A clinical study of relapses in typhoid fever : with an analysis of 25 relapses in 21 out of 166 typhoid fever cases / by H.F.L. Ziegel.

  • Ziegel, Hermann Fred Lange, 1876-
Date:
1912
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Credit: A clinical study of relapses in typhoid fever : with an analysis of 25 relapses in 21 out of 166 typhoid fever cases / by H.F.L. Ziegel. 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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    fever as these diseases now appear in New York City, as well as in the original differentiation of typhoid fever from typhus seventy-five years ago. That the relapse is a true septicemia as well as a bacteriotoxemia is proven by the recovery from the blood of typhoid bacilli during the at- tack. Regarding the etiology of the relapse, though several hypotheses appear plausible enough, yet really unknown are the underlying causes of tlie repetition or renewal of the characteristic lym- phoid changes in the small intestine which con- stitute the pathological basis of the relapse. When the Brand treatment is employed it is not unwise to prevent access of the tub water to the patient’s mouth. Relapses are at least as frequent nowadays as they were before strict precautions were ob- served in the hospital management of typhoid fever. In i66 cases of typhoid fever treated dur- ing three years by the ordinary expectant method, 12.6 per cent, of the cases had relapses. After ten days of normal temperature relapses are infrequent and after two weeks they are rare. Nevertheless, because of the occasional oc- currence of relapses after interpyrexial periods of four weeks (one of our cases) or even of six weeks (one of Osier’s cases), after deferves- cence the patient should be observed for at least two weeks in the hospital and should be seen oc- casionally at home for at least a month after discharge. Though there is no certain way of prognosti- cating a relapse, a presumptive sign is the per- sistent tumefaction of the spleen after deferves- cence ; this sign was present in 78 per cent, of the cases in which it was investigated. The relapse has nothing characteristic in its general features or its symptoms to distinguish it from the original attack; the relapse, however, usually begins without anorexia and without other prodromata,—the rise in temperature often being the first sign; moreover, relapses are us- ually comparatively mild and of short duration, and the temperature curve is more labile than in the original attack. Relapses are relatively more common in chil- dren than in adults. Since complications are infrequent in relapses and since the mortality in relapses without com- plications is practically nil, the physician should assuage needless alarm on the part of relatives and friends over the occurrence of a relapse. REFERENCES. T. Schultz. Car. Hen.: De Entero-mo.senteritide con- tasfinsa Binonti anno 18.SO grassata. Monachii, 1831. Typis J. Rosl. Dissertatio Inauguralis. (This mono- ^rnph in Latin is in the Army Medical Museum at Washington; through the courtesy of the N. Y. Acad- emy of Medicine and Library of the Surgical General. I was able to borrow this rare little volume.) 2. Gerhard. W. W.: On the typhus fever, which occurred at Philadelphia in 1836, showing the distinc- tion between this form of disease and dothinenteritis or the typhoid fever with alteration of the follicles of the small intestine. Am. J. of Med. Sc. for Feb. and Aug., 1837, Vols. XIX and XX. 3. Stewart, \. P.: Some Considerations on the Na- ture and Pathology of Typhus and Typhoid Fever, Ap- plied to the Solution of the Question of the Identi- ty or Non-Identity of the Two Diseases. Orig- inally published in Edinburgh Med. and Surg. Journ., 1840, LIV, 289. Available also in Selected Mono- graphs. The New Sydenham Society, London, 1884, CX, 157-221. 4. Allbutt and Rolleston’s System of Medicine, 1906, II, part I, 541. 5. Brill, N. E.; A Study of Seventeen Cases of a Disease Clinically Resembling Typhoid Fever, but Without the Widal Reaction. N. Y. Med. J., Jan. 8 and Jan. IS, 1898. 6. Friedman, G. A.; Brill’s symptom—complex; typhus fever; Manchurian typhus. Archiv. Int. Med. 1911, VIII, 427. 7. Anderson, John F., and Goldberger, Joseph: The Relation of So-called Brill’s Disease to Typhus Fever. An Experimental Demonstration of Their Identity; Public Health Reports, United States Public Health and Marine-Hospital Service, Feb. 2, 1912, XXVII, 149. 8. Brill, N. E.: An Acute Infectious Disease of Un- known Origin. Am. J. Med. Sc., 1910, CXXXIX, 484. 9. Brill, N. E.: Pathological and Experimental Data Derived from a Further Study of an Acute Infectious Disease of Unknown Origin. Am. J. Med. Sc., 1911, CXLII, 196. 10. Ziegel, H. F. L.: On the Affections Clinically Simulating Typhoid Fever, With Especial Reference to and Reports of Cases of Brill’s Disease. Med. Rec., 1910, CXXVII, 1087. 11. Ziegel, H. F. L.; An Analysis of Twenty Cases Bdong'ng to the Unclassified Group of Affections Clin- ically Resembling Typhoid Fever. Med. Rec., 1910, CXXVII, 641. 12. Louria, Leon; Brill’s Disease, Reports of Cases, Med. Rec., 1911, eXXX, 424. 13. Libman, E., and Celler, H. L.: The Etiology of Subacute Infective Endocarditis. Am. J. Med. Sc., 1910, CXL, 516. 14. Wood, F. C.: Chemical and Microscopical Diag- nosis. Appleton, 1905, 228. 15. Cabot, Richard C.: Differential Diagnosis. Saun- ders, 1912. Case 221. 16. Delafield, Francis; Lectures on the Practice of Medicine. Dougherty, 1898, 231. 17. Rosenblath, William; Ueber Typhus-Recidive. Gottingen, E. A. Huth, 1884. Monograph. 18. Proust, Rene; Contribution a TEtude des Reri- dives de la Fievre Typhoid. Paris, 1901. Monograph, 19. Bena, H.; Ueber Typhus-Recidive. Strasbourg, C. Goeller, 1893. Inaugural Dissertation. 20. Osier, William; Relapses in Typhoid Fevei. /. Am. Med. Assn. 1897, XXIX, 97. 21. Fitz, Reginald, H.; Typhoid Fever at the Massachusetts General Hospital During the Past Seventy Years. Mortality, Intestinal Hemorrhage, Per- foration and Relapse. 1902, Monograph. 22. Fleischl, Otto; Ueber Recidive und Nachfieber biem Abdominal-Typhus. Zurich, 1873. Monograph. 23. Ebstein, Wilhelm; Die Recidive des Typhus. Breslau, Marushke and Berendt, 1869. Monograph. 2d. Von Ziemssen, H. W.; Der Tvphus in Miinclmn Wrihrend der Letzten 20 Jahre. Miinch. Med. Woch. 1886. lO
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