[Extracted from the American Journal of the Medical Sciences for February, 1837.] 
On the Typhus Fever, which occurred at Philadelphia in the spring 
and summer of 1836; illustrated by Clinical Observations at 
the Philadelphia Hospital; showing the distinction between this 
form of disease and Dothinenteritis or the Typhoid Fever with 
alteration of the follicles of the small intestine. Ey W. W. Gerhard, 
M. D., one of the Physicians to the Hospital. 
During a residence of two or three years at Paris, I had studied 
with great care the pathology and treatment of the disease usually 
termed, in the French hospitals, typhoid fever or typhoid affection. 
There is another designation for it, founded on its anatomical cha- 
racters, and therefore more directly in accordance with modern 
medical nomenclature; it is dothinenteritis. This variety of fever, 
which is identical with the disease termed typhus mitior or nervous 
fever, is frequent at Paris, and is almost the only fever which can 
be said to be endemic there. Intermittent and remittent fevers are 
rarely seen, except amongst those individuals w'ho had already con- 
tracted some form of these diseases in the malarious districts of 
France. Some slight fevers, attended with a whitish or yellow 
tongue and gastric symptoms, occasionally occur; they scarcely as- 
sume the form of a fixed disease, and usually disappear under a 
very simple treatment. 
These fevers wrere the only ones known at Paris for some years past; 
but in 1813-14, there occurred a severe epidemic fever, character- 2 
Gerhard on Typhus Fever. 
ized bj extreme prostration and strongly marked cerebral symptoms. 
This epidemic was first noticed amongst the troops who returned 
from Napoleon’s unsuccessful campaigns in Germany and the east 
of France; it afterwards spread amongst the inhabitants of Paris 
and other large cities, and was every where extremely fatal. No 
accurate description of this fever is on record, although it was 
witnessed by several of the most distinguished French physicians. 
Some of these, more especially Louis and Chomel, are inclined to 
consider it as identical with the prevailing dothinenteritis, but their 
opinion is probably erroneous, and the disease, as far as we know, 
should be classed amongst the forms of continued fever, distinguished 
by the terms typhus, typhus gravior, petechial or spotted fever, &c. 
There are, however, complete histories of the typhoid fever or 
typhoid affection, or dothinenteritis, (all names belonging to one 
disease.) It is one of the most frequent and the most severe acute 
affections observed at Paris, and has been studied with extreme accu- 
racy, more especially by Louis and Chomel, who have both pub- 
lished admirable descriptions of it. The work of Dr. Louis is espe'-' 
daily interesting, and is a model in its kind; he has analyzed 
the symptoms and pathological phenomena of the fever so accu- 
rately and fully, as to surpass any other description of individual 
diseases. The typhoid fever was placed by this work of Dr. Louis, 
in the same relation to other fevers that pneumonia holds in refer- 
ence to the affections of the chest. They are both so well studied, 
and their symptoms are so well known, that they serve as types 
with which other less thoroughly understood affections may be com- 
pared. 
It affords us, then, great advantages in the investigation of the 
history of fevers, to begin with the typhoid, as the best known 
of these affections. Assuming this disease as the basis of our inves- 
tigations, one great point is gained, and much greater certainty can 
be given to our ulterior researches, if we compare the symptoms of 
any fever which is-little known and imperfectly described, with those 
of the typhoid fever, or dothinenteritis, as it is now frequently called 
from its anatomical lesion. 
This inquiry was in accordance with a desire which I had long 
cherished of investi-ratino- the most common fevers in the middle states 
of America, where, from our geographical position,we witness the fevers 
observed at the northern, and occasionally those of the southern states. 
The commercial relations of Philadelphia are so frequent with the 
whole southern coast of the United States, and the passage to the north 
so rapid in the summer and autumnal months, that we receive into our Gerhard on Typhus Fever. 
3 
hospitals a considerable number of patients taken ill on the coast of 
North Carolina, Virginia, and even Alabama and Louisiana. There 
are, therefore, few places where such a study could be pursued to 
more advantage than at Philadelphia. During the last three years of 
a constant connexion with our largest hospitals, either as resident or 
attending physician, I have not lost sight of this object of study, and 
I have already published in the American Journal for the year 1835, 
some cases of the dothinenteritis as well as of the remittent and in- 
termittent fevers. 
Dothinenteritis is by no means a rare disease at Philadelphia, 
although less common than at Paris. In the essay alluded to, I 
established the identity of the anatomical characters and of the symp- 
toms of the fever, occurring at Philadelphia, with that observed 
at Paris. I also showed that the patients were chiefly those who had 
resided but a short time at Philadelphia, and that they were taken ill 
on ship-board, or under some other circumstances causing an abrupt 
change of food and habits of life. They were also young persons, 
but few having passed the age of twenty-five years. Both these con- 
ditions of age and change of habit are observed to be essential to 
O O 
the developement of typhoid fever at Paris. 
Having once established the complete identity of a fever which is 
so common at Paris and so well described, with a similar affection, 
not unfrequently met with at Philadelphia, I examined the pathologi- 
cal phenomena of our remittent and intermittent fevers of the severe 
malignant character so frequently observed along the southern coast, 
and sometimes occurring in those malarious parts of the country 
which are situated within a short distance of Philadelphia. In all 
these fevers, the glands of Peyer as well as the other intestinal folli- 
cles, were found perfectly healthy; the large intestine was occasion- 
ally but not constantly diseased, while the stomach, and to a still 
greater degree the liver and spleen were invariably found in a mor- 
bid condition. If the fever proved fatal in the course of the first 
fortnight, the liver and spleen were softened as well as enlarged; but 
if the disease assumed a more chronic form, the viscera were harden- 
ed as well as hypertrophied. The latter state was the first stage of 
these chronic lesions which are formed in the livers of patients long 
affected with remittents or intermittents, and which continue through- 
out the course of the ascites, which is so common a consequence of 
these diseases. I made numerous examinations of the bodies of 
patients who died of the same variety of malignant remittent and 
intermittent during the summer of f 835, and still more frequently in 
the epidemic of 1836, a year in which these diseases have been unu- 4 
Gerhard on Typhus Fever. 
sually fatal throughout the southern states. The results of these late 
examinations have confirmed those already obtained, and showed that 
the follicles of the small intestine are free from lesions, and that the 
anatomical character of the disease is to be looked for in the spleen, 
liver, and stomach. 
The bilious and yellow fevers are probably referrible to the same 
class as the malignant remittents, but in yellow fever the disor- 
ganization seems to be most extensive in the stomach, whence arises 
the black vomit, which forms a characteristic symptom of the disease. 
Bilious fever, or, in other words, the remittent fever attended with 
unusual alteration of the liver and a disordered secretion of bile, 
is common with us. Yellow fever is rare, and occurs in an epidemic 
form at such long intervals, that I have seen but few cases of it. 
The typhus fever, which is so common throughout the British 
dominions, especially in Ireland, is not attended with ulceration or 
other lesion of the glands of Peyer.* From the account of the lesions 
presented by most of the writers upon the subject, it would seem 
that there is no constant anatomical lesion, but that the lungs pre- 
sent traces of disease more frequently than any other organ. My 
own observation of this variety of fever was limited to the examina- 
tion of the fever patients under the care of the late Dr. Gregory of 
the Edinburgh infirmary. This observation was not sufficiently long 
or accurate to enable me to do more than refer to those physicians 
who have enjoyed extended facilities for the study of this affection. 
The lesion of the glands of Peyer is now well known to the British 
physicians, but an error frequently committed by them is that they 
regard this affection (dothinenteritis) as a mere complication of their 
ordinary typhus, or a modified form of it. At least Ido not at this 
moment recollect any one who has clearly stated that the two dis- 
eases are always distinct, before the publication of a note in the Dublin 
Journal, by Dr. Lombard of Geneva, (Sept. 1836.) 
It is not possible to set this matter at rest, unless a series of accu- 
rate histories of typhus with detailed symptoms and pathological 
lesions should be published by British physicians. With the aid 
of a statement of this kind, such a comparison might be made as to 
set the points of difference between the ordinary British or Irish 
typhus and the dothinenteritis of France in their true light. From 
the information we possess, we should conjecture that the two dis- 
eases are widely and entirely different in symptoms, anatomical cha- 
*1 mean that this lesion, when it occurs, is merety accidental or a complica- 
tion not occurring in the ordinary course of the disease. Gerhard on Typhus Fever. 
5 
racters, treatment, and inode of transmission. But the British typhus 
seems to us to be identical with the disease which forms the subject 
of the present memoir, and is apparently the same affection which is 
variously designated: typhus gravior, ship fever, jail fever, camp 
fever; sometimes petechial or spotted fever. The term typhus mi- 
tiorof the older writers seems nearly synonymous with that of typhoid 
fever or dothinenteritis of the French physicians. 
In America there have occurred several epidemics of fever more or 
less similar in their nature to the British typhus. Some of these 
were confined to the New England States, where they were often 
known under the name of spotted fever, and are described by North, 
Hale, and others. Other epidemic diseases of a similar type extend- 
ed to a larger district of country and overran a considerable portion 
of the Middle States, causing extensive ravages both in town and 
country. It was of epidemics of this kind that many distinguished 
physicians of Philadelphia perished in different years, amongst them 
were the professors of the University, Rush, Wistar, and Dorsey. 
No distinct history of the typhus fevers which prevailed at Philadel- 
phia at different periods between the years 1812 and 1820 is on re- 
cord. I mean such an account of the disease as makes its diag- 
nosis so clear that there can be no danger of confounding it with 
other analogous affections. The fever was well studied by the 
physicians who practiced at that time, but the habit of analyzing 
symptoms had not been introduced, and their experience, however 
valuable to themselves, wras in a great degree lost for their suc- 
cessors. These remarks are so true, that although an eminent physi- 
cian of Philadelphia pronounced the epidemic of 1836 to be the same 
as that of 1812 and succeeding years, another distinguished medical 
gentleman who was not familiar by his own experience with the 
former disease, considered them as distinct affections, and that the 
one which first occurred was a low grade of pulmonary inflammation. 
That the fevers were really identical, was proven by the opinion of 
Dr. Parrish, one of the most experienced physicians ot Philadelphia, 
who practiced very extensively amongst all classes of inhabitants in the 
winter of 1812-13, and was remarkably successful in his treatment 
of the prevailing fever. He saw some of the cases at the Philadel- 
phia Hospital in 1836, before the disease had extended to the weal- 
thier classes, and immediately recognised its true character. 
