TYPHUS FEVER. 615 



days after the reception of these patients, two patients that had lain 

 alongside of them were attacked by the same disease (one of them 

 had been received into the hospital for intermittent fever, the other for 

 epilepsy) ; in a short time the attendants who had taken care of the 

 patients were similarly attacked. After the isolation of these patients, 

 all the other persons in the hospital escaped the disease ; nor were 

 there any other cases in the city at this time. In March, 1855, a 

 tradesman from Heiligenstadt was attacked with exanthematic typhus 

 while away from home ; he was received into my ward ; a year had 

 almost elapsed since the appearance of the last case there. Eight days 

 after the reception of this patient, a blacksmith's apprentice and a me- 

 chanic, lying next to him, were attacked by the disease. After these pa- 

 tients were isolated, my assistant, a washer-woman, and every one who 

 had been chosen to attend the patients, were also attacked. It was not 

 till a convalescent from exanthematic typhus was placed as the sole at- 

 tendant for the typhus patients, that new cases ceased to appear. (These 

 patients were nursed with great conscientiousness and self-sacrifice by 

 the convalescent, who, for twenty years previously, had been in chains 

 for the murder of a clergyman, and had only obtained his liberty a short 

 time before.) The contagion is contained in the atmosphere about the 

 patient, in his clothes, bed linen, and other property. Hence the treat- 

 ment and nursing of patients with exanthematic typhus is much more 

 dangerous than is the case with patients having cholera or abdominal 

 typhus. Like measles, the disease may be carried by persons who do 

 not themselves become affected. The more patients are crowded to- 

 gether, the more intense the contagion becomes ; this fact agrees per- 

 fectly with the recently-adopted view of a contagium vivum (see page 

 673). A place of a certain size, where many patients produce the 

 germs of the disease, is more thoroughly filled with the poison than 

 one where the germs are only produced in the body of a single patient. 

 I do not agree with most recent authors in considering the ques- 

 tion settled in regard to whether exanthematic typhus be exclusively 

 propagated by contagion, or if it be also due to miasm. There is no 

 solid ground for such assertions as this, " that a disease is either only 

 miasmatic, or only contagious," and even the persons making them do 

 not always strictly adhere to them. When one acknowledges that 

 the germs of cholera probably develop from diseased rice, and are thence 

 brought to us by cholera patients and their dejections, he cannot deny 

 the possibility, and even probability, that the germs of contagious dis- 

 eases native among us may, under favorable circumstances, develop 

 and increase outside of the human body. The hypothesis of a " spon- 

 taneous generation" of infectious diseases, in the sense that their 

 cause is a new agent induced by injurious influences, is, of course, to 

 89 



