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.

    5/100 page 389
    tenance flushed ; eyes suffused ; skin hot and dry ; tongue furred. Pulse 100. Over abdomen a few red spots were discovered. Pressure over right iliac fossa caused pain. Bowels loose, but dejections not frequent. On the 1st June, the eruption had increased in amount, and assumed a brick colour. On the 2nd, a double friction sound was heard over cardiac region uninfluenced by respiration; pulse intermittent and rapid. A blister was applied over heart, and he was ordered small doses of chalk and mercury. On the 3rd, the abdomen, chest, and extremities were covered with a dark mulberry-coloured eruption, which was confluent, and did not disappear on pressure. Heart’s action feeble* sounds heard indistinctly; friction sound less intense. Pulse 130, but regular. On the 4th, he became delirious ; the friction sound disap¬ peared, and was succeeded by a soft systolic bruit, heard loudest over the pulmonary artery and at epigastrium. Percussion detected extended pre-cordial dulness. Pulse 130, weak. He was ordered six ounces of wine. On the 5th, the delirium had subsided; but as the debility still continued, six ounces of whisky were substituted for the wine. On the 6th, the quantity was increased to twelve ounces. He died at eight o’clock p.m. on the 7th. Autopsy—Heart.—Pericardium contained about two ounces of reddish fluid; several patches of lymph adhered to serous cover¬ ing of heart. The left ventricle, at the base, was of a deep purple colour; oedematous on pressure, soft, and easily lacerated. This softened condition extended to near apex, gradually tapering to a point. The inner portion of the ventricular wall, through¬ out its whole course, was healthy in appearance; the softened part extended to about one-twelfth of an inch in thickness. A microscopic examination of this softened portion exhibited the same disintegrated condition of the muscular structure as was found in the first case. Abdomen.—The serous coat of small intestines at several places was much congested, and was of a bright-red colour. On open¬ ing the intestines the mucous membrane, from the duodenum to the colon, presented a congested appearance. It was swollen and softened; numerous solitary follicles were filled with deposit. Some had sloughed. The inflammatory condition was much more intense in the ileum, coecum, and upper part of colon. In the former, Peyer’s elliptical groups were much elevated, and the follicles distended with pulpy matter. Near the coecal valve, two of these patches were almost entirely destroyed. In the coecum several small ulcers detected. The follicles of upper portion of colon were also prominent, and distended with soft
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