For a period of at least ten years there has been no epidemic of this 
nature at Philadelphia. In the year 1827, a large number of Irish 
emigrants were ill of a typhoid fever, with ulceration of the small in- 6 
Gerhard on Typhus Fever. 
testines, which was probably dothinenteritis, and during several suc- 
cessive years there were more or less extensive epidemics of remittent 
and intermittent fevers, occurring in the neighbourhood of the city, 
but not often extending into the central parts of the town. Occa- 
sionally, sporadic cases of fever of a comatose or typhoid character 
would occur, but these cases were nearly always either some form of 
malignant remittent, or else they occurred during the winter months, 
and were complicated with pneumonia. The inflammation of the 
lungs then appeared as the first stage in the disease, which after- 
wards assumed those cerebral symptoms of stupor and feebleness 
which have procured for it the designation of pneumonia typhoides. 
These cases I often witnessed while resident physician of the Alms- 
house infirmary during the years 1828-30. 
At Boston, in the year 1833, there was an epidemic dothinenteritis 
of extreme gravity and unusually fatal. This fever was well studied by 
the late James Jackson, jr., and other physicians, and was proven by 
them to be identical in symptoms and pathological lesions with the 
typhoid fever of Paris. Some of the physicians of that city are inclined 
to regard their former epidemics as of this nature, but this opinion 
seems to us more than doubtful. Since the epidemic, the typhoid 
fever is there a common sporadic disease, rather more frequent ap- 
parently than at Philadelphia. 
In the winter of 1835 6, there was an unusual number of cases of 
gangrene of the lungs at the Philadelphia Hospital, and but few of de- 
cided pneumonia. Several cases of dothinenteritis occurred in the 
autumn, but there were few afterwards. During the winter, a form 
of fever not commonly met with at the hospitals, was observed from 
time to time. It was characterized by pungent burning heat of the 
skin, dusky aspect of the countenance, subsultus, delirium, with great 
stupor and prostration; but there was no diarrhoea, and but few other 
symptoms referrible to the alimentary canal. It was the disease 
which afterwards appeared as an epidemic. At first it was not well 
understood by us, was sometimes confounded with bronchitis or pneu- 
monia typhoides, from the complication of pulmonary disease with the 
symptoms of the fever. These cases recovered under the use of a mild 
stimulating and supporting treatment, with one exception, in which 
death ensued from sloughing of the sacrum and gangrene of the lungs. 
In the early part of the month of March, the admissions for the 
fever were more numerous. They attracted the greater attention 
from their occurring in groups of several from the same house, and 
almost all coming from a particular neighbourhood. Amongst the 
very first admitted were seven negroes, the entire population of a Gerhard on Typhus Fever. 
7 
cellar in the lower part of the city. The symptoms varied but little 
in the seven cases, and upon an examination of two of the number 
who died, no lesion of sufficient importance to account for the symp- 
toms could be detected. 
As soon as these patiefnts were admitted, I resolved to note with 
care the pathological lesions presented by the bodies of most of those 
who should die of the fever, examine its symptoms and ascertain the 
influence of therapeutic agents upon it. This research was com- 
menced with a view to obtain more precise notions as to the charac- 
ter of an epidemic which has probably more than once appeared in 
America, and seems to be endemic in Great Britain and Ireland. It 
was especially desirable to ascertain if there was a real fundamental 
difference between the form of disease which prevailed this year 
and the dothinenteritis which is always to be met with in Ame- 
rica, as a sporadic affection. My friend and colleague. Dr. Pen- 
nock, had charge of one half the medical wards of the Phila- 
delphia Hospital; his observations were conducted at the same time 
with my own, but the autopsies and the examination of doubtful cases 
were always made in the presence of both of us. Dr. Pennock noted 
a large number of cases, and has given me the privilege of adding his 
collections to my own. They are the more valuable from the familiar 
knowledge which he obtained of the dothinenteritis in the wards of 
La Pitie at Paris. Our inquiries were conducted so much in concert, 
and our opinions as to the symptoms and treatment of the fever were 
so often compared together, that this memoir is in most respects the 
expression of the results obtained by our joint labours. 
A portion of the cases were treated by Ur. rancoast; or these I 
have no notes excepting such as were obtained from the registers of 
the wards; they were chiefly admitted towards the close of the epi- 
demic season, when we had already procured a large mass of mate- 
rials.* 
Many of the observations are deficient in the history of the early 
symptoms, as the patients at their entrance into the hospital often did 
not retain intelligence enough to recollect the previous symptoms of 
their disease. The autopsies were always made with great care, 
♦These inquiries were greatly promoted by the zeal and industry of the resi- 
dent physicians of the hospital, who were all much interested in the examination 
of the disease, and untiring in their efforts to relieve the suffering of patients, 
who always required much more than ordinary care. In the rotation of service 
the most arduous duty fell to the lot of Drs. Bush, Stille, Patterson, Elmer. Frisby, 
and Johnson, of whom the two last mentioned were themselves attacked with 
fever. 8 
Gerhard on Typhus Fever. 
more particularly the examination of the small intestines; but the 
weight of occupation and the ennui of recording results which varied 
so little among themselves, caused us to neglect committing some of 
them to paper. We have, however, noted in detail, a very large 
number, showing the nature of the lesions; and we always took great 
care to remark the diseased or healthy state of the organs. We are 
quite sure that nothing of importance escaped us, and, above all, that 
the condition of the follicles of the small intestine was carefully 
ascertained. Our mass of facts is so considerable, that many im- 
portant questions will be solved by them in relation to the history of 
this form of continued fever. They will clear up many questions 
relative to the disease; for although few cases are as complete as we 
could have desired, the information which is wanting in one case may 
be gathered from others; none are deficient in all the particulars, or 
fail to give a tolerably exact statement of the.symptoms at one period 
or other of the disease. 
In our investigations, we availed ourselves of the opportunities we 
possessed to inquire into the pathological anatomy, the symptoms, the 
mode of communication, and the treatment of this fever, which had 
not been witnessed at Philadelphia for some years, even if it were 
the same disease as that of former epidemics. At each step of this 
progress, 1 shall compare the facts before us with those relating to the 
history of the typhoid fever, or dothinenteritis, and when the symp- 
toms differ, it will be easy to draw the line of distinction between 
two diseases, differing in their treatment, symptoms, duration, and 
pathological lesions. 
There is some confusion in the designations of these fevers, but it 
is not my intention to enter upon the discussion of their nomenclature. 
It is sufficient to state that in using the terms typhus, typhus fever, 
typhus gravior, spotted or petechial fever, I mean that disease which 
forms the subject of this memoir, and that by the terms typhus mitior, 
typhoid fever, or dothinenteritis, I mean the disease described by 
Louis, Chomel, &c., and attended with a lesion of the glands of 
Peyer. 
The number of cases admitted with typhus, was 214. Of this 
number there were 120 men and 94 women. A few cases who were at 
the same time in the wards, and already under treatment for other 
diseases, are not included, although they were afterwards affected 
with the prevailing epidemic, but their names on the register present 
only the disease for which they had been admitted. The whole num- 
ber of cases is, therefore, from 230 to 250. A large majority of the 214 
patients were negroes or mulattoes, there were 147 people of colour Gerhard on Typhus Fever. 
9 
and 67 whites. The disease first appeared in the former class of 
patients, and always prevailed more extensively amongst them than 
the whites who were living in the same part of the town and exposed 
nearly to the same causes of disease. 
The patients were taken with the fever in various parts of the city 
and neighbouring districts, but by much the greatest number came 
from that part of the town which extends from Lombard street to a 
little below Shippen, and from Fifth to Eighth streets; this small but 
crowded district became almost an infected suburb. Within these 
limits the poorest and most intemperate of the inhabitants of Philadel- 
phia reside. It is the St. Giles or the Faubourg Saint Marcel of Phila- 
delphia. The filthiest and most crowded alleys offered the greatest 
proportion of patients. Thus, Small street and St. Mary’s street, with 
the numerous courts and alleys running from them, contained many 
more sick than other streets inhabited by a population nearly as poor 
and intemperate, but less crowded. The different streets were not 
infected at the same time, thus the earliest patients were taken ill in 
Shippen and in Small streets, while St. Mary’s street, which furnish- 
ed an immense number of patients, was comparatively free from in- 
fection until a month afterwards. The disease appeared very soon 
in the prison (now taken down) in Arch street, but as the inmates of 
the prison came in great part from the infected district, it is possible 
that the disease may have been introduced by those who were admit- 
ted w'hile labouring under it. Towards the close of the epidemic, 
patients were admitted in considerable numbers from some of the 
streets in the Northern Liberties, and throughout its whole course 
there were scattering cases from different parts of the city, and a few 
from the country, where there were no others ill in the house from 
which the patient had come. But few cases, however, occurred in the 
central parts of the town, where the inhabitants are generally in easy 
circumstances, and comfortably fed and lodged. 
Classes of persons affected.—The first patients were almost exclu- 
sively from the poorest and most intemperate class of people, chiefly 
day-labourers. Such was the case with most of the blacks, especially 
the men, who were almost without exception in the habit of drinking 
freely of ardent spirits. The women were without fixed occupations, 
or were servants out of place. As the disease extended to the differ- 
ent parts of the city, people of various occupations were affected, 
amongst them there was one respectable physician, who died of the 
fever. The extension of the disease to those in easy circumstances, 
was shown in the practice of several eminent physicians of Philadel- 
phia; they had not seen a case until the fever had prevailed some 10 
Gerhard on Typhus Fever. 
months at the hospital, although they afterwards met with it in their 
private practice. 
Mode of propagation of the disease.—The origin of the disease is 
as unknown as that of most epidemics; according to the general rule, 
it attacked those who were sunk in poverty and intemperance, and 
huddled together in confined apartments. It also appeared at differ- 
ent and remote points, some miles distant from the focus of-infection, 
without the possibility of tracing any direct communication between 
those already attacked. There was, thus, a general cause, which ex- 
tended its influence throughout the vicinity of Philadelphia. But, 
besides the epidemic cause, from which the greater number of cases 
seemed to arise, the fever was evidently propagated in a consider- 
able proportion of patients by direct contagion. Those who entered 
at an early period of the epidemic came in groups together, some from 
the prison, whole families from the same room or the same house. 
