B 478494

LIBRARY OF
Dr. M. DESCHERE.
Ro. 382 1200
་་་་
ARTES
1837
VERITAS
LIBRARY
SCIENTIA
OF THE
{ UNIVERSITY OF MICHIGAN |
FLURIBUS UND
THEGUR
[QUAERIS PENINSULAM AMOENAMŲ,
CIACUMSPICE
HIL


4
A
TREATISE
ON
TYPHOID FEVER.
121525
AND ITS
C
HOMEOPATHIC TREATMENT.
BY
C. Frisco
M. D.,
NAPLES, ITALY.
TRANSLATED BY GEORGE E. SHIPMAN, M. D., CHICAGO, WITH
COPIOUS ADDITIONS.
CHICAGO:
DUNCAN BROTHERS,
BROTHERS, PUBLISHERS,
1878.
+


Entered according to Act of Congress in the year one thousand eight hundred
and seventy-eight, by
DUNCAN BROTHERS,
In the Office of the Librarian of Congress, at Washington, D. C.
Introduction
CONTENTS.
CHAPTER I.
NATURE OF THE DISEASE.
Synonyms and opinions about Typhoid fever
Natural causes
66
..
66
66
Age
Sex
CHAPTER II.
ETIOLOGY.
66
66
แ
66
Constitution
Temperament
Habits
Professions
Non-natural causes
66
66
66
66
66
66
Atmospheric air
Food and drink
Motion and rest
Sleep and watching
Excretions and retentions
Mental passions
Unnatural causes
66
66
Endemia
66
Epidemy
Contagion
Contagiousness of Typhoid fever
Radical causes
Lesions as causes
General symptoms
The skin
Sleep
Morale
Head
Eyes
Ears
CHAPTER III.
SYMPTOMS OF TYPHOID FEVER.
8
1
1
y
-
- 17
31
32
33
33
34
35
35
37
37
44
-
46
47
49
49
-
51
51
3585FFX
57
71
77
78
81
88
97
106
109
112
·
· 116
6
CONTENTS.
Nose
Face
Mouth
Throat
Appetite
Stomach
Abdomen
Dejections
Urine
1
Partes virilia
Menstruation
Larynx
Chest
Trunk and limbs
State of the blood
1
1
CHAPTER IV.
THE COURSE OF TYPHOID FEVER.
Common form
Prolonged typhoid fever
Benign form
Malignant form
Putrid typhoid fever
Hæmorrhagic variety
Slow, nervous
Duration and termination
Location
CHAPTER V.
ANATOMICAL CHARACTER.
External state of the body
Intestinal lesions
Mesenteric ganglia
Spleen
Liver
Pancreas
Encephalon and its annexes
Respiratory apparatus
Alterations of the blood
Heart
Muscles
117
120
122
-
128
129
-
131
133
137
143
146
146
146
149
-
153
154
1
1
CHAPTER VI.
Diagnosis
Diagnosis, differential
DIAGNOSIS.
Prognosis
CHAPTER VII.
PROGNOSIS.
1
160
169
-
169
170
-
171
172
·
173
173
· 175
-
-
180
182
- 189
189
191
191
192
194
196
197
-
- 198
202
204
207
CONTENTS.
CHAPTER VIII.
TREATMENT OF TYPHOID FEVER.
Prophylactic treatment
Prophylactic regulations
Means of purification
Hygienic preservatives
Therapeutic preventives
Curative treatment
Hygienic means
Therapeutic means
Bath treatment
Treatment of the premonitory stage
Treatment of the first period
Treatment of the second stage
Treatment of the third stage
Treatment of the complications
Surgical means
·
211
211
214
216
-
217
218
222
231
232
233
234
237
240
243
247
1
CHAPTER IX.
TREATMENT.-SYMPTOMATIC INDICATIONS.
General indications
Principal remedies
Mind symptoms
Sensorium
Internal head
External head
Sight and eyes
Hearing and ears
Smell and nose
Face
Mouth
I
1
I
1
Throat
Stomach
Abdomen
Stool
Bladder
Chest
urine
Heart-pulse
Limbs
Sleep
Aggravation
Chill
Fever
Sweat
Generalities
Skin
Model cures
Index
1
1
1
249
252
-
253
260
261
262
262
263
-
264
264
265
269
-
271
271
273
275
1
276
278
280
284
289
289
289
290
291-2
292
-
293
295
+
TRANSLATOR'S PREFACE.
It is not necessary for me to say much of Panelli's work on Typhoid
Fever, as it is now put within the reach of English readers, and they
can judge for themselves. Those of us who practiced Homœopathy
thirty years ago, would have thought such a work a real prize,
and it is to be hoped that it may be found so even now with those
who are battling this dangerous disease. The author's therapeu-
tical directions have seemed to me very correct and judicious, and
if they are lacking in any respect, the deficiency will be fully made
up in the "Symptomatic Indications," which our veteran friend
and leader, CONSTANTINE HERING, has permitted the publishers
to add to the work.
THE TRANSLATOR.
A
TREATISE
ON


TYPHOID FEVER.
INTRODUCTION.
During the past ten years I have had many cases of Typhoid fever
to treat, and I have become fully convinced that the Homœopathic
method is the best adapted to the treatment of this fever. The
patients and their friends were satisfied with Homœopathy, which
brought relief to them in the hour of suffering.
That I might treat such patients creditably, it was necessary that I
should diligently study the form of these feyers, and read, over and
again, the pathogenesis of the drugs, to learn what was perfectly
Homœopathic, and what, given to persons in perfect health, had pro-
duced symptoms for the most part identical with those which I sought
to cure in my patients. Thank Heaven, I have been, in most cases,
very successful. This is not at all due to my skill, but to the Homo-
opathic method employed, which is much superior, in the opinion of
the best physicians, to that official (Allopathic) treatment generally
adopted.
10
A TREATISE ON TYPHOID FEVER.
