The lancet. [Nos 316-317].

Date:: 1828

Credit: The lancet. [Nos 316-317]. 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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$typhus fever prevailed to an unprecedented extent, in the town and vicinity of Sunder- land ; the observations then made, and the experiments then commenced and since completed, I have now the gratification to lay before you. During the prevalence of this disease in the year 1810, and for some years afterwards, we were accustomed, in some cases, to abstract blood from the arm in all its stages; and 1 have known this plan adopted even within a few hours of the fatal termination of the disease. As to the exact value of this heroic remedy in typhus fever, it is not ray inten- tion, in this part of my discourse, to give an opinion. I merely mention these facts that you may be assured that many favour- able opportunities were afforded me, for the investigation of the nature of the venous blood of typhus patients, in all the stages of the disease ; and the result will be, in my opinion, of great importance to the pro- fession, and to our fellow-creatures in gene- ral. In the year 1818 I applied myself to the task of investigating the proximate cause of typhus fever ; a task which I have been induced to prosecute most assiduously. My experiments have been, for the most part, upon the venous blood of typhus pa- tients, holding in remembrance all the phe- nomena which that disease presents. I need not take up your time in explaining the steps which 1 followed in my chemical analysis of diseased blood, but shall proceed, without further preface, to detail the ap- pearances which a severe, though ulti- mately favourable case of typhus fever pre- sents to us; and I trust that the plan which I have adopted, will be found to be the most suitable for conveying to the profession the general results of my investigations. First Stage. From the commencement of typhus to the sixth day, the following symptoms are present:—nausea and anxorexia, the mouth is parched and dry, the taste is vitiated, in- dicating a severe attack upon the digestive system. The sensorium commune is now affected, and its functions are badly per- formed. Secretion is generally diminished, and even suspended in many organs. The food is always undigested. The whole body is affected with distressing pains, the pulse is quickened, and the respiration laborious. The bowels are generally bound, and vomit- ing sometimes occurs. During the progress of the disease, the free carbonic acid of the blood was gradually diminished in quantity, and on the sixth day this gas was no longer to be found in the blood, though that fluid was received direct from the vein, in vacuo, in an apparatus of my own invention; and I believe that heretofore blood has never been so received, as no instrument has hitherto been constructed for that purpose. I need scarcely remark to you that the spe- cific gravity cannot be accurately ascertained when blood is received in vacuo, as may be readily understood upon inspecting the ap- paratus now before you. In the following tables, you will find inserted the fluid and solid contents of healthy venous blood; with the serum and coaguluin duly calcu- lated, and their proportions so arranged that they may be examined at a glance. In this, and all the other tables, 1 give averages of my analyses, and of course the fractional parts, for the sake of the memory, are omitted. In Health. Water 678 Colouring matter 160 Albumen 121 Fibrin 28 Neutral salts 13 1000 At the sixth day I found the venous blocd to average as follows :— In Health* On the Sixth Day. Water 678 729 Colouring matter 160 136 Albumen 121 98 Fibrin 28 25 Neutral salts .. 13 12 1000 1000 Second Stage. From the sixth to the twelfth day we find severe headach, flushed skin, increased heat and irritation, attended by thirst. The bowels are sometimes costive, sometimes the reverse, the uriue is diminished in quan- tity, and at this stage deafness is a common symptom. Delirium now supervenes, at- tended with a frequent pulse, which is sometimes full, but more generally the con- trary. The patient is weary and watchful. He now assumes the supine position, and nppenrs to be abstracted from every sur- rounding object. About the twelfth day the blood is as follows:— In Health. On the Twelfth Day. Water 678 772 Colouring matter 160 122 Albumen 121 75 Fibrin 28 22 Neutral salts .. 13 9 1000 1000 * Sixteen ounces of healthy blood con- tain one cubic inch of carbonic acid gas.$

The lancet. [Nos 316-317].

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