The medical treatment of typhoid fever / by James Stewart.

  • Stewart, James, 1847-1906.
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The medical treatment of typhoid fever / by James Stewart. 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.

    7/10 (page 7)
    may be very considerable. In one case it looked as if such a deleterious after effect of opium were manifest. A man, aged 31, was admitted in October, 1897, on the ninth day of tlie disease, in a very apathetic slate, between the 27th and 28th of October, he had repeated haemorrhages, tlie loss it was computed, being upw'ards of 83 ounces, but after the 28th there was no further bleeding. On the 28th tlie abdomen was distended, and the distension continued to slowly but gradually increase, day bv day, up to ITovember 4th, when he succumbed, death apparently being due to the very great distension. After death, numerous ulcers were discovered in the lower ileum, caecum, and ascending colon, but in no instance had perforation occurred. The source of the previous bleeding could not be traced. The practice of giving astringent drugs, like iron, tannic acid, turpen- tine, etc., is, fortunately for the patient, becoming less and less frequent. Whether ergotine, hypodermically, has any influence in checking intes- tinal bleeding, I am unable to say. 'I'HE TREIATIM'ENT OP PERFORATION. When perforation occurs, the sooner the case is transferred to the surgeon the better. It is no doubt possible for spontaneous recovery to taAe place, but it is too rare an event as compared with the result following early operation, to be for a moment considered. The result of operation, considering tlie gravity of the condition for which it is performed, must be looked upon as most gratifying. Keen has collected 83 cases with 18 recoveries, a result which justifies interference in every case where the condition is recognized. Here, however, we meet with great practical difficulties. The so-called typical symptoms of perfora- tion, were, in most of our eases, conspicuous by their absence. Perfora- tion may occur in persons extremely ill, without any pain, tenderness, distension, rigidity, or vomiting, and it may be found at the post mortem without having been suspected during life. Again, the symptoms may be developed very slowly, where a patient is stuporose from the intoxication of the disease, deep-seated tenderness and a gradually increasing abdominal distension may be the only signs. In several cases I have noticed symptoms of the same character without any y erforation, recoveiy having taken place afterwards. Peritonitis may be set up in typhoid from other causes than from perforation, and I believe this to be a more common event than is generally believed. I believe I have met with several instances of a more or less generalized peritonitis where recovery took place. TOEIB DIET. There is an almost universal agreement as to the best way of feeding typhoid patients, but now and then one reads in medical journals about