In medicine, more than in any other science, facts must serve as
the ground of reasoning. But these can avail nothing when inter-
preted by prejudice. There is an abundance of facts to show that, by
the relation and specificity of the remedies to the different parts of
the organism, their action is prompt and immediate, and although
the remedy is weak in itself, it is powerfully felt by a suffering organ
which is not affected by the action, although more powerful, of any
other remedy which had not this relation. The eye affected by
inflammation is annoyed by the slightest possible degree of light,
while it remains indifferent to every other stimulant whatever with
which it has no relations. Thus, by means of the law of similars, we
obtain the prompt and certain cure of diseases, under the Homœ-
opathic treatment. Nature abhors polypharmacy, and never produces
a cure under the unrestrained abuse of drugs. She is the sole mistress
in the matter of cure, and, if the instruction, which she gives is not
followed, the healing art becomes a lie. If we study her acts in dis-
ease, we shall readily find the rule, the course, the secret, and the
source of every cure. When a treatment is undertaken in opposition
to the law of nature, if it terminates favorably, it is because nature
has overcome the opposition, and rendered it null. To seek to cure a
disease without the hidden resources of nature, or by disturbing her
operations, is folly. The physician who respects nature, in prescrib-
ing remedies, makes his selection so as to avoid those which are
opposed to, or which oppose the vital acts sustaining the animal
economy. If Hippocrates observed the causes, the cures, and the
regularity in the course of diseases, it was because he employed simple
remedies which nature could make available with her forces, without
being disturbed. Hippocrates himself established natural medicine,
and expressed the law of its progress too, in the following propositions
taken from his book: De locis in homine.
"A disease is caused and cured by similar things. The same drug
produces a dripping of urine, if it is not present, and cures it, if it is,
and a cough is caused and allayed by the same drug. Vomiting is
cured by vomiting, and diarrhoea by purging.'
In time to come we ought to bring to perfection the application of
this law, by finding the means of assisting the forces of nature in
disease, of allaying their pains and shortening their duration. Many
physicians have done this in all ages, have followed the naturalism of
Hippocrates, have defended its laws, and co-operated in bringing it
to perfection. They have always declared that the true physician, the
INTRODUCTION.
11
physician who respects nature, always runs to its aid by offering
relief, and not by adding to its suffering.
In this our present life, sharing, in all the facts of health, of sick-
ness, or of disorganization, whatever they may be, we should not
oppose nature, but always favor, develop, and enlarge it as much as
possible; in other words, it is necessary always to follow and assist
nature in curing diseases, and not to resist her.
Hahnemann, after Hippocrates, studied these precepts, and the
suggestions of the great Haller, who was the first to say that we
ought to experiment in remedies, first upon man in health, then upon
the sick; after many and repeated experiments were made by him
and his pupils, which proved the law of Hippocrates he established
the principle, similia similibus, and gave birth to Homœopathy, which
does not oppress nature with a great number of remedies, or with
large doses. One medicine, given at a time, and that in the most
attenuated form, but because it acts directly and specifically upon the
affected organ, displays great efficacy, and produces a cure, and this
one medicine is not prescribed arbitrarily, and in accordance with the
abstract idea of the physician, regarding the nature of the disease, but
from a knowledge of a law of indications, which is the law of similars,
established in the days of Hippocrates.
The state of the patient having been analyzed by the physician, who
had previously stored his mind with the pathogenetic properties of
drugs, will find, in the law of similars, the law which regulates the use
of the drug, in the cases which he is called to treat. He will form two
correlative pictures, the one containing the symptoms of the disease,
the other setting forth all the analogous phenomena, produced in man,
in a state of health, by the various remedies, and, from these rem-
edies, he will select that which most resembles the morbid condition.
Thanks to the law of similitude, the practitioner proceeds with
certainty, and medicine is for him no longer a science of inductions and
probability, as Barthez declared it to be.
In the epidemics which so often assail us, the physician should no
longer try, in succession, every therapeutical agent, but the law of
similars will indicate to him the substances in the materia medica to
which he should have recourse. Thus, in 1829, when cholera first
invaded Europe, the Homœopathic physicians, in countries where it
made its appearance, wrote to the illustrious founder of Homœopathy
to seek his advice, and Hahnemann, in his study, without having
ever seen a case of epidemic cholera, deducing his practice, as a
12
A TREATISE ON TYPHOID FEVER.
logical consequence of his principles, declared the treatment to be.
used for this disease, and this treatment has been actually followed,
and has been confirmed, on a vast scale, by clinical experience. This
notable fact is certainly the most remarkable that has occurred in all
the annals of medicine. Typhus twice desolated Germany. Hahne-
mann turned to the materia medica, and prescribed the appropriate.
curative method for each epidemic form; prescriptions, the clinical
value of which were fully established.
I do not wish, however, to be considered as declaring that Homo-
opathy guarantees the cure of every disease, and always and promptly
restores health, but I affirm that it successfully combats a multitude
of diseases which resist the official (Allopathic) therapeutics, that it
cures more surely and more rapidly, that which the common medical
practice overcomes with great effort, and that, finally, it obtains its
results without following those long and disastrous convalescences,
produced by bleeding, and all the debilitating means used by old
physic.
Dr. Rissueno d'Amador, Professor of Pathology in the celebrated
University at Montpelier, expressed the same views. "Homœopathy,"
said he, "is practically a method to be added to existing methods, but
it is a method which much excels all others; it is one way more, but
also a more direct way, in which one travels with greater celerity,
security and comfort, and, if I may be allowed to use a comparison
which pleases me, I compare the new method of cure to that new life,
opened by modern industry, which will surprise those who come after
us, as it has surprised us. Theoretically, Homeopathy is, for us, a
doctrine allied to vitalism; it is rather vitalism itself, freely applied
to therapeutics."
Many other illustrious writers hold similar opinions, as the great
Hufeland, whose name is well known, the chief physician to the king
of Prussia: he did justice to Homœopathy in the following words:
"It will make the practitioner more attentive to semeiotics, which
have been too much neglected to this very day, and more attentive to
the laws of diet. It will put an end to faith in the necessity for strong
doses; it will introduce a greater simplicity in prescribing; it will
lead to a safer method of experimenting with drugs, and of learning
their properties with more certainty. .
I have often," he adds,
66
seen Homœopathy show itself efficacious in severe diseases, when
all other methods had been tried in vain.... (Dict. omœop. Berlin
1831).
INTRODUCTION.
13
I
"While we would not cease to oppose Homœopathy," said the same
physician," he would be mistaken who treated it as a mere dynamic
effect, that is, an effect upon the living body, which could not be
appreciated by weights and measures. Who has ever been able to
determine the weight of aroma or the quantity of virus necessary to
produce any effect whatever? To attenuate a substance, is it always
to render it weaker? and the liquid which attenuates it, may it not
become a vehicle which shall develop in itself a new property, a new
mode of action, more subtle than any which it possessed before ?”
(Bayle, Biblioth. de Therapeut., tome II).