About that time, I made a careful inspection of the district as one of 
a committee of the Board of Health, and in some instances we found 
houses completely vacated, the tenants being either dead or at the 
hospitals. In other cases, the whole or a large proportion of the in- 
habitants of a room were ill. It was rare to meet with a severe case 
without seeing others in the same house. 
The evidence of contagion at the Philadelphia hospital was more 
direct and conclusive. Three of the principal nurses, and about a 
dozen assistant nurses, besides a number of patients ill with various 
diseases were taken with the fever. The three principal nurses be- 
longed, two to the wards for blacks, where there were the greatest 
number of fever patients, and the third to a ward for whites, where 
there were several cases. There was only one nurse of a ward in 
which many of the patients were collected, who escaped, but several 
of his assistants and patients were taken ill. Two of the resident 
physicians in attendance upon the same ward, where the patients were 
most numerous, were also severely ill with the fever. On the other 
hand, no nurse from the part of the hospital where there were but few 
or no typhus cases, suffered, and the number of patients taken ill in 
the surgical or lunatic wards was very small, not exceeding six in 
number. The wards in which fever patients were placed did not 
contain more than a third or a fourth of the population of the hos- 
pital, yet the number of cases originating in them after the first in- 
troduction of the disease was at least four times as great as in all the 
c? 
other parts of the building. The Alms-house and house of employ- 
ment, which are separated from the hospital by a space of at least 
forty feet at the nearest points, furnished five or six cases, proba- Gerhard on Typhus Fever. 
11 
bly not more than the same number of poor in any other part of the 
neighbourhood would have done. 
The proportion of attendants upon the sick who suffered was in exact 
relation to the number of fever patients in the ward,- thus in the wards 
for blacks, (both men and women,) and in the men’s medical, No. 1, 
scarcely an assistant escaped. In the other medical wards a few were 
taken ill, and in the surgical and lunatic wards all the nurses escaped. 
The matter of the contagion, be it what it may, was generally mingled 
with the air, but sometimes seemed to be combined with the pungent 
hot sweat of the patients. In some cases the contagion was evidently 
direct from body to body. This was established by the evidence of 
a nurse and an assistant, both persons of intelligence, and, from their 
familiarity with the disease, quite free from fear. The nurse was shaving 
a man, who died in a few hours after his entrance, he inhaled his 
breath, which had a nauseous taste, and in an hour afterwards was 
taken with nausea, cephalalgia, and ringing of the ears. From that 
moment the attack of fever began, and assumed a severe character. 
The assistant was supporting another patient who died soon after- 
wards, he felt the pungent sweat upon his skin, and was taken imme- 
diately with the symptoms of typhus.* The wards in which the 
fever patients Avere placed, were large and well ventilated. We 
were at first disinclined to believe that the disease would prove con- 
tagious, but as soon as the fact was clearly proven, measures were 
taken to remove the patients not yet affected from most of these 
wards, and, if it had continued for a longer period, an efficient local 
quarantine would have been adopted. Dead bodies either did not 
communicate the contagion or its influence was easily counteracted 
by favourable circumstances. Both Dr. Pennock and myself, and 
several of the resident physicians were engaged nearly every day 
during the most intense prevalence of the disease in making long and 
laborious anatomical investigations, without suffering from the fever. 
It is very clearly proven that the typhoid fever or dothinenteritis, 
is not contagious. Dr. Louis informed me that, in the course of his 
long experience of the disease, he had never seen a single case origi- 
nating in an hospital. I have seen but one. The contrast between 
the fevers, in this respect, is obvious. 
Age of the patients.—After childhood, the age seemed to exercise 
but little influence upon the susceptibility to the disease. But chil- 
dren were rarely attacked by it. None of the children in the Asylum 
♦Two other cases of assistant nurses also originated from similar contact, but 
as they were persons of less intelligence, I have refrained from relating their cases 
as they offer less undoubted testimony. 12 
Gerhard on Typhus Fever. 
attached to the hospital, where there were about two hundred, were 
taken ill. Nor in the inspection which I made as a member of the 
Board of Health, of the houses in the infected district, did I discover 
many children who seemed to be labouring under the fever. After 
childhood, the age of patients seemed nearly without influence. Thus, 
of sixty-six whites, there were thirty-five below the age of 35 years, 
and thirty-one beyond that age, and, on adding the number of nurses 
and patients taken ill in the wards, we shall increase the number of 
persons older than 35 years, or passed the middle of life. The blacks 
give a greater proportion of young persons, although there were patients 
amongst them who were far advanced in years. But their compara- 
tive youth is easily to be accounted for by the large number of blacks 
engaged as labourers and inhabiting the infected part of the town, 
very few of them are old or middle aged men. Another reason is 
the habit of the blacks to state themselves younger than they really 
are, partly from ignorance of the value of numbers and of the precise 
year of their birth. It would, therefore, give incorrect results to in- 
clude them in our estimate. The age of these patients differs much 
from that of those affected with the typhoid fever or dothinenteritis, 
who are all younger, the disease almost never occurring above the 
age of 55 years, the average for Paris and Philadelphia is 224- and 22 
years. (See Louis on Typhoid Fever and American Journal, 1835.) 
The sex seems to exert little influence on the liability to the dis- 
ease. The numbers were 120 men and 94 women, which is about the 
relative proportion of our ordinary patients. This result differs but 
little from that observed in typhoid fever, where, cseteris paribus, 
men are perhaps a little more subject to it than women. 
The change of life and habits from country to town was of no im- 
portance, our patients were nearly all resident for some years at 
Philadelphia, and some had been paupers for many years; their food 
and mode of living remaining unchanged during that period. The 
disease was not, as dothinenteritis, nearly confined to those persons 
who had recently removed from one place to another. 
Use of ardent spirits.—The most perfect temperance did not prove 
a safe-guard when exposed to the contagion, as was shown by the 
cases of two of the resident physicians and of many others. Still, as 
a large majority of our patients were known to be intemperate, it 
would at first sight appear that intemperance was a powerful predis- 
posing cause. But the habits of the day-labourers are such that but 
few of them abstain from using spirits more or less freely, so that the 
number of typhus patients who were intemperate does not greatly 
differ from that of those affected with other acute diseases. Most of the 
women were not given to intoxication. Gerhard on Typhus Fever. 
13 
Season of the year.—The epidemic began in March, and continued 
until August. There were a few scattering cases afterwards. The 
summer was unusually cool, and the spring and winter cold. It 
was remarked, that as the summer advanced, and an epidemic dys- 
entery appeared, the fever was changed in character, and frequently 
offered a new symptom, that is diarrhoea, which was wanting in the 
earlier months. 
Occupation, fyc.—Our tables do not give us all the necessary in- 
formation on this subject, nor would it be quite correct to receive 
their statements. The number of patients admitted with acute- 
disease from the better classes of mechanics was extremely small, 
unless the subjects of it had been reduced to poverty by previous 
intemperance. Most of the blacks, like others of their race, were 
employed as mere day-labourers, chiefly masons’ labourers, and steve- 
dores. The poorest classes, whatever might be their occupation, were 
evidently more exposed to the disease than those who were richer, 
chiefly, perhaps, from their crowded and ill-ventilated rooms, as few 
of them had actually suffered from want of a sufficient supply of food. 
Colour.—The proportion of deaths amongst the black men was 
much greater than amongst the whites, thus of the whites, one died 
in 4|y amongst the blacks, one in 2|-|. Amongst the women the re- 
verse was true; thus, one white woman died of 4|; but only one 
coloured woman in 6-1- nearly. These two results would, therefore, 
appear contradictory, unless explained by other causes. 
Age.'—Twentj-two patients, eleven male and eleven female, both 
white and coloured, were admitted under the age of twenty, (from 
ten to twenty years,) of these not one died. Youth, then, was almost 
a safeguard against the danger of the fever, and this charmed age 
(from ten to twenty) was as free from the danger of petechial fever, 
as from most other causes of death. From the age of twenty to 
thirty, of women there died one in SJ-, and in men nearly one in 4. 
It should be recollected that the largest proportion of deaths amongst 
the men of the age above-mentioned, occurred in blacks, who noto- 
riously underrate their ages, especially the men who were employed 
in occupations and under circumstances which rendered it difficult 
for them to fix their dates as accurately as the women, many of whom 
were domestic servants. Amongst the whites the mortality of the 
men between the ages of twenty and thirty was only a twelfth, but 
amongst the women it was as high as a fourth. Therefore, after making 
allowance for the causes of errors alluded to we shall have but a 
small difference in favour of women under the age of thirty. The 
deaths amongst the women above the age of thirty were one in five 14 
Gerhard on Typhus Fever. 
nearly. The influence of treatment upon the mortality will be after- 
wards noticed. 
Pathological Anatomy.—Dr. Pennock and myself examined a very 
large number of the bodies of those patients who died of the fever. 
Indeed, during nearly the whole epidemic scarcely a single examina- 
tion was omitted, excepting in cases where it was impracticable 
from the removal of the body by the friends, immediately after 
death, or where putrefaction supervened, as it sometimes did almost 
immediately after dissolution. In this large number of autopsies, 
amounting to about fifty, there was but in one case, and that 
doubtful in its diagnosis, the slightest deviation from the natural ap- 
pearance of the glands of Peyer. In the case alluded to, in which 
there had been some diarrhoea, the agglomerated glands of the small 
intestine were reddened and a little thickened; but there was no 
ulceration and no thickening or deposit of yellow puriform matter in 
the submucous tissue. The disease of the glands resembled that 
sometimes met with in small-pox, scarlet fever or measles, rather 
than the specific lesion of dothinenteritis. In all other cases, the 
glands of Peyer were remarkably healthy in this disease, as was the 
surrounding mucous membrane, which was much more free from vas- 
cular injection than it is in cases of various diseases not originally 
affecting the small intestine. 
The mesenteric glands were always found of the normal size, 
varying, as in health, from the size of a small grain of maize to 
three or four times these dimensions. With the exception of a slightly 
livid tint, common to them and the rest of the tissues, they offered 
nothing peculiar either in consistence or colour. 
The spleen was of the normal aspect, in one half the cases, in the 
other half it was softened, but not enlarged, and in one case out of 
five or six, enlarged and softened. 
