Relapsing fever in Edinburgh during the first five months of the year 1870 / by Claud Muirhead, M.D.

  • Muirhead, Claud.
Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: Relapsing fever in Edinburgh during the first five months of the year 1870 / by Claud Muirhead, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    end of the third week of the fever, a woman and a man took typhus, at the end of the fourth week a lad took typhus, and at the end of the fifth week of relapsing another lad took typhus. At first I naturally enough supposed that it was merely to be another re- lapse, until the presence of the'eruption cleared away all doubt. For a considerable time after the last relapse the temperature keeps rather under the normal point. 2. Circulatory System.~2i, The Pulse observes very much the same series of fluctuations that we have already noticed with regard to the temperature. At the outset of the attack, in each of those three cases which were seen on the very first day, it ranged from 108 to 126. The highest number of beats noted was in a child of eight years of age, where the pulse beat 148 times in the minute. And though this is to be looked for in the case of young children, still it was not uncommon to find the heart beating 120 to 130 times per minute in men and women of the age of thirty or forty. In the remission it falls as markedly as the temperature. Thus in a lad of seventeen the number of beats fell in one day from 102 to 44, or a difference of 58 beats; this was the slowest pulse observed. In another lad of seventeen the difierence was 60 beats, in another 64 beats, in the twenty-four hours. With the relapse it rapidly accelerates, rising to 112 from 65 at once, though usually this is more gradual. Its character during the paroxysms is full, sharp, thrilling, often bounding ; while in the remissions it is slow, feeble, often irregular and intermittent, and markedly dichrotic. b. Action of Heart.—Daring the remissions its action is always feeble. Generally the first sound is weakened, the second appear- ing proportionally intensified. At times the first sound at the apex is almost inaudible, and this may last for two or three days after the crisis. At other times a distinct blowing murmur is heard at the base with the first sound, propagated into the great vessels in the neck, most probably due to anaemia. But most frequently of all, the first sound of the heart is unusually prolonged, often to double the normal time in the remissions. 3. Digestive System.—a. The Tongue from the outset presents a coated appearance ; at times merely a slight silvery gray fur, such as is observed in persons who have continued the use of arsenic for a length of time. At other times the fur is of a denser white, while the posterior two-thirds may be thickly coated with a thick yellow layer. Where the film is thin the papillae are very pro- minent, and are brought boldly into relief by the general white coating. The anterior third is in general free from this fur, and offers a decided contrast to the rest of the tongue in its peculiarly red appearance, often assuming a triangular shape; the edges of the tongue also presenting a very marked red fringe. For the most part, though thickly coated, the tongue remains moist throughout the whole illness; but not unfrequently the anterior red third be-
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