Brera, a wise and celebrated professor at Venice, after referring to
his many cures, for which he was indebted to Homœopathy, adds: “I
was led to these experiments by reflecting upon that passage in
Hippocrates, pointed out to me by Blumenbach, my professor at Goet-
tingen: "Diseases may be sometimes cured by remedies capable of producing
analogous complaints. In consequence of the action of contagious
virus, and especially of the vaccine and variolous, although attenu-
ated till they reach an immaterial state, yet, on being inoculated,
they levelop an action so powerful that it multiplies a thousand times
the contagious atoms introduced. (Antolog. Med., Venice, 1834).
Dr. Roth, professor at the University of Munich, in his Report to
the King of Bavaria, of the cases of cholera treated by him in Ger-
many, expressed himself thus: "In publishing the numerous services
which Homœopathic physicians have rendered at Prague, at Vienna,
and in Hungary, in the treatment of cholera, I should observe that
the physicians mentioned by me in this report, are personally known
to me, and they are entitled all the more to a kind recommendation
on account of their love for the truth, and for that sentiment of honor
and conscientiousness which has led them carefully to omit from their
extended statistics of the cures obtained, everything which might
look like exaggeration.”
Dr. Botto, clinical professor of the faculty at Genoa, thus closes
his introductory lecture: "What result the Hahnemannian method
may finally reach in its extensive diffusion, I cannot determine, but I
entertain the hope that it will be unexampled and immense."
I will refer here also to the public testimony which the medical
faculty at Florence was obliged to give on occasion of the extra-
ordinary cure of Dr. Lazzarini, dean of the faculty, who had been
declared incurable by all the faculty, as well as by himself, and yet
who was cured by Homœopathy in a short space of time.
The celebrated Broussais said, in his chair, in 1835: "I recognize
0
14
A TREATISE ON TYPHOID FEVER.
no authority in science but that of facts, and at this moment I am
experimenting in Homœopathy," and because he saw that his words
were received with a smile of incredulity he repeated, with a piercing
voice, which checked the smile upon the lip, "Yes; I am experiment-
ing with Homœopathy. If the doctrine of Hahnemann offers us the
means of curing our patients easier and in less time, it is our duty to
sturly it, and qualify ourselves for its application at the bedside."
Dr. Imbert-Gourbeyre, Professor at the preparatory school of med-
icine at Clermont-Ferrand, gave the following opinion of Hahne-
mann and his doctrine: "We should certainly know, and I, for my
part, cannot proclaim this truth too much, that the Hahnemannian
school presents to physicians the most precious resources in the treat-
ment of diseases. All the researches of observers confirm, in every
particular, the therapeutic truth established by its founder.'
Prof. Marchal de Calvr published the following in the France Medi-
cale et Pharmaceutique :
"There is no longer in medicine, nor has there been, for a long
time, either principle, or law, or faith. We are constructing a tower of
Babel, or, rather, we construct nothing. The most general doctrine
which exists is the Homœopathic. This is strange and sad; it is a
disgrace to medicine, but it is the bare truth."
I could quote the words of many other professors, but I refrain, for
I fancy I hear some say, "these are all fine words, but the facts which
sustain them, where are they?" The facts are in the clinical results
obtained in Homœopathic hospitals, and many of them are registered
in the test of clinical Homoeopathy which was made in 1828 by order
of the King, Francis I.. in the Royal Military Hospital, Della Trinita,
under the direction of Dr. DeHoratiis. In this hospital sixty patients
were received in course of fifty-five days, fifty-two of whom were
restored to perfect health; six were remaining when the clinic was
closed, much improved, and two died. They are in the clinical results
of the Homœopathic hospital at Berlin, which His Prussian Majesty
established by a decree of Sept. 16th, 1841. They are in the results of
the hospital of St. Elizabeth in Vienna, containing 100 beds, occupied
by 100 patients, who were treated Homœopathically. They are in the
results of the hospital at Gumpendorf, near Vienna, founded in 1832
with eighty beds; in those of the hospital at Sechshaus, near Vienna,
with 160 beds; in those of the two hospitals of Linz, the capital of
Upper Austria, one founded in 1842, with forty beds, and the other
opened in 1850 especially for children; they are in the Reports of the
Homœopathic hospital at Leipsic, opened by decree of the Chamber
INTRODUCTION.
15
of Saxony; they are found in the Reports of the hospital of Güns,
opened in 1838; in that of Gyongyos founded in Sept. 1839, both in
Hungary; in the Reports of the hospitals in Bremer and of Kremsier
in Moravia, in Nechanitz in Bohemia, in Lauban in Silesian Prussia;
in the Reports of the Homœopathic hospital in London, founded in
1849, and of the Hahnemann hospital founded in 1850, also in London;
they are found in the Reports of the special Homœopathic metro-
politan hospital for the diseases of children and for vaccination at
New Road; of the Homoeopathic hospital of St. James at Don-
caster, and of the Homoeopathic hospital at Manchester, in those
of .... but why should I name, one by one, those hospitals in which
the Homœopathic treatment was used, found in all the kingdoms of
Europe or France, Spain, Italy, Russia, as it is well known that there
are Homœopathic hospitals everywhere, not excluding North and
South America. In all these hospitals, positive facts have been
reported of their clinical results, all of which demonstrate the greater
efficacy of Homoeopathy in the treatment of diseases, compared with
that of her first-born sister, Allopathy.
Many other facts may be obtained, any day, in the Homœopathic
dispensaries, where hundreds of patients go to receive advice and
medicine, gratuitously, and with great benefit. Many other facts,
however, are contained in notes which I have made in proof of this
assertion, prepared in various circumstances as opportunity offered,
in treating many and various diseases which were always cured'
easily and in a few days by the Homœopathic method. I desire some
day to give the public an account of these, by way of demonstrating
the constantly greater efficacy of Homœopathy as I now venture to
publish the following pages upon Typhoid fever.
It is well known that, after the closing of the Homœopathic clinic,
opened, as has been already said, in the Hospital Della Trinita,
Homœopathic treatment was not introduced again into any of the
hospitals in Naples. Hence I have not been able, in the rare cases of
failure, to make autopsies, to enable me to determine the material
lesions which never fail to occur in course of the disease as a result
necessarily precedent to any modification in the unity, the physio
logical harmony and the regularity of the productions of vital and
normal phenomena. These material lesions which, by the Homo-
opathists, are equally considered as symptoms, and differ in no
respect from those which consist in the alterations of the functions
and of the sensibility, will not be neglected, however, in this work,
16
A TREATISE ON TYPHOID FEVER.
having investigated them in the time of my pupilage while I was
assistant in the clinics of my masters in the hospital of Santa Maria
de Loreto e della Pace where all affected with fevers were received,
and in great numbers, and when I have read other writers upon this
subject I have not failed to make notes of that which seemed necessary,
and hence I ask the kind reader not to accuse me of plagiarism for
this, reminding him of the beautiful words of Voltaire : "It is with
books as with fire on our hearths; one takes this fire to his neighbor's
house-kindles a fire there, thence it is carried to another and belongs
to all."
