636 



ACUTE INFECTIOUS DISEASES. 



ance with the severity of the fever, the urine is concentrated, high- 

 colored, and of increased specific gravity (1020 or more). If the pa 

 tients replace the water they lose in perspiration and diarrhoea by 

 drinking freely, the absolute amount of urine is not diminished ( Vogel) 

 The production of urea, which is increased in proportion to the supply 

 of nourishment, as shown by Vogel, corresponds to the elevation of 

 temperature, which depends on the increased transformation of tissue. 

 Later in the disease, when the fever disappears, the increased produo 

 tion of urea also ceases, and, like the temperature, falls below the nor- 

 mal amount. The chlorides are diminished in the urine of typhus pa- 

 tients. The explanation of this is less simple than that of the increase 

 of urea. It partly depends on less salt being eaten with the food, 

 partly on increased excretion of the chlorides by the bowels, partly 

 perhaps because, while the blood is deficient in albumen, it retains 

 more salts. However, neither the increase of urea, nor the decrease 

 of chlorides, nor, finally, the slight albuminuria, is characteristic of 

 typhus, as it also occurs in other diseases accompanied by severe 

 fever and copious exudations. 



In the second week of the disease the complaints of pain in the 

 head and limbs cease, but the dizziness becomes worse and the noises 

 in the ears are accompanied by deafness, which, however, does not 

 depend on disturbance of innervation, but, on a propagation of the 

 typhous oral and pharyngeal catarrh to the Eustachian tube and cavity 

 of the tympanum. The expression becomes more stupid, the inatten- 

 tion greater; the intellect, which was usually clear during the first 

 week, becomes cloudy, and the patient gradually falls into a somnolent, 

 stupid state, from which he can only be aroused with difficulty, and for 

 a short time. In spite of the dry mouth, he manifests no desire for 

 water, but drinks with avidity when a glass of water is placed to his 

 lips. It is often necessary to urge the patient repeatedly, to make him 

 show his tongue, and when he has at length, after several unsuccessful 

 attempts, succeeded in protruding the trembling organ, he occasionally 

 forgets to draw it back, and must be reminded and urged to do this 

 act also. Toward the end of the second week particularly, the stools 

 and urine are often passed in bed, because the patient does not per- 

 ceive the necessity of evacuating the distended rectum or bladder, 01 

 because he neglects to contract the sphincters energetically by an ac 

 tion of his will. Many patients lie unconsciously on their backs ; if 

 placed on the side, the body and limbs follow their own weight, with- 

 out the patient making any attempt to change his position, even if it 

 be uncomfortable. The occasional trembling movements of the lips, or 

 a few incomprehensible words that the patients mumble, alone show 

 that the mental activity is not all lost (febris nervosa stupida) Othci 



