Clinical reports on continued fever based on analyses of one hundred and sixty-four cases : with remarks on the management of continued fever; the identity of typhus and typhoid fever; relapsing fever; diagnosis, etc. : to which is added a memoir on the transportation and diffusion by contagion of typhoid fever, as exemplified in the occurrence of the disease at North Boston, Erie County, N.Y. / by Austin Flint.

Austin Flint I

Date:: 1855

Credit: Clinical reports on continued fever based on analyses of one hundred and sixty-four cases : with remarks on the management of continued fever; the identity of typhus and typhoid fever; relapsing fever; diagnosis, etc. : to which is added a memoir on the transportation and diffusion by contagion of typhoid fever, as exemplified in the occurrence of the disease at North Boston, Erie County, N.Y. / by Austin Flint. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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the changes, although not uniform, either in kind or degree, in some in- stances are striking, and in a measure distinctive. Under the heading of this section, in the preliminary analysis, I have arranged whatever is recorded in the cases under examination. In several of the histories nothing is stated relative to this point. In these instan- ces here, as with regard to other points, the inference is, that nothing unusual, or striking, was observed; but there probably existed more or less of that dullness or Ustlessness of expression, which is very rarelv, if ever, entirely absent. Directing inquiries to the elements of the physiognomy separately, the complexion comes first in order. In a large proportion of the cases, the complexion was altered, the face being reddened, sometimes of a dusky hue, and occasionally slightly livid. These changes were evidently due to capillary congestion. They were always more marked in the cheeks, than elsewhere, and sometimes were chiefly observable in that situation. This state of the capillary vessels, as will be perceived when we come to speak of the symptoms referable to the skin, in many cases extended, more or less, over the entire surface of the body, but in some instances it was ex- hibited on the face when it was not on any other part of the external teg- ument. It was always exhibited in the face, if present in other portions of the external surface. I cannot suppose this symptom to have been peculiar to the cases that I have observed, and hence I am at a loss to understand why it has not attracted more notice than it appears to have done with clinical observers, more especially since, in connection with the humoral pathology of fever, it would seem to deserve consideration.* The redness of the face resembled closely the appearance which the surface presents after exposure to cold, the explanation probably being the same in either instance, viz: retarded circulation of the blood in the capil- lary vessels. On pressure with the finger the redness disappears, and returns after the pressure is removed. The redness returned less quickly in proportion to its du.skiness or lividity, showing that the color is an indi- * I do not mean to be understood by tbis remark that tbis symptom has escaped ob- servation, but only that, so far as my knowledge extends, it has received less notice than would be expected from its presumed frequency, and pathological relations. With- out having taken pains to consult authorities on the point, I cannot call to mind any writer who has alluded to it more distinctly than Dr. Gerhard, of Philadelphia. [See Graves and Gerhard's Clinical Medicine, page 733, and also Dr. Gerhard's ac- count of Epidemic Typhus Feyer in Philadelphia in 1836, published in the American Journal of Medical Sciences.] I do not discover that this symptom is embraced in the researches of Louis.

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