Now that Homœopathy may be more extended and increased in
this metropolis, and, consequently contribute to the relief and cure of
many sick, and more and more every day, I am led to publish these
few notes upon Typhoid fever, and not at all to acquire reputation as
a medical writer or to gain any credit to myself or because I have
thought it a matter of great importance.
I have published it, however, because having been obliged to pursue
lengthy investigations to find, in the materia medica, the proper rem-
edy for each case, differing as they do according to the variety of
symptoms, and lest I should have to repeat these studies, I preserved
and arranged all these minutes; but since these may also be useful to
such young physicians as find themselves in circumstances similar to
mine, that is, required to treat patients in Typhoid fever, I make these
uotes much more frequently now than in past years. But I hope that
my colleagues, to whom the progress of the Homœopathic doctrine is
as dear as to me, stimulated by my example, will publish the notes
made by them upon diseases which they treat, to demonstrate to our
adversaries that Homœopathy is not dead, as they say, but that it still
lives and ever will live, thank Heaven, for the welfare and prosperity
of the human race.
-
CHAPTER I.
NATURE OF THE DISEASE.
TYPHOI
SYNONYMS AND OPINIONS ABOUT TYPHOID FEVER.
A great number of medical writers have left us exact, minute, and
accurate descriptions of the fevers observed by them, with great care
and diligence, in the various epidemics which have appeared from
time to time.
These writers have named the fever as best pleased them, now from
a symptom, more or less prominent, now from the course, now from
the cause and then from the pathologico-anatomical changes; thus it
has had the name of putrid synochus and non-putrid: of malignant,
bilious, mucous, typhoid fever, phrenitis according to the old authors;
petechial fever by Fracastoro; mesenteric fever by Baillou and Baglivi;
slow nervous fever by Willis and Huxham; mucous fever by Roederer
and Wagler; nervous epidemic fever by Reil; angiotenic, meningeo-
gastric, adynamic and ataxic fever by Pinel; glutinous by Sarcone;
entero-mesenteric fever by Petit; dothin-enteritis by Bretonneau; gastro-
enteritis by Broussais; follicular-enteritis by Cruveilhier, Andral and
others; iliodicliditis by Bally; typhoid entero-mesenteritis by Bouillaud;
typhoemic enteritis, septicemic angibromitis by Piorry; typhoid fever,
disease or affection by Louis, Chomel, and the greater part of the
French physicians; intestinal exanthema by some modern writers,
while many others have called it prison fever, camp-fever, nosocomial,
Hungarian, septenary fever.
These fevers which attack many people at the same time, arise from
the same cause, make themselves known by symptoms quite analogous
and which usually become contagious when they prevail in thickly
settled places, are, at the present day, quite generally denominated,
Typhoid fevers, on account of the analogy, which they have, as regards
the symptoms, with the typhus of camps. But this expression can not
be preferred to all others, because the word typhus is derived from
typhos which signifies stupor and, to-day, typhus, as it was with the
ancients, is an epidemic in which stupor is observed; typhoid was an
adjective which many medical writers added to the word fever, to
18
A TREATISE ON TYPHOID FEVER.
indicate that there was stupor as a symptom. Oid only calls to mind
the idea of resemblance, and the expression typhoid fever can not
grammatically indicate anything more than an acute disease, vague
and undetermined, which resembles stupor, typhus or typhus fever.
Now, to define stupor is a difficult matter and properly to characterize
the typhus of the authors is not easy, neither does it come under what
the ancients have called typhus fever. Hence, to say that there exists
a fever called Typhoid (Louis thought fever so vague an expression
that he used affection as its synonym,) is to say that there is an
unknown fever resembling something but little known — stupor,
typhoid, typhus, etc. All this is so false, both in theory and practice,
that, in twenty cases generally set down as typhoid fever there will be
ten at least, in which there is nothing like stupor. We must not
forget that purity and exactness of language harmonize with clear-
ness of the intellect, with logic and the scientific knowledge of those
who use them.
And, if any one chooses to add an epithet to the expression Typhoid
fever to indicate that an organic lesion has united itself to this symp-
tomatic collection, as the following, encephalic typhoid, meningitic,
pneumonic, enteric, etc,, etc., yet this would not give a complete idea
of the disease, because, in Typhoid fever, we do not see an organic
lesion, unique, dominant, peculiar, but rather a great number of
morbid states according to different cases which should be indicated
by other adjectives. Therefore, Homœopathists, who study the
disease in the individual and not in its generality, say that it is very
difficult to find a name which shall combine all the morbid states
which the disease may present; indeed, it is impossible, because the
disease presents as many diversities as there are people affected by it,
hence it is necessary to inquire into the numerous lesions occurring in
the sick, the phenomenal train with which they show themselves and
the causes which have produced them, before one can prescribe the
proper remedy.
In times past, fevers have been considered as a mere complex of
symptoms, without seeking to refer them to organic changes. This
was the idea of the illustrious Professor Pinel, who, the first of all
others, sought to determine the seat of essential fevers; he erased the
word from his first works and only consented to restore it, somewhat
later, but the name which he assigned to it remains to bear witness
that he referred it to an organic alteration. This idea was developed
by Prof. Broussais, and by many others who have sought to determine
NATURE OF THE DISEASE.
19
"
the organic lesion in each disease, and hence, in fevers, giving
them names indicative of the material lesion, as we see in the
synonyms of this fever already noticed.
It is no wonder that fevers have been considered as essential mala-
dies, which would not leave behind them any trace, and that they
have been held, by the old physician, to be the most numerous of
diseases, because they only observed the symptoms themselves with-
out opening the cadaver, not even in exceptional cases, hence it was
not possible that they should have known what they never saw. In
the phlegmasiæ the sympathetic, consensual symptoms being strong
and well marked in all the organs of the animal economy, these
phlegmasiæ should be rigorously considered as general diseases,
attacking the whole organism. The name of fevers was given to
them because the heat, the thirst, the frequency of the pulse, the gen-
eral malaise were the most ordinary symptoms; and, as the phleg-
masiæ were the most frequently seen of all diseases, so it happened
that all, not excepting Boerhaave, said that fevers were the disease
which, more frequently than any others, came to torment the human
species.
