A text-book of medicine for students and practitioners / by Dr. Adolf Strümpell.

  • Adolph Strümpell
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine for students and practitioners / by Dr. Adolf Strümpell. 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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    the poorer classes were almost exclusively attacked, and especially the tramps. The uncleanly deus where these people lodge were found everywhere to be the chief centers of infection. The precise manner of infection is as yet almost wholly unknown. All ob- servers agree that the disease is directly contagious; but it can not be very con- tagious if the hygienic influences be good. At least the results of our late epi- demics would imply this. In the Leipsic hospital, where over two hundred and fifty cases were treated, and isolation could not be at all perfectly carried out, not one case of infection occurred. It is certain that the di.sease can be transmitted by direct inoculation with the blood of patients. This has been established by a Eussian physician by the experimental inoculation of healthy pei-sous. Doctors have been repeatedly inoculated at the autopsy of those who have died of relaps- ing fevei'. The disease may likewise be transferred by inoculation to monkeys, while other mammals seem to enjoy an immunity fi'ora it. [The first cases of relapsing fever observed in this country were in IrLsh immi- grants coming over in the same vessel in the year 1844. At several periods since then more or less limited outbreaks traceable to immigration Jiave oceui-red, but the disease has never acquired any foothold with us, and comparatively few physi- cians have ever seen it. So far as I can learn, only one case has ever been seen in Boston, and that was in the person of a physician from another city, who brought the disease with him and passed through it in the Massachusetts General Hospital.] Clinical History.—The stage of incubation lasts about five to eight days. It is only exceptionally that some slight prodromal symptoms present themselves just before the outbreak of the disease proper. As a rule, it begins .suddenly, with a more or less pronounced chill and intense constitutional symptoms. There are violent headache, great languor, anorexia, and especially marked pains in the loins and exti'emities. The temperature rises rapidlj', reaching generally 106° (41° C.) or higher as eai-ly as the first or second day. The skin is hot and dry, and usually quickly assumes a vei'y characteristic dirty-yellowish color. In Leipsic, we often saw herpes labialis, which seems, however, to have been rarer in epidemics else- where. The tongue becomes dry and thickly coated. Sometimes there is vomit- ing. The bowels are constipated, or there is a slight diarrhoea. The spleen be- comes I'apidly enlarged, being, as a rule, even larger than in typhoid or typhus. The liver is slightly enlarged. The chest i)resents the signs of a bronchitis, gener- ally moderate, but in exceptional instances severe. The pulse is much quickened. It is seldom that there are severe cerebral symptoms beyond a cei'tain apathy and stupor. We have seen delirium tremens sometimes, in drunkards. A very char- acteristic symptom, already mentioned, is the marked hyperajsthesia of the mus- cles, especially in the calves. After these symptoms, accompanied by persistent and generally very high fever, have lasted five days to a week, there is a critical decline of temperature, with pi'ofuse sweating. The patient now improves so rapidly and decidedly that he thinks himself completely cured, and generally gives little credence to the l)hysician's prophecy of a relapse. In rare but well-attested cases there lias been really but one attack. The rule is that, after about a week, a second attack occui-s, often a third after that, and, infrequently, even a fourth and fifth. In each of these, the above-mentioned symi)toms arc re])eated more or less completely and violently. As the only certain and constant sign of the recurring attacks (the so-called relapses) is a fresii rise of temperature, it will be well to consider their peculiarities at the same time that we describe the course of the fever. During the intervals of normal temperature the other objective symptoms of disease are usually absent, except an evident splenic tumor, and, not infrequently, the pecul- iar pale-yellow hue.
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