The principles and practice of medicine / revised by T. McCrae.

  • William Osler
Date:
1914
Catalogue details

Licence: In copyright

Credit: The principles and practice of medicine / revised by T. McCrae. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

    36/1258 (page 8)
    Dust may be an important factor, though it has been shown that the bacilli die very quickly when desiccated. In the dust storms during the South African War the food was often covered with dust. Possibly, too, as Bar- ringer suggests, the dust on the railway tracks may become contaminated. Men working on the tracks are very liable to infection. Modes of Infection.—We may recognize the following groups: (a) Ordinary typhoid fever with marhed enteric lesions. An immense majority of all the cases are of this character; and while the spleen and mesenteric glands are involved the lymphatic apparatus of the intestinal walls bears the brunt of the attack. (&) Cases in which the intestinal lesions are very slight, and may be found only after a very careful search. In reviewing the cases of “typhoid fever without intestinal lesions,” Opie and Bassett call attention to the fact that in many negative cases slight lesions really did exist, while in others death occurred so late that the lesions might have healed. In some cases the disease is a general septicjemia with symptoms of severe intoxication and high fever and delirium. In others the main lesions may be in organs— liver, gall-bladder, ]Dleura, meninges, or even the endocardium, (c) Cases in which the typhoid bacillus enters the body without causing any lesion of the intestine. In a number of the earlier cases reported as such the demonstra- tion of the typhoid bacillus was inconclusive. In others the intestine showed tuberculous ulcers, through which the organisms may have entered. But after excluding all these, a few cases remain in which the demonstration of the typhoid bacillus was conclusive, cases in which death occurred early, and yet after a very careful search no intestinal lesions could be found. There were 4 cases in this series. Undoubtedly the intestinal lesions may be so slight as not to be recognizable at autopsy, {d) Mixed infections. It is well to distinguish, as Dreschfeld pointed out, between double infections, as with bacillus tuberculosis, the diphtheria bacillus, and the plasmodia of Laveran, in which two different diseases are present and can be readily distinguished, and the true mixed or secondary infections, in which the conditions induced by one organism favor the growth of other pathogenic forms; thus in ordinary typhoid fever secondary infection with the colon bacillus, the streptococcus, staphylococcus, or the pneumococcus, is quite common, (e) Para-typhoid in- fections. In 1898 Gwyn reported a remarkable case from my clinic, which presented all of the clinical features of typhoid fever, but in which no serum reaction with B. typhosus was present. From the blood of this patient he isolated in pure culture a bacillus, differing from B. typhosus, but having properties intermediate between B. typhosus and B. coli. This organism re- sembled one which was isolated in 1897 by Widal from an oesophageal abscess, and which he called a para-colon bacillus. In 1900 Cushing reported from the Johns Hopkins Hospital the cultivation of a similar organism from a costo- chondral abscess following an attack resembling t}^phoid fever. These organ- isms belong in a group which also contains B. enteritidis, described as the cause of meat poisoning, and also several varieties causing diseases in ani- mals. Since 1900, following the introduction of more accurate bacteriological methods, similar organisms have been cultivated from numerous cases (now many hundreds) clinically like mild typlioid. Enlargement of the spleen has been quite constantly present, while rose spots have been frequently seen, and intestinal symptoms, even haemorrhages, have occurred, but perforation