The failure of opening cadavers led to the admission of other
different diseases, however many were the complex of symptoms
observed; whence, on one side, arose the grave inconvenience of
confounding under the same name, and considering as identical,
inany different affections, and, on the other hand, the inconvenience,
no less great, of regarding, as different diseases, mere symptomatic
varieties.
Then, after the pathologico-anatomical school, came the school of
organic medicine, which, in conformity with its principles, declared
that the term continued fever could not be preserved, and should be
removed from every philosophical classification; that these diseases
were nothing but visceral phlegmasiæ presenting certain symptomatic
varieties. Some are simple phlegmasiæ, others have a specific char-
acter, and, to indicate the functional and organic symptoms of similar
diseases, they were referred to the articles gastro-enteritis, dothinen-
teritis, meningitis, encephalitis, etc.
Some other pathological anatomists, not finding in fevers inflam-
mation concentrated in any one organ, declare that it is diffused and
often wandering in one or more tissues of the body, and that there
can not be more nor less than five according to the assertion of the
illustrious Prof, Lanza in his Positive Nosology, and they are the
en
3
20
A TREATISE ON TYPHOID FEVER.
rheumatic, the bilious, the plethoric or sanguine, the nervous and the
gangrenous.
The rheumatic has its seat in the fibrous aponeurotic tisssue where
it is represented by pains, and in the mucous tissue, where it is repre-
sented by fluxions. At the same time it attacks the cutaneous tissue,
the cellular, the muscular, the fibro-tendinous and articular in which
portions it is wont to wander; thus the wandering gastro-rheumatic
fever is more frequent than the seated.
The bilious consists in a diffuse inflammation of the venous system,
the vena cavæ, the pulmonary veins, the right side of the heart, of the
veins of the chest, of the jugulars and the very veins of the extremi-
ties. Indeed, the capillary venous tissue seems really to be that
which is the most affected, wherever the fever is seated, and mostly
that venous tissue which belongs to that part in which the patients
during life suffer the most pain, and where, on the approach of death,
the most fatal symptoms are wont to gather. Hence, in pathologico-
anatomical language, bilious fever is a diffuse phlebitis, principally of
the capillary venous tissue.
The sanguine fever has its inflammation diffused in the heart and
the arterial system; in a variable and wandering manner in the great
vessels, more fixedly in the capillary tissue, and it is chiefly these
tissues which are attacked. Hence the sanguine fever is properly
called a diffuse arteritis.
The nervous fever, as far as its seat is concerned, is a diffuse neuritis.
And, in the autopsy, when sufficient diligence and patience are used
in examining the investing membranes and the various parts of the
substance of the cerebrum, of the medulla, of the ganglia, of the
plexuses of the nervous trunks, and branches of the muscles, we
cannot fail to discover the congestions, the vascular net work and
arborifications and the indurations or softening of the substance,
chiefly of those organs in which the nervous symptoms during life
have been most intense and violent.
The gangrenous fever seats itself in that particular organ upon
which the inflammation has been concentrated, although, in such
cases, it is not usually lacking in that tissue where the inflammation
first presented itself. If then the fever keeps the inflammation
diffused till death, the gangrene is usually found diffused in the
fibrous tissue, the mucous, the serous, the venous, the arterial and the
nervous.
Still other writers make fevers to consist, not in inflammation of
NATURE OF THE DISE ASE.
21
the gastro-enteric tube, nor in a diffused inflammation in any general
tissue, but, in an alteration of the blood, and they reproduce the
humoral theory, which was generally in favor with the ancients, who
did not hesitate to admit a number of affections, to the list of fevers,
whose cause consisted in putridity of the humors. Hence the names
putrid fever, putrid synochus, etc. This was particularly the case
with the typhus of Hippocrates, and, the school of Galen extended
very much the received notions upon the alteration of the fluids. If we
examine the history of the great epidemics of antiquity, such as deso-
lated Athens, and of which Thucydides has left us a precise descrip-
tion, and of the seventeen plagues which, according to Livy, were seen
at Rome in the course of five centuries, we shall find all the causes of
putridity abounding in these places.
The epidemics of the middle ages, which decimated the population,
and were frequently reproduced in the crooked and unhealthy streets
of old cities, the fevers which manifested themselves in the armies,
must have confirmed the physicians of the ages which preceded ours,,
in the ancient idea of the putridity of the humors. Sydenham,
Pringle, Huxham, Sarcone, Stoll, Quarin, etc., did not, in the least,
hesitate to believe that the fiuids could be changed by putrid causes.
Pinel himself, although arrayed against the supposed putridity of the
humors, nevertheless confessed that the fetid odor of the dejections,
the rapid decomposition of the body, the alteration of the blood
drawn from the veins, were signal indications in favor of the humoral
theory. Remembering the accidents which ensued, with such grave
symptoms, in those who punctured themselves with a knife, impreg-
nated with cadaveric detritus, or who performed blood letting with a
lancet stained with injected blood, and reflecting upon the experiments.
of Prof. Orfila, who introduced in 1815, blood, bile and fragments of
putrefied tissues under the cellular tissue, in various parts of the
bodies of many dogs, in some of whom he saw prostration and vomit-
ing, while some died, and, relying upon the analysis of blood drawn
from fever patients, and upon the experiments made by Magendie,
Gaspard, Laurent, Dupuis and others, who injected, directly into the
sanguineous system, substances capable of changing it, and which
produced symptoms similar to those of local phlogosis and of fever,
they remained fully persuaded and convinced of their theory.
In these times, there are many who say that fever consists in the
rapid organic reduction, from which arises the increase of febrile
heat, together with the other symptoms, and, from which, at the same
22
A TREATISE ON TYPHOID FEVER.
time, come the alterations of the solids and fluids which occur in
fever.
Others say that fever springs from the diminished diffusion of heat,
and many others, from the real increase of the production of caloric
the organism by the increase of chemical processes, while, the
greatest numbers say that it comes from an alteration of some
nervous centre.
The greater part of the profession, however, now sustains the view
that fever may be considered as a morbid increase of the functions of
the spinal centres, produced by an affection (debility, paralysis) of the
moderating cerebral centre, by means of which a series of chemical
processes increases to such a degree as is never attained by the normal
functions of the cerebrum.
