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

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

    62/1360 page 52
    Hence the fact that the percentage of relapses as estimated by diifer- ent authors ranges from 3 to 15 per cent, need excite no surprise. The relapse may repeat itself once, twice, or even thrice, and two relapses occur in about 1 per cent, of the cases. In a case which I' reported three successive and typical relapses occurred. The pale line or ridge which was mentioned (vide Clinical History) as noticeable in the nails after typhoid occurs similarly after each relapse, and in the afore-men- tioned case of my own four distinct whitish, transverse ridges were noted. Da Costa has recorded five relapses in two cases. Recurrences.—The term recurrence should be applied only to those instances in which successive attacks are separated by longer or shorter intervals after complete recovery from a previous or the primary attack. Typhoid fever usually bestows complete and lasting immunity against subsequent attacks, but this is not an invariable rule. Eichhorst has studied 600 cases, and found that in 28 of the number (4.T per cent.) a second attack occurred. He also cites a case in which three or four attacks occurred in the same individual. I have seen two typical attacks of typhoid fever in two different persons, the intervals between the cases having been five and eight years respectively. Very rarely three separate attacks have occurred in the same person, and a second is usually milder than the first attack. Treatment.—(a) Prophylaxis.—Modern hygienic resources happily enable us to minimize the number of occurrences of typhoid, and reports of the typhoid cases in a city may be taken as a safe indicator of its sanitary status. On the same principle it has been found that whatever tends to better the sanitary arrangements of a city diminishes to a corresponding extent the prevalence of the disease, particularly im- provements affecting the water-supply and drainage. Such facts as these show typhoid fever to be a preventable affection. The best means that can be employed during the attack, with a view to limiting the spread of typhoid, is (Iif<i)it\>ction, and the following brief description comprises its essential points as applied particularly to this disease: Disinfection in typhoid may conveniently be divided into (a) that of the excreta (stools, urine, vomitus, and sputum); (6) of the bed and its coverings; (c) of the patient and the sick-room. While all of these subdivisions are of the greatest importance in the treatment of a ease, the disinfection of the excreta [it) is perhaps most fretfuently overlooked or most carelessly performed, and hence the importance of the state- ment that all stools and urine voided by the ])atient, as well as all vomitus and sputa, should invariably be treated in the following man- ner : The excreta should be received in a vessel that can be thoroughly disinfected inside and out with any one of several standard solutions, of which that of chlorinated lime is the most effective and satisfactory. Bichlorid of mercury (1 : 500) also may be used, but, as it recjuires a much longer time and forms an insoluble compound with the albumins in the feces and sputa, it is inferior to the solution of chlorid of lime, which is now very generally used in a strength of six ounces per gallon of water. A 5 per cent, solution of carbolic acid is also much em- ployed, and has proved of decided value. ' Medical and Surgiail Reporter, vol. xlvii. p. 06.
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