The daily morning journal and courier., 1895-02-21
Fever.

l tDr. H. A. Darlington in the Medical World.]
 The remarks of the editor, in the
 December number of the World, on
 levers, have been fruitful. in my case
 at least, in that they have induced me
 to write this paper.
 | During the fall just past I have seen several cases of levers which have giv-
 en rise in my mind to doubts as to their
 character. That they were such as my
 neighbors call typhoid know, but that
 they were of that type I had and have
 very grave doubts. They were con-
 tinued levers, running from fourteen days to twenty-one; the pulse ranging from 105 to 125 or 1SO; the bowels either | natural or slightly constipated; urine, as in any case of febrile disturbance; the mind unaffected; no rose spots, no gurgling in the hypochondriac region;
 the tongue in every case covered with a
 white fur; the temperature 102 to 105;
 such, in each case. was the outline of their symptoms, roughly slSetched One
 1f my brother physicians has told me
 that he had several such cases. which
 he could not call typhoid fever. Most
 of the cases wer- widely separated in
 location and Seemed to have no demon-
 strable cause. The houses were all
 supplied by water from the town reser-
 voir and not objectionable on account
 of drainage, or other sanitary condi-
 tions. That there were a number of
 other such cases in the vicinity, I had
 rao fo
 garded by their attending physicians
 as cases of typhoid fever know also,
 but it has seemed to me that they
 were lacking in the most important
 symptoms. But if not typhoid what
 were they? I certainly cannot believe that cases of typhoid fever as severe as some of these were-though none that I saw were regarded by me as dangerous ly sick-could have gone through this history without developing some symp- toms of the typhoid state. The ques- tion which has been in my mind is this Do we have an autumnal fever which | Is different from the usual typhoid? In- deed, 1t has not happened to me to see many cases of clear typhoid type. In | one of the cases there had been ex- | posture to the emanations of a foul | privy, and there had been a history of | malaise for some days before calling in | the doctor; but this case lasting nearly the three weeks, had no symptom that | could properly be called typhoid
 Do we have a simple, continued fever, as distinguished from typhus or ty- phoid? I mean a fever which runs a period of two weeks or even three weeks? I feel very sure that, in prac- tice extending over more than forty years, I have seen many cases of fever that could not be classed under either of those diseases; not merely cases of febricula lasting only a few days, but such instances asI those already spoken of; and I must think that such has been the experience of others. Does not the influence of the prevailing type of med- cal thought have something to do with the number of cases of typhoid" which are so common in the talk of physi- clans? And is not a revision of our mo- ions on that subject in order? Some of Us are old enough to remember the struggle which was had in order to se- ,ure correct diagnosis of typhoid fe- yer as distinguished from typhus; is it lot Just possible that we have been try lS to CuLlpel dll IepIlIe ulStdSeS OI d character to wear the livery 'f typhoid, without discriminating be- ween them? Or do we have typhoid fe- yers without the specific symptoms? It s true that in some other diseases, such Ls scarlatina, we do see cases in which he specific symptoms do not appear, or lse they are so evanescent as not to Ittract notice, but certainly not fre- Iuently, nor in cases of any severity Vow, in the cases to which I have re- erred, the attacks of disease have been f quite as much severity as the ordi- Lary cases of typhoid fever. So have l een accustomed to think that we in Jew Haven, at least, have continued ever which cannot be classed as ty- l hold; which is not often characterized y any distinct period of invasion; which does have very distinct morning ' 1s.,I. I