ACUTE INFECTIOUS DISEASES. 



The spleen is enlarged and soft. If death do not occur till late in the 

 disease, the rigor mortis is less marked, and soon passes off; the bodies 

 are more emaciated ; the alae nasi seem smoked, the teeth and gums are 

 covered with sordes ; the blood rarely contains any fibrinous clots ; it 

 is smeary, dark, or inclined to cherry-color, and the walls of the vessels 

 are infiltrated. There is usually extensive hypostatic congestion in 

 the lungs ; the spleen is decidedly enlarged ; it is sometimes the seat 

 of hsemorrhagic infarction, or of small abscesses. There are no con- 

 stant anomalies in the stomach or intestinal canal ; at most, there is 

 swelling of the solitary and Peyer's glands, such as is also seen in the 

 acute exanthema. Nor do the other organs show any constant char- 

 acteristic deviations from their normal state. In the rare cases, where 

 death occurs still later from the sequelae, on autopsy we find the most 

 varied anomalies, suppurating parotid glands, the remains of croup 

 and diphtheria, extensive necrosis of connective tissue, bed-sores, gan- 

 grene of the extremities, etc. 



SYMPTOMS AND COURSE. There are few diseases whose symp- 

 toms correspond so exactly in different cases, and which run such a 

 similar course in different persons, as exanthematic typhus. 



The period of incubation, which appears to last eight or nine days, 

 rarely longer, is not usually free from symptoms of the disease ; but 

 these consist of slight chills, headache, disturbed sleep, loss of appe- 

 tite, a feeling of dulness, depression, and discomfort ; in short, of symp- 

 toms such as precede the outbreak of other diseases, and give no clew 

 to the disease which is commencing. It is only during the prevalence 

 of exanthematic typhus that we should suspect from these symptoms 

 that the patient was infected with typhus poison ; the suspicion would 

 increase in certainty if there were, at the same time, catarrhal troubles, 

 cough, coryza, burning feelings in the eyes, etc. The first two cases 

 of exanthematic typhus that I saw in the Magdeburg hospital during 

 the stage of incubation, I at first supposed to be cases of simple catar- 

 rhal fever. The intensity of these prodromatae varies, so that, while 

 they last, some patients go about their business, while others are con- 

 fined to bed even at this stage of the disease. 



The stadium invasionis begins with a single protracted chill of 

 great violence, or with repeated slight rigors, followed by a continued 

 feeling of great heat. After the first chill, the patients are rarely able 

 to leave their bed ; they feel excessively fatigued and weak, complain 

 of heaviness and numbness in the head, occasionally also of headache, 

 which is not unfrequently temporarily relieved by nose-bleed. These 

 symptoms are followed by dizziness, flashes of light, tinnitus, deafness, 

 pain in the muscles, trembling of the extremities on motion ; the pa- 

 tients usually lie in a state of apathy, talk in their sleep, and even 



