TYPHUS FEVER 617 



typhus never occurred without ulcers in the intestines. It is only in 

 the last ten years that the epidemics in Upper Silesia, the fatal epi- 

 demics during the Crimean War, and recently the epidemics in East 

 Prussia, etc., have dispelled this error. In the British Islands, and in 

 certain places in middle Europe, exanthematic typhus is the endemic 

 form of the disease. In Southern Europe, Lower Italy, the Oriental 

 countries, Hungary, etc., exanthematic typhus occurs, sometimes alone 

 and sometimes combined with other forms. Small epidemics of exan- 

 thematic typhus are occasionally seen almost everywhere, and may 

 usually, but not always, be traced to contagion. 



ANATOMICAL APPEARANCES. The characteristic exanthema of ty- 

 phus, typhus roseola, cannot be recognized on the dead body any moro 

 than the exanthema of measles and scarlatina can, for the circumscribed 

 hypersemia, on which the roseola depends, disappears in the general 

 paleness of the surface. Occasionally, indeed, this circumscribed cuta- 

 neous hypersemia causes rupture of the vessels and small haemorrhages 

 in the cutis, and we then find the skin of the cadaver covered with more 

 or less numerous and extensive petechiae ; but this is by no means con- 

 stant, and we must not consider petechiae as pathognomonic of " pete- 

 chial typhus." The roseola-spots, observed on the skin of the patient 

 during life (which we shall describe under the anatomical appearances, as 

 we did measles, scarlatina, and small-pox), resemble those of measles, 

 are about the same size, shape, and color ; like these they unite to irreg- 

 ular figures, but, unlike the spots in measles, they are not capped by 

 small papules. Sometimes they are on a level with the surrounding 

 skin, sometimes they project slightly above it, while in abdominal ty- 

 phus the eruption of roseola on the chest and abdomen is usually 

 scanty and does not always exist ; in exanthematic typhus it is not 

 always confined to those parts, but usually covers the trunk and ex- 

 tremities in great numbers, and is so apparent that, even on superficial 

 examination, it is not readily overlooked. The roseola rarelv occurs 

 on the face, and this one fact is sufficient to prevent a mistake in diag- 

 nosis between the exanthema of measles and typhus. 



The other anatomical appearances also usually resemble those 

 found after other exanthemata. If death takes place early, the bodies 

 are but little emaciated, the rigor mortis is marked, and there is ex 

 tensive hypostatic congestion in the dependent parts of the body. 

 The muscles are dark-colored, the heart and great vessels contain 

 cherry-colored blood. The bronchial mucous membrane is always 

 strongly injected, and covered with tough mucus. In the lungs we 

 find more or less extensive hepatization and atelectatic spots. The 

 bronchial glands are swollen, but not infiltrated. There are no con- 

 stant, marked changes in the intestinal canal and mesenteric glands. 



