A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck.

  • Strümpell, Adolf von, 1853-1925.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of medicine : for students and practitioners / by Adolf Strümpell ; translated by permission from the 2nd and 3rd German editions by Herman F. Vickery and Philip Coombs Knapp ; with editorial notes by Frederick C. Shattuck. Source: Wellcome Collection.

    50/1008 (page 28)
    nately, limited. Many of the outbreaks which, have occurred were traceable to im- migrants, especially from Ireland. During our civil war the disease broke out neither among the armies in the field nor among the prisoners of war. A number of cases were reported at the time, but great doubt has since been thrown upon the correctness of the diagnosis. Murchison, among other authorities, maintained that the disease can be devel- oped de novo under the influence of overcrowding, insufficient food, and defect- ive hygiene in general. The possibility of the correctness of this view can not be denied as yet, and it may perhaps be stated that the arguments in its favor are stronger than those in favor of a similar development of the poison of typhoid fever. It may be that this and some other diseases and morbid conditions depend on auto-infection from an accumulation of alkaloidal substances developed in the living body. Gautier, of Paris, has made some most interesting studies of these substances, which he calls leucomaines, to distinguish them from analogous sub- stances developed in the dead body—ptomaines. This whole subject is still in em- bryo, but may have a great future.] Course and Symptoms of the Disease.—If we try to sketch the characteristic behavior of typhus fever, especially as contrasted with typhoid, we may say that the disease begins much more abruptly and rapidly, and that the fever quickly becomes very high and the general disturbance very severe, but the illness lasts a shorter time, seldom more than two weeks, and generally passes by crisis into recovery. The length of incubation seems to vary. Murchison thinks it is usually more than nine days. Sometimes, though not invariably, slight prodromata precede by some days the actual outbreak of the disease. These are languor, anorexia, headache, and pain in the limbs. Then the regular illness begins, as a rule, rather suddenly, and often with a pronounced rigor. With this the tem- perature rises quickly, and may on the very first evening reach 104° or 105°. (40°-405° C). Vomiting is not rare, and may be repeated. A grave general condition, with fever, is developed in a few days. The patient feels exhausted. There is often violent pain in the loins and extremities. Nervous symptoms soon appear : persistent and intense headache, vertigo, spots before the eyes, ringing in the ears, and in very severe cases quickly increasing stupor and de- lirium. In severe cases the fever often reaches 106° (41° C), and may be even higher, and it is almost constant, with but slight morning remissions. The skin is hot and dry, the tongue dry and thickly coated, the respiration moderate, the pulse very rapid. We very frequently find in the chest the signs of an extensive bronchitis. Nasal catarrh and conjunctivitis also occur. Serious in- testinal symptoms are generally absent, although there may be slight tympanites or diarrhoea. The spleen is almost always greatly enlarged. Only in a few epi- demics is the splenic tumor said to have been wanting (?). The urine is concen- trated and scanty, and sometimes has a trace of albumen. On the third to the seventh day of the disease the characteristic eruption ap- pears. To this the disease owes its name of spotted fever. The eruption con- sists of rose-spots, generally very numerous and widespread, upon the trunk and extremities, often also on the face. Sometimes the spots are larger, and may then bear great resemblance to a fresh eruption of measles. The skin between the sep- arate rose-spots is not infrequently diffusely reddened. After two or three days the roseolas become hsemorrhagic, and change into lighter or darker petechias. It is commonly only in the lighter cases that the rose-spots fade away without first becoming petechial. In rare though well-substantiated cases the eruption has been scanty, or even wholly wanting. Herpes does occur, but only seldom. The fever begins to abate in light cases as early as the second week, coincidently