ACUTE INFECTIOUS DISEASES. 



selves only by symptoms of excessive adynamia ("typhous symp- 

 toms"), is a peculiarity shown also by other inflammations when they 

 attack debilitated persons. We shall only call attention to the fact 

 that in old, decrepit persons, if physical examination be neglected, the 

 outward resemblance and the subjective symptoms often cause pneu- 

 monia to be diagnosed as catarrhal fever, nervous influenza, typhus, 

 etc. According to my experience, acute croupous nephritis, with the 

 retention of urine that it causes, by plugging up the uriniferous tubules, 

 is the most frequent sequel of cholera asphyxia, but is by no means 

 the constant cause of cholera typhoid, as is often asserted. If the se- 

 cretion of urine remain suppressed after the disappearance of the symp- 

 toms of collapse, or if the scanty urine contain quantities of albumen 

 and fibrinous casts for days, if vomiting recommence, and the patients 

 complain of severe headache, and become comatose, or have epilepti- 

 form convulsions, we may make a diagnosis of acute croupous nephri- 

 tis and so-called ursemic intoxication. In such cases the skin has oc- 

 casionally been found incrusted with crystallized urea. The first or 

 second day after the cessation of the asphyctic symptoms many pa- 

 tients pass a normal or even very large amount of urine ; and the albu- 

 men, which is at first constant in it, usually disappears after a few days, 

 nevertheless they fall into a state of great apathy and stupor, or mut- 

 tering delirium, the tongue becomes dry and crusted, the pulse fre- 

 quent, and often double ; the temperature is elevated ; the patients 

 slip down toward the foot of the bed, and the disease so exactly re- 

 sembles a severe typhoid, that there is no doubt the name cholera 

 typhoid was intended for these cases. Besides the above symptoms, 

 there is usually diarrhoea, with fetid evacuations mingled with shreds 

 of epithelium ; and, while the patients can scarcely be aroused from 

 their comatose state by loud cries or other irritants, they twitch the 

 face or recover consciousness, and complain of pain, if strong pressure 

 be made on the abdomen. In these cases there is diphtheritic inflam- 

 mation of the intestines, which often succeeds the catarrhal or proper 

 choleraic enteritis, and which is perhaps induced by the irritation of the 

 denuded intestines by their contents ; most patients who fall into this 

 state die of exhaustion. If, instead of diphtheritic inflammation of the 

 intestine, there be a similar affection of the genitals, a pneumonia, 

 pleurisy, or some other inflammatory sequel of cholera, the appearance 

 of the patient does not materially differ from the above description. 

 The typhoid symptoms due to the fever prevail, and the subjective 

 symptoms of the local disease fall into the background, or disappear 

 entirely. Lastly, in some cases, neither during life nor on autopsy can 

 we find any local disease to which to refer the exhausting fever, of 

 which many patients die after the cholera proper has run its course 



