The Yakima herald. [volume] (North Yakima, W.T. [Wash.]) 1889-1914, 1912-02-21
FINDS new SIGN TO
DIAGNOSE TYPHOID
Pressure on Biceps Produces Ridge
Duration of Which Indicates
the Virulence

NEW YORK, Feb. 16.-Dr. Chas.
Bernard Burke, of Atlantic, Iowa, de-
scrbes in the New York Medical Jour-
nal a new diagn ostic reflex sign in
typhoid fever which, he believes, is of
great value in determining the pres
ence or absence of that disease. He
describes and comments upon it as
follows:
THE sign to which | wish to call
your attention, so far as l am aware,
has not been described previously. My
search of the literature has been con-
fined to standard works on typhoid
fever, textbooks on the practice of
medicine and a large number of
medical journals. l believe that l am
justified in Offering this sign to the
medical profession, because it is an
independent manifestation, elected in
definite way, and is capable of af-
fording diagnostic evidence of impor-
t. nee; it does not occur in health or
in haphazard technique too complicat-
ed for routine application.
Contraction of Muscle
''1he arm of the patient is barred
to the shoulder. You arch your
thumb and middle finger in the shape
of a horseshoe and place them over
the biceps muscles of the arm, so that
the arch thus formed is completely
filed; then firm pressure is made by
the finger and thumb, and the hand
is briskly raised (pressure being con-
tinued) so that the thumb and finger
come together with a slight concus-
sion. The result if the reflex is
present, is a fibrillary contraction Of
that portion of the biceps muscles
traversed by the thumb and finger.
producing an oval ridge without COM
plete contraction of the biceps muscle.
The ridge thus formed disappears
slowly.
After applying the test in rather
large number of cases of different dis
eases during my service in ST. Jo-
seph's hospital, Joliet, ILL.,, and having
been allowed through the courtesy of
the attending physicians of Atlantic
hospital to apply the test in a num-
Der of their cases, | have come to
the conslusion: If the reflex describ-
ed is absent there is no typhoid fever
present
This conclusion is based on the
fact that / never found case of
typhoid fever that showed the Vidal
reaction or bacillus typhosus in the
blood that did not show this reflex
also. 1t Is true that I found this
sign in other diseases, but that is true
of nearly all signs. / imagine that
the absence of this reflex in diseases
stimulating typhoid fever may be a
signal aid in arriving at correct di-
agnosis.
May Aid in Prognosis
81 have observed that this reflex
seems to be governed by the virulence
of the Infection; that is, at the be-
ginning of the disease the oval ridge
is not so pronounced, nor does 1t per-
sist as long as it does at the height of
the fever. 1t is also true that the
more pronounced and the more per-
sistent the reflex. SO l think it may
be some aid in making a prognosis
81 am unable to say just how early
this reflex may be elected for every
case l examined was late in the first
week or early in the second. The
typhoid fever cases recorded in the
table We're verified either by the Vidal
raction or by finding the typhoid ba-
cillus in the blood.
1T is probably due to an irritation
of the peripheral nerves, caused by
some toxic agent. The toxine elabor-
ated by the typhoid bacillus has a
| selective property for nerve tissue
and may act as d direct irritant to
| the perphers1 nerves, thus causing
the reflex when irritated by the
thumb and hnger."