A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck.
- Adolph Strümpell
- Date:
- 1901
Licence: Public Domain Mark
Credit: A text-book of medicine for students and practitioners / by Adolf Strümpell ; With editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![be demonstrated in the blood, we are justified in making an absolute diagnosis of relapsing fever. In Germany the disease did not become epidemic till the year 1868. In 1S72 and 1873 there were considerable epidemics in Breslau and Berlin. Its last exten- sive appearance was in 1879 and 1880, when it spread over most of northern and central Germany, and was accurately studied by numerous observers. People of the poorer classes were almost exclusively attacked, and especially the tramps. The uncleanly dens where these people lodge were found everywhere to be the chief centers of infection. The precise manner of infection is as yet almost wholly unknown. All ob- servers agree that the disease is directly contagious; but it can not be very con- tagious if the hygienic influences be good. At least the results of our late epi- demics would imply this. In the Leipsic hospital, where at that time over two hundred and fifty cases were treated, and isolation could not be at all perfectly carried out, not one case of infection occurred. It is certain that the disease can be transmitted by direct inoculation with the blood of patients. This has been established by a Russian physician, by the experimental inoculation of healthy persons. Doctors have been repeatedly inoculated at the autopsy of those who have died of relapsing fever. The disease may likewise be transferred by inocula- tion to monkeys, while other mammals seem to enjoy an immunity from it. [The first cases of relapsing fever observed in this country were in Irish immi- grants coming over in the same vessel in the year 1844. At several periods since then more or less limited outbreaks traceable to immigration have occurred, but the disease has never acquired any foothold with us, and comparatively few physi- cians have ever seen it. So far as I can learn, only one case has ever been seen in Boston, and that was in the person of a physician from another city, who brought, the disease with him and passed through it in the Massachusetts General Hos- pital.] Clinical History.—The stage of incubation lasts about five to eight days. It is. only exceptionally that some slight prodromal symptoms present themselves just before the outbreak of the disease proper. As a rule, it begins suddenly, with a more or less pronounced chill and intense constitutional symptoms. There are violent headache, great languor, anorexia, and especially marked pains in the loins and extremities. The temperature rises rapidly, reaching generally 106° (41° C.) or higher as early as the first or second day. The skin is hot and dry, and usually quickly assumes a very characteristic dirty-yellowish color. In Leip- sic, we often saw herpes labialis, which seems, however, to have been rarer in epidemics elsewhere. The tongue becomes dry and thickly coated. Sometimes there is vomiting. The bowels are constipated, or there is a slight diarrhoea. The spleen becomes rapidly enlarged, being, as a rule, even larger than in typhoid or typhus. The liver is slightly enlarged. The chest presents the signs of a bron- chitis, generally moderate, but in exceptional instances severe. The pulse is much quickened. It is seldom that there are severe cerebral symptoms beyond a certain apathy and stupor. We have seen delirium tremens sometimes, in drunk- ards. A very characteristic symptom, already mentioned, is the marked hyperses- thesia of the muscles, especially in the calves. After these symptoms, accompanied by persistent and generally very high fever, have lasted five days to a week, there is a critical decline of temperature, with profuse sweating. The patient now improves so rapidly and decidedly that he thinks himself completely cured, and generally gives little credence to the physician's prophecy of a relapse. In rare but well-attested cases there has been really but one attack. The rule is that, after about a week, a second attack occurs, often a third after that, and, infrequently, even a fourth and fifth. In each of these, the above-mentioned symptoms are repeated more or less completely and vio-](https://iiif.wellcomecollection.org/image/b21206296_0062.jp2/full/800%2C/0/default.jpg)
