London medical gazette : being a weekly journal of medicine and the collateral sciences. Saturday, September 8, 1832.

Date:
1832
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Licence: Public Domain Mark

Credit: London medical gazette : being a weekly journal of medicine and the collateral sciences. Saturday, September 8, 1832. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Dr. Bright*, Dr. Carswellf, &c. It has been long disputed whether this affec- tion be the cause, the effect, or a mere complication of typhus fever. It can- not, I think, be justly said to be any one of these. It is a part—an almost essential part—of this fever, and ap- pears to bear the same relation to the entire disease which the rash and sore throat do in scarlatina, and the rash and the bronchial affection in rubeola. These ulcerations appear under various forms, being granular, pustular, fun- gous, gangrenous, &c. With these ulcerations are conjoined enlargement and softening of the cor- responding mesenteric glands. IV. The principal Functional Compli- cations are, i. Encephalic; 1. Headache. 2. Stupor. 3. Delirium. 4. Subsultus. ii. Thoracic ; 1. Cough. 2. Expectoration. 3. Rattle. iii. Gastric and Intestinal; 1. Pain and Sickness. 2. Pain and Diarrhoea. 3. Melcena. 4. Tympanitis. 5. Symptoms of Perforation of the Intestine. V. The Structural Complications\ are— 1. Encephalic, consisting of—1, ef- fusion upon the arachnoid; 2, injec- tion and softening of the cortical and medullary portions of the brain ; and, 3, of similar affections of the cerebel- lum. This complication is slighter in degree, and less frequent in its occur- rence, than is supposed. 2. Effusions of lymph, and ulcera- * Reports of Medical Cases. London, 1827. f By the liberality of Dr. Carswell, I, as well as many others, have repeatedly seen his incompa- rable drawings, amounting nearly to two thou- sand-, and I have as repeatedly contemplated this gentleman’s labours with unmingled admira- tion. They will long be the ornament of the Lon- don University. I rejoice to know that Dr. Cars- well is at length engaged in preparing Elements of Morbid Anatomy, with plates, for publication : this work must intinitely surpass every thing of the kind published in this kingdom. t Throughout the whole of these essays I un- derstand by the morbid anatomy, such changes as are essential to the disease; and by structural complications, such as are only of mote or less frequent occurrence. tions of the epiglottis, the larynx, the trachea, the pharynx, the oesophagus, &c. 3. Thoracic, generally slight, and consisting of—l, adhesions, or effusion of bloody serum into the pleura; 2, hepatization, or splenization of the lung; 3, reddish mucus in the bronchia; 4, a livid red colour, thinness, and softening of the heart, denoted gene- rally by irregularity and feebleness of the pulse. 4. Abdominal; these are—1, soften- ing, thinness, ulceration, and the matne- lated state, of the mucous membrane of the stomach ; 2, softening of that of the intestines, with constant ulcerations of the clustered glands of Peyer, and occasional ulcerations of the solitary glands of Brunner; 3, enlargement and softening of the mesenteric glands; 4, softening of the substance of the liver, spleen, kidney, &c. 5. Perforation of the Intestine. The symptoms of perforation of the in- testine are generally pain and ten- derness diffused over the abdomen, nausea and vomiting, sunken counte- nance, smallness and feebleness of the pulse, cold perspirations, with pallor over the whole surface, and rapid fail- ure and sinking of the powers of life. 6. The integuments covering the sa- crum are apt to ulcerate and slough from pressure, and those of parts cover- ed with blisters, from irritation, in a degree which becomes somewhat diag- nostic. There is also occasionally ery- sipelas. 6. The Effects of Remedies; and, 7. The State of the System.—There is, comparatively with health, and still more, comparatively with inflammation, little tolerance of loss of blood ; syn- cope is early produced on opening a vein in the erect sitting posture. III. The Sinking Form. 1. The Symptoms.—In the sinking form of typhus, or that designated the congestive, a form little seen in hospi- tals, there is early coldness of the face and general surface, with a feeble pulse, stupor, deep breathing, extreme debi- lity of the muscular system, so that ar- ticulation and all attempts to move are abortive ; the eye is sunken, the voice husky, the evacuations perhaps involun- tary. This form of typhus is noticed in this place, in order that nothing practi-
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