ACUTE INFECTIOUS DISEASES. 



ous, but occasionally it passes into general paralysis, ending in death 

 In very old or broken-down persons, the danger from a simple par- 

 oxysm lies chiefly in the threatened exhaustion of the still remaining 

 strength. Such cases, which only take on an acute course from indi- 

 vidual peculiarities of the patient, are not usually called pernicious. 



Some cases of intermittent acquire a pernicious character, from the 

 usual symptoms becoming very intense, or being protracted a long 

 time. In this class belong the cases where the hyperaemic swelling 

 of the spleen is so great that its capsule is ruptured, or where the 

 cliill is so severe as to cause dangerous obstruction of the circulation, 

 as well as those cases where the paroxysms do not cease in from six 

 to ten hours, but continue for twenty-four hours, or longer, and leave 

 the patient very much exhausted, or where only certain stages con- 

 tinue beyond the usual time. It seems to me very probable that some 

 forms of the so-called pernicious fever also should come under this 

 head, as it is probable that they are not complicated, only that the 

 customary symptoms are greatly increased. Even in simple normal 

 intermittent there is an increase of the temperature, such as is ob- 

 served in scarcely any other disease ; and the short time that this 

 increase lasts is the only reason that it does not prove dangerous to 

 the patient. In all diseases where the bodily temperature becomes 

 excessive, or remains high for a long while, we have the symptoms of 

 great adynamia, and finally of paralysis of the heart, and these are the 

 most prominent symptoms of pernicious fever. The deep stupor of 

 patients with febris intermittent comatosa, as well as the delirium 

 preceding the coma, reminds us strongly of the symptoms in severe 

 typhus, malignant measles, and other infectious diseases accompanied 

 by high fever. When these cases terminate fatally, we do not gen- 

 erally find any anatomical changes in the brain. In febris dlgida the 

 heart's action grows feebler, the pulse smaller ; the blood collects in 

 the veins ; there is cyanosis ; the temperature of the periphery closely 

 approaches that of the surrounding air, because the loss of warmth 

 due to the obstructed circulation is not replaced by a supply of warm 

 blood ; the patients grow cool ; in short, we have the symptoms of 

 acute paralysis of the heart, which may even result from the intensity 

 of the fever without complications. There is no doubt that, in these 

 severe forms of intermittent fever, there is often pigment in the blood ; 

 but the coincidence of melanaemia with severity of intermittent fever 

 does not justify us in regarding the latter as a result of the former. 

 On autopsy of several cases of intermittent fever that died with severe 

 brain-symptoms, JFrerichs found melanaemia, it is true, but he found 

 no pigment in the capillaries of the brain ; and I have observed si mi 

 lar cases. 



