30 PRACTICE OF MEDICINE. 



confined to the skin, but were numerous in the muscles and deep 

 seated cellular tissue. The skin, fasciae, muscles, and cartilages 

 were ol^ten turgid with bile. There was great congestion of the liver, 

 lungs, and brain. Thickening of the arachnoid, and effusion beneath 

 it, were common appearances. Another common lesion was an effu- 

 sion of blood in spots of variable size between the under surface of 

 the dura mater and the outer lamina, or parietal layer of the arach- 

 noid. 



Andral mentions two cases of this kind, and considers them rare. 

 In one it was the result of an injury, and in the other the result of 

 chronic inflammation of the membranes of the brain. 



Causes. — Crowding together a number of persons in badly venti- 

 lated and filthy apartments ; the persons so situated are capable of 

 communicating the disease to others, although they may not have it 

 themselves. Contagion is also a cause of this disease, though not a 

 very powerful one where cleanliness and ventilation are duly attended 

 to. Depressing influences of any kind are also capable of producing 

 it : sex has little influence upon it ; it is more common after 35 than 

 before this age, and it is rare in infancy. It prevails at all seasons, 

 and in all climates, though perhaps more in the winter, and in the 

 temperate and cold climate. 



Of the nature of the disease little is known. The probability is, 

 that a poison is absorbed which at once depresses the powers of the 

 nervous system, and vitiates the blood. 



Diagnosis. — The peculiar hue of the countenance, with suflxision 

 of the eyes ; the dark tongue, the sordes upon the teeth, the peculiar 

 eruption, the constipation, the characteristic odour, and the collapse 

 of the last stage, mark the disease. The differential diagnosis be- 

 tween it and typhoid fever, with which it is oflen confounded, is pre- 

 sented in a tabular form. 



TYPHOID FEVER. TYPHUS FEVER. 



Usually endemic; rarely epidemic. Epidemic usually. 



Not contagious. Certainly contagious ; may be commu- 



nicated by those unaffected. 



Young adults and children most liable. Spares no age but infants. 



Age of greatest'liability under 25. Age of greatest liability over 25. 



Best age for recovery from 15 to 25. Less fatal in early than in advanced 



life. 



Attacks strangers chiefly. Attacks all residents. 



Seldom ends before the 21st day. Ends sometimes by critical discharges 



from the 7th to the 14th day. 



Has no well-marked remissions. Remission afler the 3d, 7th and 14th 



day generally, and afler marked ex- 

 acerbations. 



Epistaxis common. Epistaxis very rare. 



Diarrhoea a frequent accompaniment; Costive usually until the 2d or .3d week ; 

 tympanitis. abdomen flat. 



Pulse usually under 100. Pulse usually over 100. 



