119 



pears to us, totally insufficient to establish the specific character of 

 the disease. The more important of these phenomena are lenticular 

 rose-coloured spots on the trunk, chiefly on the anterior part of the 

 abdomen and chest, sudamina, gurgling in the right iliac region, ten- 

 derness of the abdomen, diarrhoea, meteorism, enlargement of the 

 spleen, and epistaxis. But which of these phenomena does not occur in 

 typhus ? In regard to the size, colour, situation, and time of appear- 

 ance of the eruption, there is nothing remarkable in the one disease 

 "which is not equally so in the other. The eruption in typhus, though 

 among the characteristics of the disorder, is variable in size and 

 colour ; sometimes it is of a rose hue, but frequently violet or purple, 

 at one time persistent under pressure, and at another evanescent. 

 Such were the varieties of the eruption in the cases of typhus, treated 

 under the direction of one of your committee, in the New York Hos- 

 pital in June, 1840, and at various times in subsequent years, — cases 

 of the identical nature of which there was not the slightest doubt, 

 all of them having originated from the same source; namely, the 

 fever poison idio-miasma, generated in crowded emigrant ships. In 

 no respect did the eruption differ essentially from that which occurs 

 in dothinenteritis or typhoid fever. As to sudamina, they are common 

 to various states and kinds of disease. 



It is well known that age, constitution and modes of life, climate r 

 season, and especially epidemic influences exert a powerful agency 

 in modifying the symptoms of diseases; and there is good reason to 

 believe that to such causes, the varying forms and character of the 

 eruptions in essential fevers are in a great degree attributable. In 

 some seasons the eruption in typhus is absent in very many cases; 

 and moreover, it is sometimes wanting in cases in which the Peyerian 

 glands are extensively diseased. Dr. Elliot, one of the physicians 

 of the Bellevue Hospital, reports an instance in which "Peyer's 

 plates were much enlarged and deeply ulcerated," and in which 

 "there was no eruption, nor any diarrhoea, during the whole progress 

 of the case."* Are not the rose-coloured spots of typhoid fever, the 

 primary forms or conditions of the petechias or maculae of typhus? 

 Professor Clark, one of the physicians of the hospital just named, 

 says, that "in the proportion of about one-half of the typhus fever 

 patients, a rose-coloured eruption occurs on the < body, which fre- 

 quently in the progress of the fever assumes a petechial appearance. f 



* Annalist, vol. ii. p. 249; edited by William C. Roberts, M.D., New York. 



f Transactions of the Medical Society of the State of New York, vol. vii. p. 59, 184S. 