The essence of fever is unknown and will be for a long time to
come, if not forever, and the different manner of reasoning regarding
its essence, although it seems that each one sets out from known
facts, is the cause of these diverse opinions. Leaving each one to
consider the subject, and investigate these facts, as it seems best to
him, it is necessary that we return to the proposition and inquire
what idea may be attached to the expression Typhoid fever.
WHAT IS TYPHOID FEVER?
By the greater part of the medical practitioners of this city the
expression typhus is used in a very wide sense, as they apply it, not
only to every fever, but, perhaps with a certain abuse, to every acute
fever, provided it is characterized by loss of the senses, prostration of
the forces and subsultus tendinum, although produced by common
causes. By others, however, it is used in a limited sense and they call
typhus those fevers which are marked by petechiæ, otherwise called
petechial fever, which always arises from a specific cause, besides the
common which act as occasional causes.
There are, then, practitioners, who, to the above named typhus,
taken in a wide sense, give the name Typhoid fever on account of the
symptoms of malignity which it has in common with typhus, and
declare that they do not observe, in their practice, any Typhoid fever,
or very rarely, in the restricted sense of the French physicians, who
apply this name to the dothinenteritis of Bretonneau, that is, enteritis
with a furuncular eruption, which is a disease truly specific, and arises
from causes purely specific and not from common causes which
produce simple enteritis and not the furuncular as described by
Bretonneau.
NATURE OF THE DISEASE.
23
To this writer is due the credit of having called attention of physi-
cians, to this subject, in a paper read by him before the Royal
Academy of Medicine as well as in various lectures. Many other
physicians afterwards took up the subject, chief among whom was
Prof. Trousseau who described, day by day, the appearance of this
inflammation seated exclusively in the glands of Peyer and Brunner
which are found in the jejunum, the ileum and the great intestines,
commencing with the fifth day of the disease, as Bretonneau had no
opportunity to examine cadavers earlier than that day.
At the present day, not a few physicians affirm that typhus and
Typhoid fevers are identically the same, resting on the authority of the
most skillful and accredited writers of medicine who say that the
symptoms, the course, the duration, the anatomical changes and the
causes are the same in the two diseases, with the most trifling variety.
They say, moreover, that the same typhus arising from specific causes
identically the same, and, in the course of the same epidemic, pres-
ent varieties in symptoms in their course, in their situation, etc.,
which practitioners indicate by name; in fact, we hear to-day of
dermo-typhus, ileo-typhus, pneumo-typhus and not typhus simply, and
this, not because there are specific differences, but, because the disease
manifests itself more upon the skin or in the ileum or the lungs, etc.,
without changing its nature at all. Whence they conclude that
Typhoid fever, consisting in a specific disease, arising from specific
causes is not a different disease from ileo-typhus, from dermo-typhus,
from pneumo-typhus, and that they should not be confounded with
Typhoid fever arising from common causes, and that it is quite
arbitrary to call them such a name on account of the similarity of a
few symptoms.
In medicine it is of the greatest importance to speak clearly, to use
words which cannot engender confusion in the mind, and to adopt
precise expressions, by which one disease may be easily distinguished
from another, so that a suitable curative method may be selected for
each.
From this failure in precisely individualizing the disease, to which
has been given the name of typhus, and thus, from calling by the
same name, different, common diseases, has arisen confusion in the
treatment. Each physician has praised and extolled the method
adopted by him, which has always been followed with happy results.
I should inquire, has he always treated, by his method, the specific
typhus, or, has it been a simple fever, which he has arbitrarily
24
A TREATISE ON TYPHOID FEVER.
called typhus? The same holds good as regards Typhoid fever which
therefore is called, by some physicians, a slight disease, and by others
grave. We can arrive at precision only by avoiding equivocal expres-
sions; and statistics of cure, and deaths, with any given method of
treatment, can be taken as exact, and as authority in medicine, only
when they are accompanied with the history of each particular case of
the disease and not made up, in the gross, without any particulars.
Every disease may be more or less light, or severe, according to many
and diverse circumstances, and a physician may havę cases to treat
which, at one time, are always mild, and, at another, always malig-
nant; if these cases are not described minutely, it can only be said that
the method adopted by such a physician is good because it always
succeeds, and that the practice of some other one is bad because it
has not produced good results. To judge with exactness and truth,
we should not keep the number of deaths and of cures, in the gross,
but should search into the particulars of each case, so that we may
know if those cured by a certain method were as sick as those who
died under another, or were in much more favorable circumstances;
whether the cases cured presented the same symptoms of malignity,
the same complications, and the same pathologico-anatomical changes
as those not cured, etc. In fact, we should preserve every individual
particularity and not the name by which the disease is called.
It seems very clear that the name which we give anything, is of
very little moment, but it is very important, and indeed, is absolutely
necessary, to present, intelligibly, the value which we wish to give
them without giving rise to a false idea or to a vague conceit in the
mind of the listener. And, because the term Typhoid fever is now gen-
erally adopted, though it can not be preferred to all others, yet it is
adopted in this monograph to indicate not merely a common and
indeterminate disease, but a specific malady, which presents symp-
toms, course, seat and anatomical alterations proper to itself and
arises from specific causes. From the totality of all these facts, which
are always presented with a certain diversity, in different individuals,
and which, in Homeopathy, are called symptoms, we should obtain
the indications for the appropriate remedy, in each particular case,
and not from one symptom alone as would be the pathologico-
anatomical appearance which many still hold as the principal fact
from which all others are derived.
Every morbid symptom, they say, depends upon a lesion, upon a
material alteration occurring in the organism and, if this cannot be
removed, the morbid symptom can not cease.
NATURE OF THE DISEASE.
25
The Homœopathic school does not deny organic alterations but
gives them a symptomatological value, as well as to other symptoms,
and considers man as a complete and inseparable whole, from which
we cannot abstract life nor matter; and every disease which invades it,
reflects its disorders, from the beginning, as well upon the vital force,
as upon the solids and the liquids of the organism, in a word, upon
the complex whole. Hence the method of cure should be founded
upon the totality of all the symptoms which manifest themselves in
the texture, the form, the relations and actions of the organs and the
tissues and these therapeutic agents can not remove these symptoms
except on the condition of modifying the very cause whence the
symptoms proceeded; the effects of this cause can only cease with
the cause itself. Hence it is upon the cause of the disease that the
medicinal agents operates, whatever may be the mode of action attrib-
uted to that agent.
