ACUTE INFECTIOUS DISEASES. 



of typhus; usually it is hard and friable, and on section the Mal 

 pighian bodies project as grayish-white or jaundiced points the size of 

 a pin's head. Occasionally in the spleen we find yellowish-white foci, 

 roundish or irregular in shape, from the size of a hemp-seed to that 

 of a hazel-nut, at first quite firm, but later breaking down into pus. 

 Kattner considers these as ruptures in the cavernous venous meshes 

 of the spleen, which subsequently, as in phlebitis after venous throm- 

 bosis, induce inflammation, suppuration, and putrefaction of the parts 

 around. 



The kidneys also are enlarged, sometimes to double their normal 

 size ; this is due solely to swelling of the cortical structure. It is 

 difficult to detach the capsule, and, when this is done forcibly, small 

 portions of the renal tissue remain adherent to it. On microscopical 

 examination we find the epithelium of the uriniferous tubules swollen 

 and filled with fine molecules ; in the later stages the epithelial cells 

 have been destroyed, and the tubules are filled with fine granular de- 

 tritus. Rarely there are numerous small abscesses scattered through 

 the kidneys. 



SYMPTOMS AND COURSE. The length of the period of incubation 

 is not yet accurately determined. Many patients feel perfectly well 

 from the inception of contagion till the outbreak of the disease, while 

 others complain, a few days before the actual commencement of the 

 malady, of ill-defined and uncharacteristic disturbances of their 

 general health, of great weariness, pain and heaviness in the head, 

 increased thirst, and occasionally of migratory pain in the extrem- 

 ities. 



Whether the above prodromata have occurred or not, the disease 

 itself almost unexceptionally begins with a chill of variable duration 

 and intensity, followed by a persistent feeling of great heat. 



With the commencement of the fever the patients become very 

 weak, complain of pain in the head, especially in the forehead, often 

 also of dizziness and tinnitus, and of severe muscular pains almost 

 characteristic of the disease, which affect chiefly the neck and limbs, 

 and are among the most annoying symptoms of the disease. A slight 

 amount of psychical excitement, usually present at first, generally 

 passes off. The feeling of illness is unmistakable, the patients show- 

 ing no interest in their surroundings. Delirium and deep sopor are 

 exceptional, even where the fever is very high, which is a strong argu- 

 ment against the exclusive dependence of psychical disturbances, in 

 acute infectious diseases, on the height of the bodily temperature. 

 At first, the face is slightly flushed, the skin hot and dry, rarely is it 

 severed with slight perspiration. We must beware of regarding this 

 moisture of the skin at the height of the disease as a favorable sign. 



