Clinical lectures on typhus and continued fever / by Charles Ritchie.

  • Ritchie, Charles.
Date:
[1854-1855]
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on typhus and continued fever / by Charles Ritchie. Source: Wellcome Collection.

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    stopping or shortening the fever in the enteric or typhoid form of the disease. I believe that every one who has had much expe¬ rience of this kind of fever will have been often disappointed in the results of all exclusive modes of treatment in it, whether ex¬ pectant, antiphlogistic, evacuant, sedative, tonic, or stimulant; and that every such practitioner also will have frequently met with instances of apparent arrest of the complaint, especially when re¬ course was had to remedies calculated to unload the mesenteric system. In the second and subsequent weeks of enteric fever, there is often nothing between the abdominal cavity and the con¬ tents of the bowel other than the attenuated peritoneal coat, and sometimes large openings may be observed after death even _in it, which have been plugged up by masses of feculent matter. In such circumstances the paramount importance of rest and quiet of the bowel will be apparent, but, in the first week of the disease, the chief element in the affection, in addition to the disturbance of the nervous centres, is a condition of sanguineous congestion of the abdominal viscera. The symptoms at this time, such as febrile reaction, anorexia, nausea, red tongue painted with bile, pain in the pit of the stomach and forehead, and, perhaps, diarrhoea, strongly suggest the propriety both of bleeding from the epigastrium, of warm fomentations, tepid baths, strict diet, and also of largely diluted and mild saline purgatives. Now, I have seen in¬ stances of this nature, which were also caused by cold and not by contagion, and which, therefore, were more likely to be amenable to treatment, fail to receive benefit from such means, and I have also seen them prove eminently successful. I think that the proper course in regard to the exhibition of purgatives at the out¬ set of enteric fever, is to select those which, by producing large watery stools, are fitted to unload the mesenteric vessels, as, for example, sulphate of magnesia in a state of great dilution • and that, should the case not manifest improvement within forty-eight hours, the treatment on this principle should be discontinued. In relation, finally, to the previous topics referred to in this lec¬ ture, I believe that 1 am safe in affirming that a true ephemera may exist independently of a local inflammation, and that its conversion into a more protracted form of fever may be prevented by treat¬ ment. I think that there is evidence, farther, that a fever, when dependent on causes suddenly applied, as cold or insolation, may be greatly modified by active treatment at its commencement, but that no fever which has a lengthened incubation period—that is, which depends on the introduction of a poison into the blood for several days before the symptoms appear—can be prevented run¬ ning its normal course. The head, the liver, the veins, the presumed air in the arteries, and, in modern tims, the arteries themselves, have been adopted as the seat of fever. Van Helmont, who was a remarkably acute, although eccentric person, declared, with a pertinacity and dog-