The sources and mode of propagation of the continued fevers of Great Britain and Ireland / by William Davidson.

Date:
1841
Catalogue details

Licence: Public Domain Mark

Credit: The sources and mode of propagation of the continued fevers of Great Britain and Ireland / by William Davidson. 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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    IDENTITY OF TYPHUS AND TYPHOID FEVER. Abnormal serum in brain . . . .34 Bronchia r-ed . . . . . 25 Spleen rather large and soft . . . .14 Spleen large and pulpy . . . . 30 Peyer’s glands enlarged 1 to 3 . . .12 Peyer’s glands enlarged 3 to 6 . . . . 14. Peyer’s glands enlarged 6 and upwards . . .22 Solitary glands enlarged . . . . . 14 No intestinal glands enlarged . • . .12 Ulceration of intestines . . . . . 13 The mesenteric glands were allhost uniformly enlarged when ulceration of the intestines was present, but very rarely in other cases. Nowit may be contended that this simple enlargement or figuration of the intestinal follicles is a different affection from that which occurs in the continental typhoid fever, and hence ought to have a different clas- sification. Such an assumption would lead to an endless and very un- philosophical division, and obviously to the formation of three species of typhus, out of the various complications or appearances which are ob- served in the intestines; namely, 1st, typhus without any intestinal af- fection whatever ; 2d, typhus with simple enlargement of Peyer’s glands ; 3d, typhoid fever complicated with the follicular affection described by M. Louis; for if one author distinguish a species by a peculiar morbid appearance of the intestinal follicles, another has the same right to form a second, if the affection of these glands, in a certain number of other cases, be denied a pathological similarity to the first; whilst the morbid affections of the spleen, the lungs, the brain, &c. might all be brought forward to increase the subdivision still farther. The strength of our argument, however, that typhus and typhoid fever are the same diseases modified by place, season, epidemic influence, and perhaps by circum- stances not yet ascertained, lies in the fact, that it has been admitted that cases of the latter disease, although rare, have occurred without any morbid appearance being discovered in the intestinal follicles; proving that this morbid condition of these glands is not a necessary anatomical character of the disease, such as hepatization or suppuration is of pneu- monia, or serum of hydrocephalus. It has also been admitted' that the intensity of the symptoms is not proportional to the lesions which ought to occur if the latter were the cause of the former ; and it would be con- trary to all experience to attribute the formidable symptoms of typhus or the typhoid fever to the lesion of one or two intestinal follicles, even though affected in the form described by the French writers. Would it not, therefore, be refining our classification of diseases beyond all pre- cedent, to separate typhus and typhoid fever into two species, where it has been shown that the symptoms in both are the same, or very nearly so, that they have nearly the same laws, as far as these have been ascer- tained ; that the severity of the symptoms in both is not in proportion to the lesions of the intestinal follicles; and that the other complications of both are similar, although various in the same places at different periods, while the only characteristic in dispute has been acknowledged not a constant and therefore not a necessary element for the existence of the disease, Printedby C. Aj>i,AitD, Uartholomew Close.