Hahnemann set aside all speculative notions upon the nature of
these organic modifications and saw nothing, in them, but an indica-
tion of the period to which is added the pathological affection. "The
morbid phenomena," said he," accessible to our senses, express all the
internal change, that is to say, the totality of the disturbance of the
internal forces, in a word they put the entire disease in evidence. Con-
sequently the cure, or rather, the cessation of every morbid manifest-
ation, the disappearance of all the appreciable changes which are
incompatible with the normal state of life has, for its condition, and
necessarily supposes, that the vital force may be re-established in its
integrity and the organism restored to health."
In the view of the Master, lesions and affections are, then, two things
which are connected, and he always said that the dynamic phenomena
were anterior to the material or anatomical phenomena.
The diseases of men consist, without doubt, in certain groups of
phenomena which may be changed by the greatest number of circum-
stances, and of which two can never be found perfectly alike.
The Homœopathic physician, instructed in this, is free from the
prejudices of the ordinary school, does not establish, as that school.
does, a number of fevers beyond which it forbids nature to generate
any more; he does not give to these, certain names in order to treat
them all in the very same manner; he does not recognize the names,
prison fever, bilious fever, typhoid, putrid, nervous, mucous, etc., but
disregards them and directs himself according to that which each
disease offers in particular. Surely no more pestiferous evil has
2
26
A TREATISE ON TYPHOID FEVER.
:
+
Į
ever crept into the medical art than to give certain general names to
diseases, and to seek to find some general medicine for them."
It is thus that Huxham, a physician as enlightened as he is admired
for his candor, has expressed himself. (Op. Phys. Med. t. i.) Fritze
likewise complains (Annalen, i. p. 80) that the same names have been
given to diseases that are essentially different.
"Even epidemic diseases, which are probably propagated by a specific
miasm in each particular case of epidemy, receive names from the
existing medical school, as if they were fixed diseases, already known
and always returning under the same form. It is thus they speak of
hospital fever, jail fever, camp fever, bilious fever, nervous fever, mucous
fever, etc., although each epidemic of these erratic fevers manifests
itself beneath the aspect of a new disease that never existed before,
varying considerably both in its course and the most characteristic
symptoms, and also in its whole deportment. Each of them differs so
widely from all the anterior epidemics, whatever names they bear,
that it is overturning every principle in logic to give to diseases so
manifestly different from each other, one of those names that have
been introduced into the pathology, and then to regulate the medical
treatment according to a name that has been so abused. Sydenham
alone discovered the truth of this (Oper. cap. 2, de morbepid., p. 43);
for he insists upon the necessity of never believing in the identity of
one epidemic disease with another that had manifested itself before,
or of treating it according to this affinity, because the epidemics which
exhibit themselves successively, have all differed from each other.
From all this, it is clear that these useless names of diseases, which
are so much abused, ought to have no influence whatever upon the
plan of treatment adopted by a true physician who knows that he is
not to judge of and treat diseases after the nominal resemblance of a
symptom, but according to the totality of the signs of the individual
state of each patient; his duty is, therefore, to search scrupulously
for diseases, and not to build his opinion upon gratuitous hypotheses.
"Should it, however, be thought sometimes necessary to have names
for diseases in order to render ourselves intelligible, in a few words, to
the ordinary classes, when speaking of a patient, let none be made use
of but such as are collective. We ought to say, for example, that the
patient has a species of chorea, a species of dropsy, a species of
nervous fever, a species of ague, because there certainly do not exist
any diseases that are permanent and always retaining their identity,
which deserve these denominations or others that are analogous. It is
thus we might by degrees dissipate the illusion produced by the
names given to diseases."
This long extract from a note in the Organon of the Healing Art,
by Samuel Hahnemann, with an addition by de Horatiis, his commen-
tator, shows what value Homœopathists attach to the names given to
diseases, and what idea they form of them. They describe diseases
NATURE OF THE DISEASE.
27
by their symptoms, by their pathologico-anatomical changes, they
determine their course, study their causes, etc., but they do not
arrange them in classes; they consider each disease as specific and
individual.
Many practitioners, following the idea of Bretonneau, relative to
diphtheria and dothinenteritis and not varying at all from the views
of Trousseau and Bouchut, say that the specificity of the disease
should lead to the specificity of the cure, and hence conclude that,
in the actual state of our science, specificity rests upon three condi-
tions.
1. A specific cause.
2. Specific characters.
3. A specific treatment.
It may be said, that in this regard, all physicians are of one mind.
Some, however, affirm that these characteristics are found in a very
small number of morbid states, while others, make of them a general
rule. Hahnemann taught that specificity should be one of the bases
of pathology.
If we would inquire into the causes of these divergences we shall
find them chiefly in the difficulty of satisfying the third condition.
There is no longer any dispute about diseases for which therapeu-
tics possesses specific agents. Who would doubt the specificity of
syphilis in view of the successes of Mercury and the Iodide of Potas-
sium? Who would deny the specific nature of paludal intermittent
fever when the Sulphate of Quinine can cure it?
One may readily understand how easily Hahnemann, having pro-
claimed the law "similia " and found the means to discover the proper
remedy, not for each disease, but, for each patient, was obliged to
ascend from specific therapeutics to a specific pathology.
But when he taught that diseases could not be cured, certainly and
promptly, with the disturbing agents of rational medicine, he should
have inquired if there was error in asserting that there existed a
series of pathological states, generated by a multitude of causes,
while others would be the effect of pathogenetic agents, distinct,
special, specific, which alone could produce them.
Properly to appreciate this teaching we must consider the distance
which separates the stand-points in which the Homœopathic and
Allopathic schools are placed. If one sees in a disease, only an
organic lesion, he has the right to reject the etiological specificity.
They insist, and with reason that the lung becomes engorged or
28
A TREATISE ON TYPHOID FEVER.
hepatized under various influences, cold, typhoid infection, the mor-
billous miasma, etc. But if he acknowledges, with Hahnemann,
that disease consists, first of all, in a dynamic discordance, he will
then conclude, at the same time, that this ought to be in rapport
with the agent capable of producing it. He would say then, that
organic lesions arise from various influences, inflammation, the
typhoid condition, measles, variola, etc., that each one of these
diseases has a fixed and determinate cause, which, as soon as it
touches a living organism, produces this disease and, without
which, these diseases cannot exist. Thus the etiological consideration
becomes primordial and makes it necessary that it should be taken
the basis of the grand nosological divisions; this is just what Homo-
opathy proposes.