Thus, the triple lesion of the glands of Peyer, mesenteric glands 
and spleen, constituting the anatomical characteristic of the dothi- 
nenteritis or typhoid lever, although sought tor with the greatest care, 
evidently did not exist in the epidemic typhus. Indeed, it was a 
subject of remark, that in the typhus fever the intestines were more 
free from lesion than in any other disease accompanied by a febrile 
movement. This exemption extended to the large intestine until the 
summer heats began, when a few scattering cases offered some symp- 
toms of diarrhoea, during the prevalence of an epidemic dysentery; 
and, where they terminated fatally, softening and other signs of in- 
flammation of the mucous coat of the colon were observed. 
The fact that the morbid changes pathognomonic of dothinen- Gerhard on Typhus Fever. 
15 
teritis, are not met with in the typhus fever, would of itself seem con- 
clusive that the two diseases are no more identical than pneumonia 
and pleurisy. Although, in some respects, the two affections are 
analogous, and even similar, the radical difference of anatomical 
lesions is at least as well marked as the distinction between the 
symptoms. It is, indeed, singular that there should of late be a strong- 
tendency to confound two fevers, which were regarded as entirely 
distinct by some of the older physicians. The prominent symptoms 
and difference of treatment being particularly well pointed out by 
Huxham. 
We will now give a series of dissections in the different stages of the 
& O 
disease. Some of the cases are detailed at length, the notes of others 
are not published, excepting that portion which relates to the patho- 
logical phenomena. 
Case I. A stout mulatto entered in June, 1836, with chronic dis- 
ease of the heart and rheumatic pains. A mild treatment had been 
directed, when the patient was taken with the prevailing epidemic, 
and died on the fourth day. 
Autopsy—fifteen hours after death.'—Exterior—very muscular; no 
infiltration; moderate rigidity. 
Head.—Blood darker and more abundant than usual in the outer 
surface of the dura mater, and in the sinus; arachnoid contains one to 
two ounces of serum; pia mater not injected, the largest veins only 
filled with dark blood. Brain firm, moist, but pale; central parts 
pale; a drachm or two of serum in each ventricle; cerebellum and 
adjoining parts firm and pale. 
Neck.—Pharynx pale; larynx slightly injected; trachea brightly 
injected throughout its whole extent. 
Thorax.—Right pleura dry, brightly injected over the diaphragm, 
where it presents an abundant net-work of vessels; the same injec- 
tion extends to the aortal and pulmonary pleura. The serous coat in 
these portions is covered by a thin layer of false membrane, a little 
thicker than common writing paper, of a yellowish tint, easily de- 
tached Irom the serous coat. The lower lobe of the lung is of a dull 
red colour, not containing air, not granulated, rather hard, not friable, 
more like the splenetized lung of pleurisy than pneumonia. The 
other lobes are oi a light red colour, firm, and not infiltrated. Bronchi 
rosy and natural, except in the lower lobe, where they are reddish, 
and contain a dark serum. The left pleura is not injected; offers no 
serum: lung grayish and easily compressed. Bronchi natural; peri- 
cardium contains no serum. Heart much enlarged, one half larger than 
the fist of the subject. Left ventricle offers a cavity scarcely larger 16 
Gerhard on Typhus Fever. 
than natural, but its walls are about fourteen lines thick, of a deep 
red colour, and very firm. Columnse carnete much enlarged; mitral 
valve thickened from cartilaginous deposits within its substance; 
semi-lunar valves of the aorta contracted, cartilaginous, of irregular 
shape, so that they neither could close nor open completely the orifice. 
Stomach distended, contains a whitish mucous liquid; mucous 
coat nearly removed in the cardiac half, light grayish pulp only re- 
maining; the other coats thinned and softened. In the pyloric two- 
thirds the coat is mammillated, thinned irregularly, of a general 
bluish-red colour, without bright injection. 
Small intestine contains the usual liquid, lined by a coating of white 
mucus, not injected or softened; mesenteric glands small and firm; 
large intestine contains healthy fasces, pale; liver rather larger and 
paler than usual, a little less consistent. Spleen softened, not en- 
larged. Kidneys dark but firm. Bladder contracted. 
The next case which was treated by Dr. Pennock, is recorded in full, 
furnishing a complete account of both symptoms and pathological phe- 
nomena. In the autopsy which has already been inserted, the lesions are 
very slight, being limited to a partial disease and softening of the mu- 
cous coat of the great tuberosity of the stomach. The patient died four 
days after the supervention of the symptoms. It is the earliest case 
of death amongst those patients who had enjoyed a tolerable state of 
previous health; but more than one patient, exhausted by some chro- 
nic affection, such as consumption, were seized with symptoms of 
typhus, and were carried off* within the first twenty-four hours. In 
such cases no trace of the passage of the fatal affection was left after 
death. 
Case IT. Premonitory symptoms during four days:—Disease ush- 
ered in by chilliness, frontal cephalalgia, erratic pains, muscular 
soreness—Petechia on the fourth day—Type of fever remittent—Death 
on the tivelfth day—Autopsy.* 
March \7th. Margaret Walters, aged 24, has been assistant nurse 
in women’s medical ward during the preceding month. Last summer she 
had intermittent complicated with severe neuralgia; her health, how- 
ever, was entirely re-established; she was robust, and perfectly well 
until the 13th inst.,when she experienced general muscular soreness, 
some sore throat, pain in the joints, constipation, languor, want of 
sleep, lancinating pain through the head and occasional tinnitus aurium, 
which symptoms, attended with a voracious appetite, continued during 
the four succeeding days, but did not oblige her to discontinue the 
*Case from the note-book of Dr. Bush, resident physician. Gerhard on Typhus Fever. 
17 
performance of the ward duties until this morning. At the hour of 
the visit (10 o’clock, A. M.,) she presented the following symptoms: 
embonpoint considerable; intelligence languid; position in bed indi- 
cative of feebleness; surface of body warm, horripilations; great pain 
in the head and small ol the back; lower extremities feel sore; ex- 
pression of countenance anxious and distressed; sighs frequently;- 
eyes languid, light is unpleasant; capillary circulation of face, which 
is flushed, active; tongue moist, slightly coated with light yellow 
fur; offensive odour of the breath; anorexia, with nausea and bitter 
taste in the mouth; great thirst, desires cool acid drinks; no soreness 
of throat; deglutition easy; constipation; no eruption or spots on the 
body. Pulse irregular, 68, of medium volume and force. Respira- 
tion 40, pure and expansive over the chest. Treatment: apply dry 
cups. No. 6, until vesication takes place, to the nape of the neck and 
small of the back; sinapisms to feet; farinaceous diet; mineral water. 
18th. 8, P. M., muttering delirium, but no sleep during last night; 
intelligence obtuse; skin was warm and dry this morning, accompa- 
nied with intense headache, it is now covered wijh perspiration, and 
the cephalalgia has diminished; face flushed; tongue moist, coated 
with white fur; much thirst; herpetic eruption about mouth; anorexia; 
some tympanitis, but no pain on pressure of abdomen. Pulse irregu- 
lar, intermittent, about 68, soft, weaker than yesterday; respiration 
irregular—this morning it was 50, it is now 32. Dry cups, No. 15, 
were applied over the thorax this morning; alvine dejections were in- 
duced by mucilaginous eneraata. R. Effervescent mixture t~i. q. h., 
cold drinks; stimulating pediluvium. Sulph. morph, grs. iq.b. h. 
until sleep takes place. Diet, sago. 
21 st. Patient has slept well tor several nights, after taking small 
portions of the sulphate of morphia;, exacerbations of fever have been 
observed at irregular intervals, though most marked in the afternoon. 
10, A. M., expression of countenance is now idiotic; eyes half closed; 
mouth open; intelligence obtuse; hearing dull; disposition to sleep; 
cephalalgia much diminished; muscular soreness, pains in the back 
and articulations abated; cheeks of violet hue, with languid capillary 
circulation; skin warm, soft, disposed to moisture; tongue clammy, 
covered with a brown yellow coat, through which the papillae are 
elongated; thirst, desires cold acid drinks; some appetite; no nausea; 
constipation; abdomen tympanitic, soreness on pressure; urine of deep 
red colour, without flocculi, resembling intermixture of blood and 
water, voided without pain or burning sensation. Pulse 72, regular, 
small volume, feeble. Respiration costal, 28. Percussion of thorax 
anteriorly resonant; the respiration is there expansive, with sonorous 18 
Gerhard on Typhus Fever. 
and sibilant ronchi. At the back percussion is dull on inferior two- 
thirds, where the respiration is extremely feeble, almost suppressed, 
with subcrepitant rhonchus on forcible and full inspiration. 
The surface of the neck, chest, abdomen, and arms presents a 
mottled appearance, in consequence of being covered with spots 
varying from one to three lines in diameter. The smaller are rose 
coloured, whilst the larger have a lilac hue; the first disappear upon 
slight pressure, the larger, on the contrary, are not so easily effaced, 
and reappear more slowly. Take of blood, by cups, from 
temples and back of the neck; carb. ammonia grs. xv. q. b. h. (in 
julep;) effervescent mixture q. h. mineral water. Sponge with 
evaporating lotions, and exhibit cool mucilaginous enema, when sur- 
face is warm. At night pulv. Doveri grs. xv. Diet, essence of beef; 
wine whey. 
22nd. 10, A. M., only tpj. of blood were abstracted, as patient 
was much exhausted; slept well during four hours; intelligence im- 
proved; but little cephalalgia; no tinnitus aurium, except when sitting 
up; eyes injected; tongue cleaning in centre; much thirst; soreness 
of throat, fauces and tonsils red and tumid; deglutition painful; no 
nausea; alvine evacuations natural in colour and odour; tympanitis 
continues; no pain on pressure of abdomen. Skin, above natural 
temperature; some moisture on the breast; spots are of a darker co- 
lour, and do not disappear upon pressure so readily as yesterday. 
Pulse 88, medium volume; respiration 20, costal. R. Carb. ammo- 
nise grs. v. q. h.; rubefacient application to the throat; sponging; ice; 
orange; lemonade; oysters and beef essence; wine whey. Opiate at 
night. 
4, P. M., pulse 100, regular, good volume, yielding to moderate 
pressure; face much flushed, capillary circulation very active; skin 
hot; spots more numerous, are readily effaced, but instantly reappear; 
no increase of cephalalgia; tongue thickly coated in middle with 
white fur; no pain on pressure of abdomen. Cool enema and spong- 
ing were resorted to; stimulants were discontinued, and in the course 
of that evening skin became soft and perspirable. 
