634 AFFECTIONS OF THE INTESTINAL CANAL. 



ing " that we find open or even cicatrizing intestinal ulcers in these 

 cases." The long duration of the disease, the slightness of the fever, 

 the great extent of the catarrh, the excessive production of mucus, and 

 other points, decide me to doubt the correctness of Grriesinger *s belief 

 till I have learned the facts on which he bases it. The description 

 which I shall now give of the symptoms and course of catarrhal fever, 

 I take partly from my own observation, partly from the excellent 

 iescription of this disease, given in Schonleirfs lectures, and which 

 exactly corresponds with my own observation. 



This disease does not begin with frequent pulse, pain in the limbs, 

 severe headache, and restlessness, as gastric fever does. The pulse 

 is usually moderately increased, the temperature slightly elevated, but 

 the patients feel very dull and heavy, are apathetic, constantly sleepy, 

 and disgusted at all food. If the patient be compelled to eat some- 

 thing, he soon has a distressing feeling of fulness ; then vomiting oc- 

 curs, and the food is thrown up, enveloped in large quantities of tough 

 mucus. The accompanying oral and pharyngeal catarrh is also pecu- 

 liar : the coating of the tongue is, at first, thick and yellowish ; teeth 

 and gums, palate and pharynx are covered with tough mucus ; later 

 the whole epithelial covering of the tongue is often thrown off, and it 

 then looks red, like a piece of raw meat, or as if coated with varnish. 

 In the morning, especially, the patients raise so much mucus, by spit- 

 ting, hawking, vomiting, and coughing, that a spittoon will hardly con- 

 tain it all ; quantities of mucus are mixed with the undigested food, in 

 the passages from the bowels, while the urine contains a mucous 

 deposit. Even in the subsequent course, the fever remains moderate, 

 and has sometimes a remittent, sometimes a continued type. The 

 patients become very feeble; their apathy increases so, that while 

 they do not sleep, they lie without any interest in their own state, or 

 in things about them. If the disease begins to mend, which frequently 

 does not occur till the third or fourth week, the production of mucus 

 gradually ceases, the appetite slowly returns, the pulse becomes very 

 sluggish, and the exhausted patients do not recover strength for a long 

 time. The slightest cause induces a relapse ; then the process begins 

 anew, and months may pass before a perfect cure, or, in weak, decrepit 

 persons, death may result. 



It is difficult to determine what disease the older physicians meant 

 by bilious, or gall-fever. I hope, however, by my observations during 

 the last few years, to have arrived at a better understanding of those 

 fevers accompanied by icteric symptoms. I no longer believe that 

 this icterus is due to a polycholia, where more bile is produced than 

 can be expelled from the gall-ducts, and that, consequently, part of it 

 is reabsorbed. I rather consider the icterus accompanying excessive 



