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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    A CLINICAL STUDY OF RELAPSES IN TYPh/^D FEVER; WITH AN ANALYSIS OF 25 RELAPSES IN 21 OUT_^|;^ lee/^YPHOID FEVER CASES. By H^F. L. ZIEGEl^]|rS., M.D., I Introductory and historical; pathological nature of the relapse.—In the early part of * the nineteenth century there prevailed much confusion and a long controversy as to the identity or non-identity of typhoid and typhus fever, and in the studies which finally estab- lished the entity of typhoid fever and definitely determined its differentiation from typhus, the relapse played an important role. The first writer to report relapses in typhoid fever was Schultz,^ who in an epidemic in 1830 at Zwei- briicken, Bavaria, had observed three relapses in 55 cases. An epidemic of typhus fever in 1836 at Philadelphia was studied by Gerhard,^ who first called attention to the absence of re- lapses in typhus. The credit for having estab- lished the pathological basis for relapses belongs to A. P. Stewart,^ whose autopsy performed in 1839 on an individual who had died of pneu- monia during a relapse showed characteristic lymphoid infiltration and fresh ulceration of Peyer’s patches as well as healed or healing ul- cers. Part of the report of this autopsy is as follows; “Incomplete splenisation of lower part of right lung; diseased aggregate glands at the lower part of the ileum, some ulcerated, some going on towards cicatrization, others not ul- cerated and in the state in which they are de- scribed about the sixth day of the disease.” II. The relapse an important factor seventy- five years ago in the original differentiation of typhus and typhoid fever as well as in the differ- entiation of modified typhus and typhoid fever as these diseases now appear in New York City.—In the classical article just referred to “On the Nature and Pathology of Typhus and Typhoid Fever Applied to the Question of the Identity or Non-Identity of the Two Diseases,” Stewart says: “With respect to typhus, I have never, among thousands of cases, seen a single case of relapse, in the proper sense of the term, after the symptoms had begun to decline.” Af- ter quoting Montault and Louis to the effect that relapses do occur in dothinenteritis, and af- ter giving the histories of several relapse cases, Stewart states further: “After the facts which have been adduced, I feel almost certain to ex- pect assent to the likelihood of the opinion, which, I am convinced, future observation will con- firm, that in typhus, when uncomplicated with any secondary affection, a second attack does not take place, while in typhoid fever the contrary is the case.” Stewart’s conclusions and predictions of nearly 75 years ago as to the practical non-occurrence of relapse in European typhus are borne out by recent observations; in 18,268 cases of typhus fever reported during twenty-three years at the London Fever Hospital, there was only one re- lapse.^ G. A. Friedman, whose experience with typhus in Russia enabled him to recognize and identify the so-called Brill’s disease as attenuated typhus, states in a personal communication: “In a large experience with both epidemic and sporadic typhus I was never able to observe a relapse. On the other hand, I certainly have seen a repetition of the disease in two individ- uals, to which I referred in my article. But the interval between the first and the second infec- tion in both instances was so long (one year in the first case, two years in the second), that a relapse could not be taken into consideration.” The rarity of relapses in Mexican typhus will be considered under the next heading. Truly history has repeated itself in regard to the relapse, which has in our own times again figured prominently in the distinction between typhus and typhoid fever. In the group of af- fections which were at first regarded by some writers as a new disease of unknown origin but which were quite recently proven by Anderson and Goldberger to be identical with Mexican typhus, there were no relapses. To Brill® be- longs the credit for having first differentiated these cases from typhoid fever; later he proved also that they were distinct from paratyphoid fever and from typhoid-colon and Gartner group infections. Though the original clinical recog- nition of the disease as attenuated typhus by G. A. Friedman® of New York has been con- firmed by the masterly experiments of Ander- son and Goldberger,'^ yet it had required fifteen years for the Board of Health and most of the physicians of New York City to be convinced that these cases were not mild, atypical or abor- tive typhoid. Now again, as in the years from 1830 to 1840, the uniform absence of relapses in the non-typhoid cases has been an important factor in determining this differentiation. Relapses are more frequent in the abortive than in the ordinary type of typhoid fever, whereas in Brill’s® ® 255 cases studied at Mount Sinai Hos- pital there were no relapses. ZiegeF® has re- ported 23 similar cases studied at Beth Israel Hospital with no relapses; and Louria^® has re- ported 18 such cases observed at the Jewish Hospital in Brooklyn, with no relapses. HI. Occurrence of the relapse in infectious diseases other than typhoid fever, vis., syphilis, relapsing fever, subacute infective endocarditis, and Mexican typhus; recurrences in scarlet and rheumatic fever.—Comparable to typhoid fever