A text-book of medicine : for students and practitioners / by Adolf Strümpell.
- Date:
- 1893
Licence: Public Domain Mark
Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![Nephro-typhoid is analogous to pneumo-typhoid and tonsillo-typhoid. A simple so-called febrile albuminuria occurs very frequently at the acme of typhoid, and is not to be interpreted unfavorably. It is probably the result of that slight par- enchymatous degeneration of the kidneys which occurs in typhoid with the same frequency as in most of the other severe infectious diseases. There does not seem to be a du-ect relation between the albuminuria and the fever, although some authors assume it to exist. It is more likely that the renal epithelium is injured by the noxious products which have been formed in the body and excreted by the kidneys. In other respects the m'ine presents the same peculiarities as in most other severe febrile diseases : its amount is diminished ; its color dark ; its specific gravity increased ; the excretion of urea greater than normal. It should be added that the urine at the height of the disease presents Ehrlich's diazo-reaction in almost all cases.* Cystitis is not a rare development toward the end of the illness. It is probably always secondary. In men, orchitis is sometimes observed. Women often have their catamenia at the beginning of typhoid. Later in the course of the disease, and in convales- cence from severe attacks, the menses are often absent for several periods. In pregnant women there is considerable danger of abortion or miscarriage. PECUIilARITIES m THE COURSE OF THE DISEASE. The above statements show an almost inexhaustible variety in the possible com- plications of typhoid. The course of the disease as a whole may likewise present many diverse forms and peculiarities. We shall attempt merely to cite the most essential. The numerous light and rudimentary attacks (typhus levissimus) are first to be mentioned. It was not recognized till lately that they belonged to typhoid fever at all (Griesinger). They used to have all sorts of names applied to them, the favorite term being gastric fever. This light form lasts eight to fourteen days. The fever is moderate and often decidedly remittent. There is almost no proper fastigium. The typhoid symptoms are but slightly developed. There are no severe pulmonary or cerebral symptoms. There is generally a moderate diarrhoea, the spleen is plainly enlarged, and often rose-spots can be found. The diagnosis of these cases is of course difficult in proportion to the scanty develop- ment of typhoid symptoms. It is best established by demonstrating an etiological relation between these cases and others which are plainly typhoid fever. Abortive typhoid is justly distinguished by Liebermeister from typhus levis. The name belongs to cases which begin with severe symptoms and high fever, as if they were going to be grave, but in which these violent symptoms disappear after a few days and give place to a rapid convalescence. On the other hand, there are cases which for a long time cause so little subject- ive discomfort that the patient does not even go to bed (walking typhoid). It is not till quite late that there occurs a sudden change for the worse, or some severe complication. Thus it has happened that people who were apparently healthy * This reaction consists in the red coloration of the urine upon the addition of Ehrlich's reagent (chiefly sulphanilic aeid) and ammonia. For particulars, see treatises upon chemical analysis. [Ehrlich's test is can-ied out as follows: Solution 1 consists of strong hydrochloric acid, one part, mixed with twenty parts of a saturated aqueous solution of sulphanilic acid. Solution 2 is a one-half-per-cent. solution of sodic nitrite in water. A test-tube is ono-cighth part filled with solution 1, and five to ten drops of solution 2 are added to this; a quarter of the test-tube of urine is then added, and, lastly, enough ammonia to make it strongly alkaline. Tlie deep-red color, which appears promptly, is not so characteristic as a green precipitate of phosphates, which appears at the bottom of the tube after standing for twenty-four hours.]](https://iiif.wellcomecollection.org/image/b21981553_0046.jp2/full/800%2C/0/default.jpg)
