22 ACUTE INFECTIOUS DISEASES. 



that the same sequelae also occur after abdominal typhus, puerperal 

 fever, cholera, and some other severe diseases. Some patients, with 

 out our being able to find inflammations of any important organ or 

 other material cause for it, are attacked by a new fever, of which they 

 die, with the symptoms of great prostration, the already exhausted 

 powers being rapidly consumed. In other patients, after the typhus 

 has run its course, there are inflammation and suppuration of the paro- 

 tids ; in others, there are pneumonia, pleurisy, diptheritic and follicular 

 inflammation of the intestine ; in still others there are numerous furun- 

 cles, ecthyma pustules, or large abscesses in the subcutaneous and in- 

 termuscular connective tissue. In many cases, the slowly-healing bed- 

 sores prove dangerous, partly from the drain on the system, partly 

 from reabsorption of ichor. Lastly, there is frequently thrombosis of 

 the femoral veins, with its results. Recovery is by far the most fre- 

 quent termination of exanthematic typhus in most epidemics, especially 

 in those which are not very extensive. The circumstance that a fatal 

 termination is less frequent than persons unacquainted with the disease 

 would expect from the severity of the symptoms, is probably because 

 the disease, which runs a cyclical course, is of comparatively short 

 duration. The organism could not long stand such a fever as ac- 

 companies typhus. The hypothesis which we have frequently ad- 

 vanced, that the chief danger in infectious diseases is from the eleva- 

 tion of the temperature to a point where general paralysis is induced 

 and the continuation of life impossible, is well supported by the obser- 

 vations made in WunderlicJi's clinic during a small epidemic of typhus. 

 In the fatal cases, death almost always resulted at the height of the 

 tever ; moreover, all patients in whom the temperature reached 108 

 died ; and of fourteen patients that died, five, or more than one-third, 

 had this high temperature. Of the patients whose temperature never 

 rose above 105.5, not one died. Besides the high temperature, capil- 

 lary bronchitis, pneumonia, and atelectasis, are dangerous to the pa- 

 tient ; other patients die of the sequelae. Exhausting haemorrhages, 

 gangrene of the tip of the nose, fingers, toes, and lungs, and other 

 complications, which formerly proved so destructive in the malignant 

 form of exanthematic typhus, called putrid fever, are rarely observed 

 in the present day ; but, in the severe epidemics, such as occurred dur- 

 ing the Crimean War, which cannot be compared in danger to those 

 above mentioned, half the persons attacked died. 



Lastly, I shall speak of a rarely-mentioned abortive form of typhus, 

 of which I observed some cases in the Magdeburg hospital ; a large 

 number of observations made in the Prague epidemics of 1843 and 

 1848 exactly correspond with mine. The patients, who, in my cases, 

 bad always been exposed to typhus poison (among others, the nurse 



