640 ACUTE INFECTIOUS DISEASES. 



the symptoms grow worse, and the patients die of paralysis of the 

 heart and suffocation. In some cases, finally, the above symptoms are 

 followed by those of retarded repair of the typhous local affections 

 and sequelae. The appetite, which often becomes wolfish during con- 

 valescence, may prove fatal, if the physician be careless, or the patient 

 intractable. We shall again refer to the danger accompanying this 

 symptom. Almost all convalescents lose their hair. But, as the hair- 

 follicles have undergone no permanent disturbance of nutrition, a new 

 growth of hair sprouts up soon after the old has fallen out. 



We have attempted to give as comprehensive a view as possible, 

 and, at the same time, a tolerably complete one, of a severe " normal " 

 case of typhus.* But it would lead us too far to describe with equal 

 fulness the numerous and varied deviations that it presents in differ 

 ent cases, and-we must satisfy ourselves with noting the most impor- 



* Wunderlich, who has made a very large number of measurements of tempera- 

 ture in typhoid fever, gives the most important results of his observations about as 

 follows : The course of the fever is typical and perfectly characteristic ; it distin- 

 guishes abdominal typhus from any other disease. Besides the cases which exactly 

 follow the regular type, there are others which deviate from it irregular cases. The 

 causes of the irregularities cannot be recognized in every instance. The course of the 

 disease shows two sharply-bounded, distinct periods, which correspond to the deposir 

 tion and reabsorption of the infiltrations and exudations. These periods agree with 

 certain portions of time, and in regular or nearly regular cases they respectively 

 correspond to the first and last half of the disease. In mild forms, the first period 

 lasts only a week, or a week and a half; the entire disease lasts three or four weeks. 

 In severe cases, tlie first period lasts two, three, or three and a half weeks ; the en- 

 tire disease lasts five, six, or occasionally from eight to ten weeks. 



In the first week, it is such an absolute rule for the temperature to rise two de- 

 grees toward evening, and to fall one degree before the next morning, that, if the 

 temperature on the second or third day be 104 or over, we may exclude typhoid ; 

 the same is true, if between the fourth and sixth days the evening temperature do 

 not rise to 103, and, lastly, if the evening temperature begins to decrease again 

 as early as in the second half of the first week. A decided increase of temperature 

 during the first week is generally an unfavorable sign, while u slight increase ia 

 favorable. 



In the second week we may exclude typhoid, if the temperature be below 104 on one 

 or more evenings between the eighth and eleventh day, and, conversely, on the evenings 

 of the second week, scarcely any other acute disease shows repeated rise of the even- 

 ing temperature to 104. A favorable course of the disease during the second week 

 renders it probable that the third week will be still milder, while, on the contrary, a 

 severe and unfavorable second week may lead us to expect that the subsequent course 

 of the disease will be unfavorable. Among the favorable indications during the sec- 

 ond week are : an evening temperature between 104 and 105 ; a morning tempera- 

 ture one or two degrees lower; late occurrence of the exacerbation (not before 10 

 A. v.) ; early occurrence of the remission (before midnight) ; regular and daily moder- 

 ate decrease of temperature, as compared with that of the preceding day. Among the 

 unfavorable indications are : continued elevation of the morning temperature ; in 

 crease of the evening temperature to 105. 5, or more; early occurrence of the daily 



