(562 ACUTE INFECTIOUS DISEASES. 



fever. It is very interesting to me to find that Obermejer has proved 

 that there is a steady decrease of the weight of the body during the 

 attack, but that it is far greater and more rapid on the critical days. 

 These observations agree perfectly with those which were made in 

 my clinic by Dr. Steiner even before the Leyden investigations, and 

 which led to the following conclusions : Where the bodily tempera- 

 ture is only moderately increased, the loss of weight may be less than 

 that observed during the same length of time in healthy persons. This 

 is because during fever the function of the perspiratory glands, as 

 well as of other secretory organs, is suspended, and the loss of bodily 

 weight from evaporation depends chiefly on evaporation of the per- 

 spiration. But, if the bodily temperature rise to 102 or 104, the loss 

 of weight is always greater than in healthy persons under circum- 

 stances as nearly as possible the same. When the temperature of the 

 body is so high, even if the secretion from the sweat-glands be entirely 

 arrested, more fluid is evaporated from the mucous membrane of the 

 respiratory passages than is usually evaporated from the surface of the 

 body and the air-passages together of persons with normally-acting 

 sweat-glands. The most rapid decrease of bodily weight occurs at the 

 defervescence of the fever, for then the sweat-glands again act, while 

 the still-elevated temperature is accompanied by accelerated evapora- 

 tion. I believe in the correctness of the idea that, at the height of the 

 fever, there is only a relative retention of water in the body, but do 

 not think it necessary to refer this retention to diminished action of 

 the sweat-glands. 



Under certain influences still unknown, possibly merely as a re- 

 sult of the action of a particularly intense contagion, relapsing fever 

 assumes a very malignant character. The appearance of the disease 

 is especially modified by excessive participation of the biliary appara- 

 tus, and in most cases death appears with severe symptoms. Grie- 

 sinfjer describes this malignant form of relapsing fever, from his obser- 

 vations made in the East, and terms it bilious typhoid. The St. Peters- 

 burg epidemic of 1864 to 1866, where, besides simple recurrent fever, 

 there were numerous cases of bilious typhoid, especially at its com- 

 mencement, fully confirmed Griesinger's description of the disease, 

 as well as his opinion that it was a severe form of recurrent fever. 



At first the symptoms vary little from those of simple recurrent 

 fever, except that there are more depression and headache, and greater 

 mental sluggishness, bilious vomiting is more frequent, and the 

 tongue shows a tendency to dryness, while in simple recurrent fever 

 it is apt to remain moist during the whole course of the disease. 

 Usually, after a few days there is diarrhoea, with evacuation of bilious 

 looking masses; or else the passages have a dysenteric appearance. 





