A text-book of the Practice of medicine / by James M. Anders.

  • Anders, James M. (James Meschter), 1854-1936
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of the Practice of medicine / by James M. Anders. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    some of those that lend fresh peril to the typhoid patient, arranging them with some regard for the order of their relative gravity, may prove helpful to the student. They are—perforation with diffuse peritonitis, intestinal hemorrhage, lobar pneumonia, lobular pneumonia, sudden col- lapse (due to cardiac weakness), excessive tympanites (often with marked diarrhea), and hypostatic congestion of the lungs. Relapses of Typhoid Fever. A relapse is a repetition of all the characteristics of typhoid after the latter has run its course. As a rule, the return occurs from one week to ten days after the beginning of convalescence, though it may be either earlier or later; and occasionally a relapse develops before the temperature has become normal. This is termed an intercurrent relapse. The cause of relapses is a reinvasion of the blood by the typhoid bacilli or their secretions; but whether this is attributable to a reinfection from without or from within (most probably the latter) cannot be definitely stated. The pathologic lesions differ in no essential way from those de- scribed as belonging to the primary attack, but the stages through which they pass are not quite so long. In the interval between the primary attack and the relapse there may be present suspicious features, such as a slight enlargement of the spleen, a trivial evening rise of temperature, an unnatural apathy or dulness, and a more profound prostration than is usual. In the majority of in- stances, however, there are no premonitory symptoms. The onset is rather more sudden than in primary typhoid. The temperature, how- ever, rises in the characteristic ''step-ladder fashion, reaching the fastigium in two or three days, and the same relative abridgment of the fastigium and defervescence is observed. It follows that a relapse has a shorter duration than a primary attack, and, indeed, it rarely exceeds two or three weeks. The temperature may, however, touch a higher limit in the relapse than in the primary attack; but. with rare exceptions, when the ])rimary typhoid is of average or even a greater than average severity, the temperature in the relapse does not reach an equal height. The characteristic rash appears earlier—from the second to the fourth day—and is somewhat darker and coarser than that of the first attack. The spleen swells rapidly. The intercurrent relapse sets in while the temperature is declining; the fever again rises, and may become higher than in the primary attack. Diagnosis.—Upon the points that are distinctive of a primary attack of typhoid fever rests the important diagnosis between a relapse and a recrudescence {spurious relapse). The latter is usually attributable either to errors in diet, to undue muscular exertion, or to great mental excite- ment ; and, whilst it occurs during convalescence, it seldom lasts longer than one, two, or three days, and is not characterized by the diagnostic symptom-group of a relapse (peculiar temperature-curve, enlarged spleen, and specific eruption). The prognosis of relapses depends very much upon the severity of the primary attack, those following severe attacks being relatively milder than those that follow the rudimentary, primary attacks. The frequency of relapses differs widely in different epidemics.
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