24th. 1, P. M., slept well; no deliriums In the morning at 10 
o’clock, skin was moist; pulse of moderate volume and quickness. 
Skin is now hot; face flushed; capillary circulation active; eyes in- 
jected; tendency to coma; dull expression of countenance; tongue dry, 
covered with brown fur; lips parched; sordes on teeth; much thirst; 
no nausea; petechial spots fading. Pulse 114, small, jerking; caro- 
tids vibratory, especially on the right side; respiration 28, costal. P. 
01. terebinth gts. xv. q. h. (in emulsion,) sulph. quinine grs. vi. q. b. Gerhard on Typhus Fever. 
19 
h. per enema: sulph. quinine grs. iij. q. h. during remission of fever; 
blisters on the ankles and abdomen until redness. Diet as before. 
Very little alteration was presented in the symptoms during the 
three succeeding days. The patient was extremely prostrated; febrile 
exacerbation recurred in the afternoon, slight remission in the morn- 
ing. The skin at times was slightly perspirable, though generally 
dry and hot. The petechial spots, which were pale on the 24th, re- 
appeared in increased numbers on the 26th, covering every part of the 
surface. Intelligence very dull and confused. Countenance idiotic, 
eyes half closed, and mouth open. Sleep was tranquil, by exhibition 
of Dover’s powders and paregoric; almost entire deafness existed. 
Pulse varied from 100 to 120, of small volume, easily extinguished, 
but without subsultus. Respiration 20 to 26, costal. Respiration 
expansive, except posteriorly; anteriorly mucous and sibilant ronchi 
existed and masked the vesicular respiration; cough slight, without 
expectoration; dejections dark yellow-brown colour, of moderate con- 
sistence; urine became more natural in colour. 
The treatment previously mentioned was continued, tonics and 
stimulants being exhibited in the remission, discontinued during the 
exacerbation, and replaced by evaporating lotions, cool mucilaginous 
or saline enemata, and diaphoretics of the neutral salts. 
On the 28th, whilst the weather was cold and damp, a portion of 
the chimney passing through the ward in which she was placed, was 
torn down, rendering it impossible to maintain a proper temperature- 
The noise which the hammering occasioned, caused agonizing cepha- 
lalgia, inducing delirium; the periodical exacerbation in afternoon 
was exceedingly violent, accompanied with convulsions. In the eve- 
ning (Ji o’clock) skin was warm but moist, no pain in the head; 
patient rational; pulse 120, gaseous. Respiration 26, costo-abdominal. 
She slept soundly during two hours, after taking an opiate, (pulv. 
Doveri grs. xv.) Nurse reports, that towards morning she had a 
chill; surface of the body was cold; lips, cheeks, and extremities pre- 
senting a blue appearance, and that the reaction took place at seven 
o’clock. 
29th, 10 A. M. Skin natural temperature and moist; body covered 
with petechia and vibices, which do not disappear on pressure; ca- 
pillary circulation moderately active; hearing very obtuse; no cepha- 
lalgia; slight tinnitus aurium; operation of mind, languid; constant 
moaning; speaks slowly, articulates with difficulty. Tongue smooth, 
clean and tumid at the point, covered posteriorly with a brown and 
loose incrustation; two alvine dejections resembling light thin jelly 
in the last twenty-four hours; some appetite, much thirst; abdomen 20 
Gerhard on Typhus Fever. 
distended by flatus; urine slightly turbid, but has not the deep red 
hue previously mentioned. Pulse 120, small volume, regular, extin- 
guished by slight pressure; vessels of neck undulatory, especially on 
right side. Respiration 28, irregular. R. port wine 1 gill, quinine 
solution (grs. iv.) q. h.; quinine grs. x. q. 2\ h., with essence of 
beef in injection. Emul. 01. terebinth, q. h. Diet, essence of 
beef. 8, P. M. Stimuli have been discontinued for last two hours in 
consequence of reaction. Hiccups for a short time. Nurse reports 
that an hour since convulsive movements took place, continued ten 
minutes, and was succeeded by vomiting. Alvine dejections frequent, 
watery; cannot retain the injections. Pulse 124, very weak, undu- 
lating, pulsations not definite. Countenance vacant, but answers 
when repeatedly spoken to; swallows with difficulty; respiration 40, 
rattling in throat; mucous rhonchus in lungs, especially the right. 
Surface became cold, and death took place at 11, P. M. 
Autopsy 36 hours after death. 
Large frame; no emaciation; a layer of fat half an inch in thick- 
ness, through which is distributed streaks of black blood covering the 
abdomen; spots of a purple colour, resembling purpura haemorrhagica, 
cover the legs, thighs and abdomen; petechia on the arms and chest 
as during life; abdomen distended and resonant on percussion. 
Brain.—Falx engorged with blood, and contains soft yellow-green 
coagula. The larger veins of the dura mater are filled with blood, 
and its arteries contain a small quantity of dark thin blood. Arach- 
noid and pia mater injected with blood of a bluish-black colour; no 
effusion of serum between these meninges. Pia mater is torn from 
the cortical substance without lacerating it. 
Cerebrum.—Cortical substance pale, of usual consistence, medullary 
portions firm, of light violet hue; its horizontal sections dotted with 
black points at the cut orifices of its vessels. About Jiss. of trans- 
parent serum in each ventricle. The cerebellum of usual consistence 
and colour; the arachnoid is less injected here than elsewhere. 
Thorax.—Old adhesions of the right lung near the base to the ribs; 
no effusion of serum in either thoracic cavity. Lower lobes of both 
lungs condensed, almost impermeable to air, congested moderately, 
friable, not hepatized; but resembling, when torn, the appearance of 
the spleen. Posteriorly the upper lobes are engorged, tissue friable; 
whilst anteriorly the pulmonary tissue is firm, tears with difficulty, 
crepitant, and but slightly congested. Bronchi of a livid colour, 
contain a small portion of sero-mucus fluid; the lining membrane, 
when detached, is transparent and not thickened. Larynx moderately 
injected; no tumidity of the lining membrane. Trachea of a deep red Gerhard on Typhus Fever. 
21 
colour, its mucous membrane of usual consistence. Heart is of the 
natural size, its parietes flabby, easily broken clown; valves normal; 
right ventricle contains a soft coagulum of slight firmness. In the 
left ventricle was a small quantity of black blood. No coagulum in 
the aorta, which contained a small quantity of dark blood, having oil- 
like particles distributed through it. No coagula either in the vena 
cava ascendens or in the femoral vein; both contain a thick black 
blood, similar in consistence and colour to molasses, having minute 
fatty globules floating in it. 
Abdomen.— Stomach distended by gas, and contains several ounces 
of a straw coloured fluid; patches of dark injection, in which mucous 
membrane is softened, are seen in those portions of the large cul-de- 
sac covered by the contained fluids, in all other parts the con- 
sistence and appearance of the mucous membrane are natural. Mucous 
membrane of duodenum stained of a dark yellow colour. The small 
intestines in the greater part of their extent are translucent, with 
scarcely the appearance of blood-vessels; several ecchymosed spots, 
however, are seen; over which, as in all its extent, the mucous mem- 
brane is healthy, yielding stripes of from six to ten lines. One of 
these spots, which is in the ileum, is several inches in length, and 
when the mucous coat is raised the ecchymosis is seen in the cellular 
coat. Glands of Peyer healthy, not developed; seen with difficulty. 
jßrunner’s follicles normal. The large intestine contains faeces of a 
yellowish-brown colour and of moderate consistence; the mucous 
membranes and follicles normal. Liver natural size, surface fawn 
coloured, mottled with purple spots of ecchymosis; structure granular, 
friable; blood-vessels filled with dark fluid blood, containing oily par- 
ticles. Gall bladder contains dark grumuus bile. Spleen twice its 
usual size, colour natural, softened, almost diffluent. Kidneys of 
natural size, the conoidal portions much darker than usual, but of 
natural consistence. Bladder contains no urine, coated with thick 
white mucus; its internal coat moderately injected. Uterus normal. 
Remarks.—The fever in the preceding case was of a remittent type 
in the commencement, and evidently intermittent during the two last 
days of life. Death took place in the cold stage, and the depressing 
influence of the low temperature of the medical ward no doubt con- 
tributed to produce the fatal result. The cause of the irregularity of 
the pulse at the commencement, and its subsequent regularity, are 
not explained by the state of the heart. The ecchymosis on the liver, 
and the effused blood on the cellular coat of the small intestines, are 
strikingly analogous to the vibices on the surface of the body, and 
probably depend on the same cause. The presence of black blood in 22 
Gerhard on Typhus Fever. 
the arterial system, and the friability of the lungs, are remarkable 
pathological features in this disease, and are very similar to the ap- 
pearances presented in death from asphyxia, and would seem to prove 
that the blood in both diseases is unchanged in its passage through 
the lungs. 
Case 111. Precursory symptoms Jive days—disease commenced 
with cephalalgia, muscular and erratic pains,fever remittent, petechise, 
vihices, great prostration, death on the 14th day. Autopsy. Lungs 
friable, patches of Peyer healthy, black blood in arterial system.— 
Susan C , aged 21, intemperate, entered the hospital March 27th. 
She was discharged from prison last winter, and has suffered from 
intense cold and privations of every description. Health generally 
good, with the exception of a syphilitic affection manifested a year 
since. She had been sick sixteen days, and although she was much 
prostrated, her memory was sufficiently accurate to fix the date of 
the occurrence of the different symptoms of the present disease. On 
the 16th, after experiencing lassitude, loss of appetite, and want of 
sleep during five days, she was seized with sharp pains in the calves 
of the legs, extending to the knees, thighs, and intestines. On the 
19th, soreness of throat, great thirst, but no difficulty in deglutition. 
On the 20th, intense pain in the temples and eye-balls, with vertigo. 
On the 23d acute pain was felt in the lumbar region. Constipation 
had existed two weeks previous to the 22nd, when several copious, 
foetid, dark alvine discharges took place. The soreness of the throat 
disappeared spontaneously in two days, but the dizziness of the head 
and the local pains have continued, with but slight alteration, until 
the present time. 
