The lancet. [Nos 316-317].

Date:
1828
Catalogue details

Licence: Public Domain Mark

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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    sanguification not be restored to the patient, the following symptoms, which show the vitiated state of the blood, take place. The patient has oppression of the thorax; anxiety, restlessness, and weariness, are upon the increase. The skin is very hot, the tongue parched, and the thirst is incessant. The lips, mouth, teeth, and tongue, are, in many cases, covered with a hard brown fur. De- lirium or coma is constantly present. The secretions, during the lymphatic state of the blood, are much vitiated. The urine is dark and fetid—the faeces highly offensive. Pe- techia? are seen upon different parts of the body. Blood is poured out from the gums, mouth, and nostrils. Fetid and cadaverous sweats break out, and there is a coldness of the forehead, nose, and extremities. Hiccup, and intermitting pulse, too plainly indicate excessive debility, and death comes to the patient’s relief, like the visit of a kind friend to the distressed. During the fatal progress of the disease, catbonic acid is not to be found in the blood ; and except a turn take place, by which fresh chyle is carried to the thoracic duct, the blood is rendered vapid, and, in some cases, it passes to a pu- trid state. I beg to remark, that I consider putrid fever as merely typhus fever in the worst form ; and when we attentively ob- serve certain constitutions we ought not to be surprised should putrid fever prevail to a greater extent than we find it to do in these islands. Danger is greatly to be feared in typhus fever, when it occurs in shattered constitutions, and in persons afflicted with diseases of the brain, liver, or lungs; for, under such circumstances, sanguification is at all times performed with considerable difficulty. The lymphatics have an univer- sal distribution, and commence with open mouths at every part of the body, their office being to take up and carry back to the blood those elements of the system which disappear, either to make place for newly secreted matter, or without substitu- tion, as in typhus fever. From the lym- phatic blood in typhus, we are not, a priori, led to expect any very peculiar appearances upon dissection, in the early stages of the disease ; for as the lymph at all times, whe- ther in health or disease, forms a part of the blood, we find that morbid anatomy, though it throws little light upon the immediate nature of typhus, in the first or second stage, developes some of the changes which have been induced by this disease in the advanced stages. The duration of typhus is modified in the following manner, cist o'is paribus. In the spring and summer its nature is inflamma- tory, and in the autumnal months it is in- clined to putrescency. The quantity of albumen and fibrin in the blood at the com- mencement of typhus fever, modifies its subsequent condition ; for, as in the pro- gress of fatal cases no new' blood is formed, the lymph, always unequal to the task of suitably supplying the place of genuine blood, in process of time becomes itself much vitiated, and this accounts for the very rapid changes which take place in the last stage of unfavourable cases of typhus fever, as also for the petechiae. It is well known to the faculty, that typhus fever is wonderfully uniform in its leading symp- toms, whatever the sex, age, temperament, or habits of the patient may be, and this, in my opinion, demonstrates that an univer- sal cause operates in this disease. The blood, from its stimulant effect upon the internal coats of the heart, arteries, and veins, causes its circulation through those important organs ; but when the blood is in a lymphatic state, as demonstrated in this lecture, the circulation is performed in the singular manner which obtains in typhus fever, and hence the relaxed or expanded state of the blood-vessels in certain parts of the system, which permits determinations of blood in those parts, and which are some- times designated “ congestions.” I have experimented upon the blood taken from persons labouring under acute diseases, and could in no instance find those changes which invariably present themselves in ty- phus fever. Even in hydrophobia, a case of which I witnessed in London last spring, no change could be detected in the blood, which induces me to be of opinion, that this disease has its seat in the nervous system ; and when we reflect upon its similarity to traumatic tetanus, a corroboration is thereby afforded us. In many important diseases, we find that the blood always shows certain changes. These I need not particularise here, as they are well known to the facultv. Chylification, like secretion, is a function of the brain, which, under peculiar circum- stances, or states of the atmosphere, is im- paired, and in severe cases is suspended altogether: lienee typhus fever. As we cannot explain the tnudus operandi of the brain in the process of chylification, neither can we explain the manner in which it is impaired or suspended. We know that when the kidneys cease to secrete urine, the liver to secrete bile, and the absorbents to perform their functions, death must be the result, if relief be not obtained. I be- lieve that no person has hitherto offered an opinion as to the exact length of lime which the latent period of typhus fever is sup- posed to occupy. According to my investi- gations, it must be calculated from the com- mencement of the cessation of sanguification till the disease begin to show itself. When we hold in remembrance the regularity which obtains in exlhematous fever, and the facts which I have just communicated.
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