Typhoid fever.
Difficulty in
diagnosing.
41
GENERAL HOSPITAL.
2nd Table A a.—Simple periodic or malarious fevers, which are both acute or recent,
and uncomplicated by other maladies. Some cases are recorded in the hospital books as
intermittent fever which were admitted with an apparently trustworthy history of this
affection and placed at once on the usual antiperiodic treatment, viz. a purge,
diaphoretic salines, and quinine in five or ten-grain doses. As, however, no distinct evidence
was afforded of the existence of fever after admission (they being probably cured at once),
they are classed in the table (A a 4) as "doubtful cases."
Column A a 1 gives the total number of simple acute periodic fevers admitted each month.
It is required that these cases be recorded in hospital returns as either remittent, quotidian,
tertian, or quartan fevers. If the previous history given on admission were entirely reliable and
trustworthy, or if the commencement of the treatment were postponed for some time after
admission, such classification would be more satisfactory ; but so many of them yield
immediately to treatment, that they are either cured at once, or they lapse in the
milder forms.
Satisfactory evidence that these cases were really what are called malarious or periodic
fevers is afforded by the transcript of the temperature observations given in table C, and
also by the number of days the patients were in hospital.
Column A a 3, columns A a 1 and 2, and A b 1 and 2, show that periodic fevers are most rife
in the hotter months of the year, viz. June, July, August, and September. This is more
especially remarkable if attention is confined to the simple forms of the fever, as detailed in
column A a 1.
Table C exhibits at a glance how rapidly these uncomplicated and recent periodic fevers
yield to treatment. It is sometimes doubted whether quinine is the valuable remedy it has
been reputed to be in these fevers. Nobody who sees the practice of a European hospital
where recent and uncomplicated cases occur so frequently as here, could for a moment
entertain a doubt of the specific power of that drug.
Whenever quinine fails to cure the disease at once, diligent search must be made for the
co-existence of some other constitutional disturbance. This may sometimes be so intricate and
remote as to elude the search at first ; but in all cases either the existence of some such disease
will be discovered, or else the fever is of long standing, or it is some other kind of fever
altogether.
Simple periodic
fevers.
Column A b 1 shows the number of cases of complicated or chronic malarious fevers
occurring in the different months of the year. The efficacy of quinine in curing this class
of cases depends on the amount of constitutional disturbance caused either by the former
attacks of fever or the co-existing malady. Cases of incipient deposit of tubercle in the
lungs are seldom cured of the fever for more than a few days at a time.
Column B—non-malarious fevers— shows the number of simple ephemeral fevers. The
proportion of these to the whole is probably less than would be seen either in private practice
or military hospitals, most of those occurring among the class from which our patients
come being treated on board the ships.
Column B 2, Typhoid or Gastric Fever.—Four cases were treated during the year—and
this is about the usual number; one died. The temperature observations in two of these
cases which recovered are transcribed in table C.
There is difficulty in diagnosing these cases during the very early stage—before the
bowel complication, the macula, and the several other characteristics, are developed.
During this period of doubt they were all treated as if they were remittent fever. This
was, however, discontinued as soon as satisfactory evidence of the existence of typhoid
fever could be obtained, as quinine is not found to have any beneficial effect in this disease,
though it rarely or ever appears to aggravate the bowel symptoms when given only in
the early stage. It has been sometimes doubted whether there is any essential difference
between typhoid and remittent fever of the malarious type; but every year's experience at
this hospital has deepened this impression on my mind, that the two fevers are different in
kind, and that they may always be distinguished from one another after the very early stage.
Chronic malarious
fevers.
Non-malarious
fevers.
Column B 3.—Anomalous Form of Fever.— One case of this occurred in a well-built, strong,
young, ship's officer. He was admitted on the third day of his sickness, in a state of fever,
but with active intelligence ; his face was flushed and rosy, without any duskiness in the
whiter parts ; tongue slightly furred, bowels normal, &c., &c.
A. glance at the chart of his temperature in table C would lead one to infer the
existence of typhoid fever, but he was cheerful and intelligent throughout. His bowels were
never disordered, no macula were developed, his color was always bright and clear, his tongue
never became dry and brown, nor did his urine ever assume that dark-colored and fœtid
character seen in cases of typhoid. On the twentieth day after admission, and the twenty-
third or twenty-fourth day of the disease, an erythematous blush appeared, uniformly spread
over the arms and legs, and in spots over the trunk. This was accompanied with hyper-
asthesia, so that a mere touch on the limbs gave pain. The throat was uniformly red and
slightly swollen. The appearance of this rash was accompanied by a decided subsidence of
temperature to 98°F. The rash disappeared on the fifth day after it came out. There was
a sharp attack of purging for a day at this time, viz. twenty-fifth day in the hospital, after
Anomalous form
of fever.