Present state, March 27th. Large frame, embonpoint consider- 
able; dark blue eyes, chestnut hair, decubitus on either side; expres- 
sion of the countenance anxious; skin of natural heat and dry; capil- 
lary circulation of the face, which is of a violet hue, languid, colour 
disappearing upon pressure and returning slowly. Intelligence slightly 
obscured; tinnitus aurium, but no pain in the head; tongue dry, thick 
dark coating in the centre, red on the edges; teeth covered with sordes; 
thirst very great, desires cold drinks. No soreness of throat, deglu- 
tition easy; abdomen distended, resonant on percussion over colon 
and stomach; pressure causes pain in left lumbar region; bowels 
opened; urine scanty, of high colour, voided without pain or heat. 
Pulse 150 per minute, regular, of moderate volume, bounding, gaseous 
and extinguished on slight pressure. Carotids and vessels of the 
neck visibly pulsating, especially those on the right side. Heart yields Gerhard on Typhus Fever, 
23 
no impulse, but its sounds are distinct over the prsecordial region, 
with bruit de soufflet over the valves. 
Thorax.—Percussion anteriorly, resonant under both clavicles; 
obscure on the right side below the second rib. Respiration on the 
right, blowing, with sibilant ronchi; on the left side, in the clavicular 
region, strongly sibilant, occasionally sub-crepitant; over the prsecor- 
dial region it is feeble, with mucous ronchus. Percussion posteriorly 
yields a dull sound in the entire extent of the chest, especially in the 
middle Sd. Respiration is extremely feeble, except at the root of the 
lung, where it is rude; the voice is there remarkably clear (argentine.) 
Respiration 30, more abdominal than costal; sputa aerated somewhat 
viscid; slight cough, no soreness on pressure of larynx. 
The body is covered with two varieties of spots; one of a brownish- 
red, varying in size from a pin’s head to that of a ten cent piece, do 
not disappear on pressure, and covered with slight scales, are the 
result of a syphilitic eruption; these, the patient says, had entirely 
disappeared previous to present illness. The other spots, which are 
of a lilac colour, vary from a line to a quarter of an inch in diameter: 
they disappear on long continued pressure, reappear slowly, are not ele- 
vated or covered by scales, and are numerous, especially on the breast. 
Treatment: Tr. cinchona compos. 5j- q. b. h. Solution of quinine, 
grs. ij. every hour. Effervescing mixture. Blisters to the thighs 
until redness is produced. Sulph. morph, grs. g every hour until sleep 
takes place. Diet, essence of beef. 
28th. Had disturbed sleep last night, after taking fof gr. of mor- 
phia; first sleep, the patient says, since the 21st. No delirium during 
the night; two slimy alvine dejections since yesterday, of a yellow 
colour, without odour. Exacerbation of fever at three o’clock this 
morning, subsided at eight, and was followed by some moisture of the 
skin, but no decided perspiration. 11 o’clock, A. M., skin warm, 
soft; countenance flushed, capillary circulation of cheeks active, red- 
ness reappears immediately after pressure; eyes watery, conjunctiva 
congested; dimness of vision, which is increased by rising in bed; 
hearing very dull; no pain in the head, but noise in the ears, compared 
by the patient to blacksmiths hammering in the head; tongue less 
furred, edges cleaner than yesterday, violet colour. Pulse still vibra- 
tory, but firmer, 138 per minute. Respiration 20, costo-abdominal; 
some cough, expectoration as yesterday. Continue treatment; dry 
cups to the chest, blister 4 by 6 to the back of the neck. 
29th. Fever yesterday commenced at 12 M., continued four hours. 
skin was exceedingly hot, thirst intense, desiring ice; mind excited 
but not delirious, no perspiration was observable after subsidence. 24 
Gerhard on Typhus Fever. 
Fever recurred at 11, P. M., but less violent than in the afternoon. 
Delirium throughout the night; blister drew well. This morning the 
skin is warm, soft, but without moisture; spots on the body and ex- 
tremities are more numerous; arms and hands present a mottled ap- 
pearance of white and deep rose colour, which disappears on pressure 
and reappears slowly. Spots are not elevated; they vary in size from 
a pin’s head to half an inch in diameter. Hearing very obtuse; eyes 
congested, pupils small, contracted, insensible to light; countenance 
flushed, capillary circulation rapid; tongue moist, violet colour, some 
yellowish fur in the centre; no swelling of the tonsils; tickling in the 
throat, no pain in swallowing. Pulse 142, gaseous; respiration 30. 
Treatment:—Solution of acetate of ammonia, gss. q. h.; dress blis- 
tered surface with quinine; blister calves of legs to redness. Discon- 
tinue the quinine while the skin is hot. Diet, essence of beef, with 
eggs and wine. 
SOth. Some fever yesterday afternoon, slight fever through the 
night, no sleep, constant moaning, but no marked delirium; had two 
alvine evacuations of a yellow colour, good consistence, no odour. 
This morning, at 10j|, A. M., skin of nearly natural temperature, 
capillary circulation extremely languid. The spots which were yes- 
terday of a lilac are now dark violet; do not disappear on pressure. 
Tongue is dry, coated with brown fur; deafness more marked. Intel- 
ligence languid; answers questions slowly, but correctly. Pulse 120, 
regular, small volume, extremely feeble. Respiration 15; carotid 
strongly vibratory. Treatment:—Rub the limbs with a liniment of 
equal parts of turpentine and tinct. of cantharides; turpentine emul- 
sion; small portions of brandy toddy. Diet as before. Death took 
place at 5, P. M. 
Autopsy eighteen hours after death. 
No emaciation, great cadaveric rigidity; abdomen much distended, 
resonant on percussion. Body and extremities covered with petechias 
and vibices as in life; those of the upper extremities and legs are of 
a deep purple colour, especially those on the lower extremities, where 
they are numerous, and of half an inch in diameter. 
Brain.—A small quantity of black blood is found in the vessels of 
the dura mater; falx tilled with soft coagulum, of yellowish-green 
colour; no thickening or opacity of the tunica arachnoides; pia mater 
transparent, its vessels congested with black blood; no effusion of 
serum between arachnoid and pia mater. Cortical substance pale, 
medullary of usual consistence, of violet colour; each ventricle con- 
tains about a drachm of serum. Cerebellum normal. 
Thorax.—Adeps considerable over the thorax and abdomen. Gerhard on Typhus Fever. 
25 
Larynx.—Lining membrane reddened, transparent, its consistence 
natural. Mucous membrane of the fauces tumid, of violet colour; 
amygdala contain numerous cicatrices filled with calcareous deposit. 
Left lung contracted, not crepitant upon pressure, extremely friable. 
Right lung congested, especially in the middle lobe, infiltrated with 
bloody serum, its structure not granulated, friable upon pressure, 
mucous membrane of the bronchi red but normal in consistence; each 
thoracic cavity contains about four ounces of red serum. No adhesion 
of lungs to pleura costalis. 
Heart small, parietes of usual thickness and muscular, consistence 
good, valves healthy; coagula in the right ventricles thin and easily 
broken; a few drops of black blood in the left ventricle. Aorta con- 
tains black blood with some coagula. 
Abdomen.—The omentum charged with fat. Stomach and small 
intestines distended by gas; the mucous coat of the stomach in its 
large curvature stellated with red points of blood, its consistence, 
however, is normal throughout, excepting in the great cul-de-sac, 
where it is softer than natural. Small intestines contain some green 
faeces; mucous coat normal, yields by traction strips from six to eight 
lines in length. PeyePs glands healthy. BrunnePs follicles not de- 
veloped. Ccecum and colon healthy. Liver natural size, structure 
normal. Bile thick, ropy, and of very dark colour. Spleen twice 
the natural size, six by four inches, structure much softened, (difflu- 
ent.) Kidneys natural in consistence and size. Bladder not dis- 
tended, contains a small portion of light coloured mucus. Pancreas 
usual size, violet hue. Uterus natural. 
Remarks.—The fever in this, as in the case of Walters, was re- 
mittent; the presence of black blood in the arterial system was also 
observed; the lungs were much more friable and more impermeable 
to air. The brain exhibited a state of passive congestion of some of 
its larger vessels; meninges unchanged in structure. 
Case IY. Precursory symptoms, anorexia, lassitude, constipation— 
Bisease commenced with nausea, vomiting, frontal cephalalgia, sore 
throat—Delirium, extreme prostration, petechia on the gums and lips 
—Death on twenty-ninth day—Lungs friable, black blood in the 
arterial system—Patches of Peyer healthy.—Bush, negress, washer- 
woman, aged 20, entered March 6th, 1836. During the last winter, 
she, with four negroes, occupied a small, damp, confined cellar in 
south Water street, near the Delaware, and suffered greatly from 
want of food and intense cold. Has been sick three weeks; at the 
commencement experienced lassitude, general debility, loss of appe- 
tite, followed on the succeeding day by nausea and vomiting. On the 26 
Gerhard on Typhus Fever. 
morning of the third day, whilst washing, was suddenly seized by 
violent pain in the forehead; in the evening the throat became sore, 
and continued so, with difficult deglutition, three or four days, when 
it disappeared spontaneously. Cephalalgia with tinnitus aurium, some 
deafness, and much thirst had been constantly present. Patient says 
she has slept very little, and that constipation has been constant. 
Ordered stimulating enema of 01. terebinth, sulph. morph, grs. 
every hour until sleep takes place. Bowels were opened by the 
enema, and patient slept after the exhibition of | gr. of morphia. 
Present state.—March 7th. Decubitus dorsal; skin warm and dry; 
dark spots, not elevated, from two to four lines in diameter, cover the 
breast and abdomen; expression of the countenance anxious; intelli- 
gence confused, answers slowly but correctly, when her attention has 
been strongly directed to the question; constant moaning; conjunc- 
tiva injected; pupil contracted to a point and uninfluenced by light; 
pain in eye balls; feeling of soreness rather than of pain in frontal 
region; no tinnitus aurium; deafness in the left ear; tongue moist, 
covered with light fur, edges red, papillae much enlarged; gums of a 
rose red colour, mottled with dark purple spots which do not disap- 
pear upon pressure; teeth covered with sordes; great thirst; some 
soreness of the throat; amygdala not enlarged; deglutition not easy; 
anorexia; abdomen hard, slightly tumid, resonant on percussion over 
the coecum; some epigastric tenderness; liver (tested by percussion) 
not enlarged. Pulse 150, weak, jerking, thread-like, extinguished 
by the slightest pressure, constant spasmodic twitching of fingers, 
and subsultus of tendons of the arms. Respiration costal, short, con- 
tracted, irregular, 66 per minute, (counted after interrogating the 
patient.) Percussion of the chest, anteriorly; under both clavicles, 
normal; slightly obscure in the lower two-thirds of the right side, 
where the respiration is vesicular, but extremely feeble; on the left, 
respiration is expansive, with sonorous ronchus. On the back, percus- 
sion yields a dull sound, especially on the left side. Respiration very 
feeble, with occasional sibilant ronchi on the left. Voice transmitted 
near the root of the lung remarkably clear, not resonant (argentine.) 
