Contributions to the pathology and therapeutics of typhus fever / by Joseph Bell.

  • Joseph Bell
Date:
[1860]
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to the pathology and therapeutics of typhus fever / by Joseph Bell. Source: Wellcome Collection.

    16/100 (page 400)
    I have narrated, and that it also completely coincides with the description given by Dr. Stokes himself. Again, if we turn to Wedl’s account of the effects of inflammation on muscular tissue, we find a similar description. He says that “ the fasciculi adhere more closely together, and in the aggregate appear of a paler colour. In the muscular parenchyma, in this state of gelatinous metamorphosis, opaque spots may be noticed inclosing primitive fasciculi, transformed into a fine molecular substance. Their con¬ sistence is thus so far reduced that in some places the limits of the individual fasciculi can no longer be distinguished. The sarcolcmma is so much softened by the exudation as to be dis¬ solved, leaving nothing but a fine molecular substance, in which not a single primitive fasciculus can be discerned.”—(Path. Ilistol., p. 241, Syden. Soc. ed.) Lastly, Virchow has described the condition in almost the same terms,, denominating the pathological change “ inflammatory softening.” Whether or not wo can prove the softening of the heart to be the result of inflammation, it cannot be questioned but that the condition of the muscular fibres is identical with that which is produced by inflammatory action in muscular tissue. A gain, though Dr. Stokes has never met with a case in which the results of pericarditis were detected, yet I have found unmis¬ takable evidence of such disease in three instances, besides the two narrated in this paper. I am certain that I have met with the same condition on other occasions; but as recovery fortunately took place, I was not able to verify my opinion by inspection. In these cases I have heard a friction sound, succeeded by a bellows murmur, which disappeared in a few days. Dr. Stokes states that lie has also detected such bellows murmurs, but he ascribes the sound to u a nervous or mnemie condition.” The for egoing considerations induce me to doubt the correct¬ ness of the doctrine of the non-inflammatory nature of the softened heart in typhus. On the other hand, I am inclined to view the condition as a secondary effect of the typhus poison on the struc¬ ture ot the heart, and that this pathological change is similar in its nature to those morbid alterations which occasionally arise during fever in the brain and lungs, and which conditions are considered to be of an inflammatory nature, modified no doubt in the results by the typhus influence. I have entered on this point at some length, as it is one of great practical importance in reference both to the therapeutics and symptoms of the disease. For example, we know that inflam¬ mation, of a muscle, gives rise to a greater or less amount of paralysis, and this is precisely the effect on the heart’s action which the symptoms during life denote, viz., loss of impulse and first sound, especially at left side of heart, the portion which we find after death chiefly diseased.