused by an ulcer eating its way through the wall of the intestines, is much more dangerous.  It happens most frequently during the third or the fourth week.  The patient feels a sudden, most intense pain in the abdomen; he collapses rapidly, the cheeks become hollow, the nose pointed and cool.  Vomiting follows, the pulse becomes weak and extremely rapid.  The abdomen is enormously inflated and painful.  In the severest cases death ensues, at latest, within two or three days, the cause being purulent and ichorous (or pus-laden) peritonitis.

Such extreme developments as these, however, are infrequent, since the illness, by timely attention according to the methods herein prescribed, will, as a rule, respond to the treatment and take a favourable turn.

Respiratory Organs:—­

In the course of typhus, intense bleeding of the nose is not infrequent.  In the severer cases this is a sign of decomposition of the blood, but in lighter cases it merely serves to alleviate the intense headache which is a feature of the case.  The throat is liable to be affected; hoarseness and coughing occur; hardly any case of typhus catarrh.  This sometimes extends into the air-passes without a more or less intense bronchial cells and causes catarrhal pneumonia, which—­if not promptly treated according to the instructions herein detailed—­may become extremely dangerous.

Organs of Circulations:—­

With the exception of a strongly accelerated action, no change is noticeable in the heart.  It may, however, suddenly become paralyzed and cease entirely, owing to the general weakness of the patient and the intensity of the fever.  Weakness of the heart and possible cessation occur only during the climax or convalescence.

Nervous System:—­