Soreness on pressure of left breast prevented percussion of prsecordial 
region. The heart gives no impulse; second sound predominates; 
bruit-de-soufilet over the valves. 
Treatment.—Dry cups to the anterior parietes of the chest; blister 
4x6 between the shoulders; evaporating lotions to the head. Pulv. 
camph. grs. v. 01. terebinth, gtts. xv., in emulsion, every hour. Diet, 
essence of beef and wine whey. Sulph. of morphia, to be given at 
night, and quinine grs. ij. every hour, should the skin become cool. Gerhard on Typhus Fever. 
27 
Bth. Took grs. xx. of quinine, yesterday. Camphor and opium 
suspended in the afternoon. Blister to the back partly vesicated. 
Disturbed sleep, with delirium, hiccup and jactitation through the 
night. This morning (10 o’clock) expression of countenance wild 
and anxious; moaning, but no marked delirium. Hearing very ob- 
tuse; constant movement ot head from side to side; cannot protrude 
the tongue beyond the teeth; tongue moist, rose coloured at the point, 
coated posteriorly, dark incrustation, papillae enlarged; skin dry, 
temperature natural; pulse 144, less jerking, subsultus diminished; 
respiration 30, costal, no dilatation of nostrils upon inspiration; urine 
scanty, high red colour, resembling blood. Last evening had one 
alvine evacuation of natural colour and consistence. R. Sulph. qui- 
nine grs. ij. every hour. Camphor julap and turpentine every third 
hour. Enema of essence of beef; wine. Diet, essence of beef; mor- 
phia at night. In the afternoon vomiting frequently took place, but 
was checked by exhibition of kreosote rt\, l q. h. 
9th. Slept well last night after ten o’clock, without either delirium 
or moaning. (Took | gr. sulph. morph.) 9-| o’clock, A. M., decubi- 
tus dorsal with legs drawn up on the thighs; abandoned; deafness in- 
creased; constant moving of head from side to side; twitching of lips; 
eyes much congested, half closed, balls constantly rolling in the 
orbit; speechless, cannot articulate; tongue cannot be seen, as the 
teeth are firmly closed and covered with sordes; lips .are dry, covered 
with dark fur externally, internal membrane mottled. Pulse 132, 
thread-like, regular, extinguished by slight pressure. Respiration 
36, more costal than abdominal; on the right side, anteriorly, rude; 
pure on the left. Posteriorly rude in the interscapular space. Sub- 
sultus diminished. Both arms swollen, slightest movement causing 
pain. R. Dress blister between the shoulders with quinine. Enema 
of essence of beef, with camphor, grs. x. Other treatment continued. 
Patient became gradually weaker, and was insensible to external 
impressions at 8 o’clock, F. M. Convulsions took place, and, at 10 
o’clock, death. 
Autopsy, thirty-six hours after death.—No emaciation; no infiltra- 
tion of serum. Body covered with vibices varying in size from two 
lines to half an inch in diameter, particularly on the abdomen and 
thighs. Percussion of thorax same as during life. 
Brain.—The vessels of dura mater contain globules of black blood, 
separated by air, the falx contains dark dissolved blood, with some 
soft yellow green coagula. A large portion of bone was found in the 
anterior portion of the brain between the dura and pia mater. The 
large vessels of the pia mater are congested with black blood, the 28 
Gerhard on Typhus Fever. 
smaller are empty: no effusion of serum between the pia mater and 
arachnoid. Arachnoid transparent, the membranes do not adhere to 
the cortical substance, which is of a pale ash colour, and of natural 
consistence. The medullary substance of usual consistence, and of a 
very slight violet tinge; its horizontal sections present numerous 
black points at the orifice of the vessels; ventricles each contain a 
drachm of limpid serum; corpora striata and thalami, normal, cerebel- 
um and central portions of the brain also normal; tunica arachnoidea 
somewhat opaque at the base of the brain. 
Thorax.—No adhesion of lungs to the ribs; on each side the pleura 
contains a small portion (one ounce) of bloody fluid (resembling blood.) 
The right side. Lung compressed, permeable in the upper lobe, im- 
permeable in the lower lobes, excepting the middle anterior portions; 
lower lobe is friable, not hepatized, contains some bloody serum; the 
bronchial tubes are of a red colour, their lining membrane transpa- 
rent and of good consistence; the left lung is condensed in its inferior 
portions, which are impermeable to air, friable, but not hepatized; 
upper lobe natural anteriorly; posteriorly, impermeable, congested and 
friable. On the surface of the lungs beneath the pleura are seen 
eight or ten ecchyrnosed spots of blood. 
Heart enlarged, twice its usual size; no adhesions between the 
heart and pericardium, which contains one ounce of effused blood; 
the muscular parietes of the heart are of the usual thickness but soft- 
ened; the valves natural; soft coagula in both cavities, those in the 
left ventricle surrounded by black blood; black blood, with coagula, 
is found in the aorta; the blood in the vena cava ascendens is thick, 
black, and oleaginous. 
Abdomen.—Stomach and intestines distended by gas; mucous coat 
of the stomach presents a dark slate colour, with the exception of a 
space an inch square in the cardiac (cul-de-sac) extremity, in which 
the mucous coat is somewhat softened; this membrane is mammillon- 
ated and thickened near the pyloric orifice, and yields strips of 
eighteen lines in length. Small intestines natural throughout the 
whole extent except the middle portion, where are presented nume- 
rous purple spots from the blood effused into the cellular coat at the 
capillary extremities of the blood-vessels; mucous coat throughout 
natural. Glands of Peyer and Brunner healthy. Spleen natural 
size and normal. Liver not enlarged, fawn coloured externally, 
softened. 
The last three cases were noted by Dr. Pennock with extreme care, 
and are given as illustrations of the pathological terms, as well as of 
the. symptoms in the fatal cases. As the subject is one of importance, Gerhard on Typhus Fever. 
29 
I shall give two more cases, in which the symptoms are related in a 
condensed manner. 
Case Y. Death in the fourth week—Great stupor, abundant erup- 
tion of petechise—Dark blood in the brain and lungs, and ecchymosis 
of the intestines—Glands of Peyer natural—Softening of the great 
tuberosity of the stomach and enlargement of the spleen.—Jacob, a 
German, aged 38, is a chemist by trade, has been in America four 
years, and has lived in Philadelphia during the whole time. There 
was no other person ill in the house with him; remembers scarcely 
any thing of his disease, except that he had chills and vomiting, and 
has been ill nearly three weeks. 
On the Bth of April, the day after his entrance, I found him in the 
following state: He is very stout and muscular; lies on his back in 
a state of constant stuporyeyes injected, pupils small, not contracted; 
face dull, livid; intelligence very obtuse, answers slow and hesitating; 
memory impaired; slight cephalalgia; sight confused; tinnitus con- 
stant; hearing dull. Sleep sound during a part of the night; subsultus 
in the tendons of the wrists and legs. The surface of the whole body 
is covered with an eruption resembling measles in colour, not irregu- 
lar and not elevated; on pressure it does not disappear entirely. 
Sweating since six or seven this morning; hot, harsh and dry skin 
previously; tongue dry and harsh; abdomen tender, containing little 
gas; one stool of a dark yellow colour after the injection; appetite not 
much impaired; thirst great. Pulse 140, feeble; a slight pressure 
completely arrests it. Respiration a little stertorous; sonorous and 
mucous ronchus abundant throughout the chest, bat percussion sonor- 
ous. 
Blister 7 by 5 inches between shoulders, for five hours; weak sina- 
pism to legs and wrists. Milk punch. Huxham’s tincture of bark 
£ss. q. secunda h. in a cup of water. Camphor gr. v. q. sex. h. 
Essence of two pounds of beef. 
In the evening of the 7th he took five grains of camphor every two 
hours, the effervescing draught, and a camphor enema, with both. 
Bth, at 3, P. M. The blister had vesicated the neck. The patient 
was more intelligent. 
9th. He had slept but little. Peteehise paler; teeth fuliginous; some 
twitching of the face and subsultus; cephalalgia, no delirium; intelli- 
gence clearer, but the senses are in the same state as yesterday. 
Pulse fuller and stronger, 140; no chills, some sweating during the 
night; no vomiting or dejection; thirst great, appetite apparently good. 
Brandy in milk; wine in gruel; tincture of bark less 
frequently given; camphor as before; essence of beef. Sponging 30 
Gerhard on Typhus Fever. 
with vinegar and water. In the evening the coma increased; face 
livid and swollen. Sinapisms, &c. Death the 10th, at 7, A. M. 
Autopsy on the 1 Ith—twenty-seven hours after death: 
Exterior.—Very corpulent subject. Petechiae livid, but much paler 
and fewer in number than before death. Skin of the posterior parts 
of the body of a dull livid colour. Rigidity of limbs. 
Head.—A large quantity ot black blood on the external surface of 
the dura mater. Curdled dark blood in all the sinus of the brain. 
Large veins full of blood; smaller vessels rather more than usually 
injected; arachnoid moist. Ventricles contain about two drachms of 
serum; substance of brain of good consistence, but more moist than 
usual. The medullary portion is of a marbled violet colour, with 
thin dark blood oozing from the cut surface. Cerebellum and pons 
varolii firm, not injected, but of a bluish tint. 
Neck.—Pharynx of a slight violet hue. Larynx less livid than 
the pharynx. 
Thorax.—Pericardium contains several ounces of bloody serum. 
The heart is large, pale, and very flaccid, a slight pressure being suf- 
ficient to tear it. The internal surface is of a dark red colour, which 
extends to the valves, and is deepest at the most depending part, but 
there is no trace of false membrane or thickening. The aorta, caro- 
tid, and iliac arteries contain a dark fluid blood, and their internal 
coat is of a dark red colour. 
