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.

    6/100 (page 390)
    material, and several small patches of the entire mucous mem¬ brane destroyed. Remarks.—Doubtless, in this case, the disease of heart and pericardium caused death. The occurrence of pericarditis may be considered uncommon. I have met with five other cases in the course of my practice. Louis mentions only one instance, and Dr. Stokes seems to have never seen a case. The softened condition of the muscular tissue was extensive. The destruction of the fibres was as complete as we found in the other instance. The friction sound heard on the eighth day of the illness arose, no doubt, from the effusion of lymph. As soon as this became covered with fluid, the bellows murmur supplanted the friction sound. With regard to the abdominal lesion, the serous coat of intes¬ tines did not present such an extensive and severe amount of inflammatory action as in Case 1. But the disease of the mucous coat was much more intense. Peyer’s glands were much more severely involved, and contained a much softer product ; and many had sloughed, and not a few ulcerated. It must, however, be remembered, that the patient lived to the twelfth day, the other only to the ninth. This circumstance accounts satisfactorily for the difference. The few scattered red spots which were discovered on the day of admission (the 6th of the disease) might lead to the impression that the case was one of typhoid. But, in the first place, these red spots became vesicular in a few days ; and, secondly, a most extensive dark-coloured confluent eruption appeared on the seventh day,and ultimately became petechial; that is,uninfluenced by pres¬ sure—thus establishing beyond doubt the typhus character of the attack. Case III.—Maculated and Petechial Typhus—Rapid Loss of Impulse, and First Sound of Heart over whole Cardiac Region— Death on the Eighth day—Autopsy.—(Deported by Mr. Gilland.) T. Mfljf., aged 18 years; admitted June 25, 1859—Pyrexial symptoms of three days’ duration; face flushed, eyes congested, tongue furred, thirst urgent, skin hot and dry. Pulse 108, soft. Heart’s sounds normal. Pressure over abdomen caused uneasi¬ ness. Bowels regular. On the 27th, the impulse and first sound of heart being feeble, he was ordered six ounces of wine. On the 28th, an extensive eruption of mulberry-coloured spots appeared over body and extremities. Pressure over right iliac fossa caused pain, and elicited slight gurgling. The impulse of heart was still feebly felt, and the first sound nearly inaudible. A blister was applied over right iliac fossa, and the wine continued. On the 29th, at left apex of heart no impulse could be felt, and the first sound was quite inaudible. Over right apex, impulse and sounds were weakened. Eruption much darker in colour, and did