The swelled leg of fevers / [J. Warburton Begbie].

  • Begbie, James Warburton, 1826-1876
Date:
1882
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Licence: Public Domain Mark

Credit: The swelled leg of fevers / [J. Warburton Begbie]. Source: Wellcome Collection.

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    after fever, by Dr. Risdon Bennett, in which the affection occurring after fever is stated to be of extreme infrequency in London, called forth an interesting letter in the immediately subsequent number of the same journal by Dr. A. P. Stewart,1 whose name is so justly connected with the discovery of the non-identity of typhus and typhoid fevers. Dr. Stewart, in this letter, remarks : “During the memorable and destructive epidemic of typhus which prevailed in Glasgow from October, 1836, to May, 1838, phlegmasia dolens and purulent deposits in the joints were by no means rare sequelae of typhus. Though I cannot at present state the number of these cases witnessed by Dr. A. Anderson and myself, having mislaid my clinical notes, I think I am under the mark when I express my convic- tion that there could not be fewer than eighteen or twenty.” The late Dr. A. Anderson of Glasgow, the colleague of Dr. Stewart, alluded to in the letter which has been quoted, has referred in distinct terms to the latter of these sequelae. “ Some- times a patient will be recovering very well from fever—say from typhus—when he has the rigor which I have described ; and after it he is much worse than you would expect him to be were he only about to take erysipelas. His pulse is exceedingly rapid; he is exhausted, and in particular complains of pains in his joints, in his ankles, wrists, elbows. He becomes very ill. Asthenia is developed, and the most ominous symptom is jaundice ; his eyes and skin become yellow. There is swelling and reduess about the joints, and he has considerable pain when they are touched or moved. These cases all die, and as far as I have seen they die rapidly, with symptoms of poisoning of the blood, like cases of the worst puerperal fever, or pytemia after surgical operations. I have seen some dozen of them, and upon inspection found the synovial membrane injected with blood and bathed in pus; pus not the result of ulceration, but the primary secretion from the inflamed membrane, as in puru- lent ophthalmia.”2 Dr. Magnus Huss, in recording his large experience of typhus and typhoid fevers, as gathered in the Seraphim Hospital of Stockholm, has observed, regarding local oedema as a sequela : “ This affection occurs chiefly in the extremities, especially the lower, commonly on one side, seldom 1 ‘Medical Times and Gazette,’ 2nd May, 1857, page 446. 2 ‘Ten Lectures Introductory to the Study of Fever.’ 1861. See page 48.