There is a little reddish serum in the pleurae; the lungs are of a 
livid red colour in their lower lobes, which are engorged with liquid 
blood, but are not friable. Bronchi not thickened, but tinged of the 
same colour as the subjacent pulmonary tissue. 
Abdomen.—Peritoneum pale; stomach distended, containing in its 
cardiac third a whitish mucus; at this part all the coats are so soft 
that the finger passes through them on slight pressure, they have a 
pearly aspect, and the mucous coat in some spots is entirely removed. 
In the rest of its extent this coat is of a dull slate colour, mammil- 
lated, thickened, and very firm. The capillary vessels are very 
slightly injected. The small intestine is not distended, and contains 
a greenish-yellow mucus. The mucous coat is throughout pale, ex- 
cept in the fourth nearest the valve, which offers a general dark red 
tint, (ecchymosis.) The glands of Peyer are of the same colour as 
the rest of the intestine, not more prominent than usual, and of per- 
fectly normal aspect. Isolated follicles not visible. Large intestine 
contains a little faeces. The mucous coat is not injected, and is of 
natural thickness and consistence. Liver firm, of the average size, 
presenting nothing remarkable. Bile, viscid. Spleen softened, more Gerhard on Typhus Fever. 
31 
than six inches long, of a very dark colour. Kidneys of the usual ap- 
pearance. Mesenteric glands small and firm. The coats of the sto- 
mach contained much acid, tinging litmus paper red immediately. 
Remarks.—This patient entered in the most advanced period of 
the disease, and with very malignant symptoms. The fcetor arising 
from the skin and breath was very intense, and one of the assistants 
contracted the disease directly from him, while supporting him in bed. 
After death the lesions were a very dissolved dark blood, permeating 
the tissues like a sponge, and, from the livid aspect of the face, the 
same condition of the blood probably existed during life. The de- 
composition of the body seemed to have begun already—the autopsy 
was made twenty-seven hours after death, in a cool season of the year. 
Another lesion intimately connected with the state of the fluids was 
the softening of the great tuberosity of the stomach and the acid de- 
veloped in its coats. The glands of the intestines and mesentery were 
as usual found perfectly healthy, but the spleen was enlarged and 
softened. The lesion, then, was chiefly a very liquid state of the 
blood, which was darker than usual, and infiltrated the most depend- 
ing tissues. The stimulating treatment was adopted, and seemed to 
promise some success, but the patient afterwards sank into a greater 
degree of prostration. 
Case VI. Fever began after a debauch, and lasted eighteen days— 
Great prostration, stupor, tyc.—Pneumonia of the right lung and 
softening of the cardiac portion of the stomach.—Henry Holmes, 
black, aged 22, employed in unloading vessels, lived with four others, 
in a small cellar. On the 12th of May drank very freely. Taken 
ill on the 13th, with the following symptoms: pain in back, pelvis 
and limbs, chilliness lasting a short time, and returning frequently; 
very dry skin; no sweating; slight delirium; sight confused; hearing 
good; tinnitus aurium; no nausea nor vomiting; bowels constipated; 
urine red, not altered in quantity. 
Admitted 20th May. His tongue furred; cephalalgia great; no 
injection of eyes; sight confused; hearing good; a little tinnitus; 
pain in back and limbs; no chilliness; skin hot and pungent; bowels 
open. Pulse 100, feeble. Intelligence good. R. Mixt. efferves., cups 
to back of neck; neut. mixt. with 1 gr. antim. tart. Sponging with 
vinegar; gruel; lemonade. 
May 21 st. Intellect much more obtuse; decubitus more abandoned; 
no cephalalgia; answers confused; giddiness slight; sight and hear- 
ing good; no tinnitus aurium; tremor great; eyes more suffused; 
tongue moist at edges, furred at centre; bad taste in mouth; thirst 
great; no appetite; has once vomited; two or three stools, daily. No 32 
Gerhard on Typhus Fever. 
cutaneous sensibility; no pain in back or limbs; skin hot, pungent and 
dry. Pulse 108, regular, undulating, but firm. Spirit, mindereri. 
spt. nitri, dulc. S. q. sec. hora. Sponging; cold 
applications to the head; flaxseed enemata; gruel; thin broth. On 
the evening of the 20th, dry cups were applied to the back of the 
neck with some diminution of the cerebral symptoms. 
On the 23d there was much more dulness of intellect, and insomnia; 
a blister was ordered to the back of the neck. In the night of the 
23d to the 24th, there was frequent muttering delirium; skin clammy 
and cool. On the 25th, the prostration was extreme; heat of skin 
pungent. Delirium throughout the day; a blister was applied over the 
whole scalp, and, on the preceding evening, five grains of the carbo- 
nate of ammonia and ten drops of the spirits of turpentine were given 
every hour, and continued on the 25th. 
On the 26th, the intelligence was clearer, the thirst greater; can 
take food with pleasure. Pulse 128, feeble. The teeth and tongue 
were more coated, and the prostration greater. 
On the 27th, Huxham’s tincture of bark, carbonate of ammonia and 
camphor, as injection. Blister to thighs. 
28th. Eyes less injected; articulation still difficult; feels better; 
stupor continues, but he hears and answers questions. Skin less 
burning; extremities cool; great thirst; tongue brownish, mouth dry; 
constipation. Pulse 120, father feeble. Continue treatment; wine, 
sixteen ounces; broth; gruel; poultice, with chloride of soda, to abdo- 
men. 
29th. Less stupor; pulse 120, less feeble. Respiration quick; 
much increase of cough; some subsultus; tongue less fuliginous; skin 
of natural temperature; one dejection. Continue treatment. 
30th. Much more intelligent, but extreme prostration. No cepha- 
lalgia; no subsultus; sight nearly natural; tongue less brown and less 
dry; skin quite cool at extremities, and on the rest of the surface of 
less temperature than natural; very little delirium; sleep pretty good; 
thirst; some appetite; one stool. Pulse 120, less feeble. No subsul- 
tus; no cough. Continue wine, carbonate of ammonia, &c. 
Death occurred on the morning of the 31st. 
Autopsy, thirty-six hours after death.—Exterior. General rigidi- 
ty, no emaciation, nor infiltration. 
Head.—Sinus of the dura mater containing a small quantity of 
dark blood; arachnoid moist; almost two ounces of serum at the base 
of the brain. Pia mater easily detached; the large veins are distend- 
ed with dark blood, but there is no injection of the smaller vessels. 
Cortical substance ot a violet colour, which also extends to the medul- Gerhard on Typhus Fever. 
33 
lary portion, from which drops of dark blood exude in abundance. 
Consistence good throughout. Ventricles containing two drachms 
each of limpid serum—cerebellum and medullary protuberance firm, 
rather livid. 
Neck.—Larynx and pharynx not injected, firm. 
Thorax.—Left pleura contains no serum; has an unctuous feel to 
the touch. The left lung is soft, grayish, permeable to the air, the 
bronchi pale and natural. The right pleura is free from adhesions, 
and contains no serum. The upper and middle lobes of the right 
lung are soft and grayish, but the lower lobe and the lower margin of 
the upper, is heavy, impervious to the air, of a dark red colour, 
slightly granulated. The bronchi are reddish, and contain thick red- 
dish mucus. Pericardium of the same unctuous feel as the pleura. 
Heart of the usual red colour; the valves natural, except a slight 
cartilaginous deposit in the mitral; tissue firm, large, flaccid; coagu- 
lum in the right cavities surrounded by much serum, a little fluid 
blood in the left; aorta pale and empty. 
Stomach, rather distended by a grayish liquid. Cardiac half of the 
mucous coat is of a dirty-white colour, traversed by large blue veins, 
of the natural thickness, but much softened. In the rest of its ex- 
tent this coat is of a slate colour, a little mammillated, but firm and 
not thickened. Small intestine contains the usual greenish mucous, 
its inner coat is throughout pale and of good consistence. Glands 
of Peyer distinctly visible, but slightly elevated, perfectly normal. 
Isolated follicles not visible. Mesenteric glands small and firm. 
Large intestine contains some liquid faeces, mucous coat pale and firm. 
Liver darker than usual, and rather less firm. Bile abundant and 
healthy. Spleen four inches in length, firm. Kidneys normal. 
Bladder contracted. 
In this case there existed a considerable degree of inflammation of 
the right lung, which probably had an important agency in accelerat- 
ing the patient’s death. The stomach also presented the general slate 
colour so frequently seen in cases of chronic inflammation of its mu- 
cous coat, and the cardiac portion was softened, although the body 
was examined within thirty hours after death. The termination of 
the case was unexpected. The patient had decidedly improved and 
the disease would probably have terminated happily, if the inflamma- 
tion of the lungs had not intervened, and rapidly increased just before 
death. On account of the extreme exhaustion of the patient the chest 
was not thoroughly examined in the last two days of his life, it had 
previously offered the usual signs of bronchitis, sonorous, sibilant and 
mucous rhonchi. 34 
Gerhard on Typhus Fever. 
I have prepared for publication a case of dothinenteritis, and one of 
malignant remittent, or as it is called in the southern states, conges- 
tive fever. These cases occurred during the past summer when the 
epidemic of typhus still continued. The appearances observed on 
dissection did not differ from those already described in this Jour- 
nal, in the report of cases which I published in the year 1834. 
In the dothinenteritis there were inflammation, and ulceration of the 
glands of Peyer, with a diseased condition of the mesenteric glands, 
and of the spleen. In the case of remittent fever the lesions were 
limited to softening and enlargement of the spleen and liver, and in- 
flammation of the mucous coat of the stomach. 
As their publication would extend the length of this memoir be- 
yond the limits of a Journal, I refer the reader to the cases report- 
ed in 1834. The fevers differed in their symptoms, as well as in 
their anatomical lesions. The symptoms of these different affections 
will be compared in the concluding part of this memoir, at present, 
and I shall consider the anatomical lesions only, which were as differ- 
ent in each form of fever as the pustules of small pox are unlike the 
eruption of measles. The anatomical characters of these varieties of 
fevers are peculiar to themselves, and it is as impossible to substitute 
the lesion of the follicles of the small intestine observed in the 
typhoid fever for the pathological phenomena of typhus, as it is by 
treatment or other means to transform the eruption of measles into 
the pustules of small pox. 
We shall hereafter inquire if the symptoms are equally distinct 
and characteristic in these fevers, which, from an abuse of names, are 
so often confounded with each other.