profuse diarrhœa; and the patient emaciates rapidly. The skin is
continuously hot, and has often a peculiar pungent feel. Patches of
erythema sometimes appear scattered over the body. The skin may assume a
dull sallow or earthy hue, or a bright yellow icteric tint may appear.
The conjunctivæ also may be yellow. In the latter stages of the disease
the pulse becomes small and fluttering; the tongue becomes dry and
brown; sordes collect on the teeth; and a low muttering form of delirium
supervenes.

Secondary infection of the parotid gland frequently occurs, and gives
rise to a suppurative parotitis. This condition is associated with
severe pain, gradually extending from behind the angle of the jaw on to
the face. There is also swelling over the gland, and eventually
suppuration and sloughing of the gland tissue and overlying skin.

Secondary abscesses in the lymph glands, subcutaneous tissue, or joints
are often so insidious and painless in their development that they are
only discovered accidentally. When the abscess is evacuated, healing
often takes place with remarkable rapidity, and with little impairment
of function.

The general symptoms may be simulated by an attack of malaria.

_Prognosis._--The prognosis in acute pyæmia is much less hopeless than
it once was, a considerable proportion of the patients recovering. In
acute cases the disease proves fatal in ten days or a fortnight, death
being due to toxæmia. Chronic cases often run a long course, lasting for
weeks or even months, and prove fatal from exhaustion and waxy disease
following on prolonged suppuration.