Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

232/440 (page 214)

Thus we see that 4 only of the 23 in whom diarrhoea was spontaneous rank in the above list. In one of the 4, the diarrhoea depended on an attack of simple enteritis, which came on after partial convalescence, and carried ofi the patient on the 34th day. No trace of follicular disease was found on inspection, but universal softening of the mucous membrane from the duodenum to the rectum, Two of the remaining 3 may almost be said to have presented no trace of follicular disease, for the three or four follicles observed in each were barely perceptible to the naked eye. In the fourth, fourteen Peyer's glands, scarcely at all elevated, were detected. But what chiefly concerns us to notice is the striking fact, that, as the number of enlarged follicles increases, the cases of spontaneous diarrhoea diminish, and those in whom consecutive diarrhosa and costiveness were observed become more numerous. In fact, not one of those in whom the greatest number of enlarged follicles was observed, but was either constipated, or had diarrhoea brought on by medicine, during life. This confirms our former deductions, agrees entirely with those of Valleix, and shoWs that the appearances observed in typhus depend upon local irritation and not on specific disease. It will also be observed that in 10 of the 22 (including 5 of those in whom from 15 to 30 enlarged glands were observed) the feel of the abdomen was natural throughout the disease. Of the 6 in whom the belly was slightly tym- panitic, that symptom was observed only one day in four patients (the one in whom the greatest number of enlarged follicles was found being among them) ; in one with forty enlarged glands, it was present during two days; the sixth was the patient who died of enteritis. Of the six, on the other hand, who presented a high degree of tympanites, in not one were there so many as twenty, and in one whoso abdomen was excessively distended scarcely a trace of fol- licular disease was detected. There seems, at first sight, to be more connection between tlie presence of abdominal pain and the number of altered glands, but this is only apparent, for a reference to the figures given above shows that, in 8 of the 9 in whom the pain was acute, not more than twenty were found in the