Analysis and general summary of the cases from 1889-1899 and special features, symptoms and complications / by William Osler.

  • Osler, William, Sir, 1849-1919
Date:
[1900?]
Catalogue details

Licence: In copyright

Credit: Analysis and general summary of the cases from 1889-1899 and special features, symptoms and complications / by William Osler. Source: Wellcome Collection.

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    chill. Repeated chills and drenching sweats. Right leg swollen. Recovery. Fanny II., aged 9 (IIosp. No. 23,799), admitted Ang. 16, 1898. Severe attack. In the third week, shaking chills, recurring on several days for a week, followed by heavy sweats; no malarial organisms. Albert A., aged 33 (IIosp. No. 24,062), admitted Sept. 13, 1898. On the 34th day the patient had pain abont the rectum from haemorrhoids. Irrigation with cold water. Patient had a chill: temperature rose to 102.2°; normal ten hours later. John S. G., aged 22 (IIosp. No. 25,111), admitted Dec. 29, 1898. Severe attack. On the 25th, 26th, 28th and 36th days chills followed by profuse sweats. Some additional cases of chills will be found under the section on post-typhoid elevations of temperature. 2.—-RELAPSE. We recognize two varieties: first, a genuine relapse, in which there is a reinfection after a distinct and definite period of a pyrexia; secondly, the intercurrent relapse, in which, after the temperature has fallen nearly to normal, or after the morning temperature has been at 99° or 99.5° for three or four days, and there has been a decided lull in the symptoms, the fever again rises, and the patient goes through all the features of another attack. The conditions under which relapse occurs are not, I think, as a rule, within the control of the physician. The sources of the reinfection are doubtful. The typhoid bacilli linger in the adenoid tiss\ies of the mucous membrane for a long time, and Dr. Mark Richardson has shown that thev mav be found in the stools even after a consider- «/ «/ able period of a pyrexia. We know, too, that they remain for a long time in the mesenteric glands and in the spleen. The inter- esting observations by Chiari, amply confirmed by others, that typhoid bacilli may remain in the gall-bladder for an indefinite period, suggest that this may sometimes be the source of reinfec- tion. Errors in diet may be associated with gastric disturbance, and the passage of a large number of bacilli from the bile-ducts into the intestines. We are still really without full knowledge of the causes of re-