Since then Hahnemann, and his followers, maintain that every
disease is specific and individual, so that a name cannot be given it, it
is clearly of prime necessity to study, very carefully, all the facts and
circumstances which make the disease individual, independently of
the facts common to and identical in various cases. And since all
agree that, for the physician to succeed readily in curing tuto cito et
jucunde, the patients committed to his care, he must have carefully
examined all the symptoms and determined the order of their subordi-
nation without which he can never tell characteristic symptoms from
those which are common, general symptoms from diathesic, formal
symptoms from individual; he must weigh well the febrile state, con-
sider its seat and determine, not only the organ most affected, but
also the degree of its alteration; he must know, as much as possible,
the causes which have concurred in the production of the disease and
must know also the individual quality of the patient. All these facts
are never identical, in every case, and since they are not perfectly
similar in all cases, they cannot be cured by the same remedies even
when relying upon the adage, analoga analogis curantur.
In case of an epidemic, the Homœopathic physician should indi-
vidualize it, as regards the one preceding it, since all do not demand
the same remedies, though the disease may be essentially the same.
It is true that Pulsatilla is, as Leon Simon says, the essential remedy
for measles; now it happened that, in an epidemic occurring in
Dresden, some years ago, this drug was not efficacious. The disease
was severe and many died. Dr. Trincks examined carefully the
symptoms, comparing them with those of similar and previous
NATURE OF THE DISEASE.
29
epidemics, and recognized the differential symptoms which indicated
the use for Calcarea carb. On substituting this new remedy for the
Pulsatilla, it displayed a prompt and favorable influence in case of all
the children to whom it was administered, and, in a short time, a
great number of cures were effected.
The same has been observed in cholera. Camphor, Arsenicum,
Veratrum and Cuprum are the remedies first to be thought of, but
Camphor will succeed only when cold predominates; Arsenicum when
the movements and the vomitings are abundant and when the thirst is
violent and intense; Veratrum when the diarrhoea exceeds the vomit-
ing and Cuprum if the vomiting exceeds the diarrhoea and there are
violent cramps. In fine, it is necessary to collect the distinctive traits
of the prevailing epidemic and, to individualize the disease in each
patient affected by it.
In the same way we must proceed in an epidemic of Typhoid fever,
for every epidemic has its own proper characters, as physicians have
generally observed, and hence require remedies proper to themselves,
besides those specifics required by special cases and individuals as the
curative method clearly makes known in its indications.
CHAPTER II.
ETIOLOGY.
Every living body enjoys the property of preserving its organiza-
tion in a sound and normal state, and of manifesting the activity
proper to itself, according to laws prescribed it from the beginning,
and, hence, it invariably preserves its health, if causes of disease do
not turn it aside and make it sick. These acting causes change, in
the essence of life, that condition necessary to constitute it healthy,
by effecting upon it that alteration proper to the particular disease
which it produces. The physician who wishes to preserve health
ought to know what are the causes which may disturb it and what
may produce and maintain the disease or remove it when necessary.
Unfortunately they will be found everywhere about or within us.
The things most necessary to our existence, as the air which we
breathe, the food and drink which repair our daily losses, the products
of human industry intended to render life more pleasant or agreeable,
often become the causes of the diseases which affect us. The same
may be said of the various organs, the union of which constitutes our
economy. Destined to the preservation of everything, of which they
are a part, they may, in certain circumstances disturb their harmony.
Thus when we observe, in the economy, or out of it, the things
most indispensable to the life of man and to the preservation of the
species, becoming the cause of the diseases which afflict it, we are
tempted to admit, with Testa that, properly speaking, there is
no morbid cause whatever, and that nothing is hurtful by itself,
“Nihil proprie morbificum, nil noxium natura sua dicere prestat." But
this assertion, though founded upon the greater part of the causes
which disturb the health, is not the same for all, and, when we
reflect upon the subtile poisons which prevail in the vegetable king-
dom, and especially the contagious principles of disease, we are forced
to admit that there are certain things which are hurtful in themselves
and independently of the abuse which may be made of them.
These causes have been divided into external and internal; proximate
ETIOLOGY.
31
and remote, principal and accessory; mechanical, physical, chemical or
physiological; negative and positive, manifest or occult.
Others, not giving any importance to all these divisions, and, con-
sidering the part which they represent in producing diseases classify
them as follows:
Predisposing.— Those which predispose to the disease.
Occasional or accidental.― Those which give rise to the disease after
the predisposition.
Determinant.— Which give rise to various diseases.
Specific.- Which determine diseases the nature of which is always
simple.
Now, although this may facilitate the important. investigation into
the causes of a disease, and the discovery of that part which each
one plays in producing it, as the predisposing or occasional, or deter-
minant, or specific, we think better to arrange them in five categories,
as VINCENZIO LANZA has done in his Positive Nosology.
I. Natural.
II.
Non-natural.
1II.
Unnatural.
IV.
Radical.
V. Mechanical or chemical.
I. NATURAL CAUSES.
The natural causes are the differences which men present among
themselves and which seem to be inherent in their constitutions,
because they are the specific traits of human individuality. The
number, the delicacy of the parts which compose the human machine,
the sympathetic relations which unite them, compose an illimitable
series of gradations, whether in the intimate structure of their organs
or in the manner in which they perform their functions or correspond
with each other. Hence the races, the nations, the castes, the fami-
lies, all the individual twigs or branches of the same stock, but
separated and planted in other soils, immersed in other atmospheres,
and vegetating, each one in its own manner, communicates to its
twigs a peculiar vitality.
To comprehend these differences is of great importance, in the
study of medicine, which, as it consists in preserving and re-arrang-
ing the health of men, cannot attain this end by ignoring these differ-
ences. External agents do not manifest the same action in all, and
diseases are presented to view, with phenomena infinitely graduated,
32
A TREATISE ON TYPHOID FEVER.
according to the subjects affected. Two cases of one and the same
disease never resemble each other exactly. The merit and suc-
cess of the physician come, in fact, from knowing how to manage
skilfully external influences and how, opportunely, to adapt therapeu-
tic means to the numerous cases observed. A uniform medication,
given to a series of patients with the same energy, shows the falsity of
the theory which suggests it. Nature does not present it and art
treats only the individual.
The specific characters of the economy upon which we have to fix
our attention are those derived from age, sex, constitution, tempera-
ment, etc. It is necessary to study them now, and see what relation
they bear to Typhoid fever, although, as regards many points of its
etiology, we have but uncertain data.
I. AGE.
Age cannot be considered as a cause of disease, for many diseases
develope themselves in every epoch of life, from the time when the
fœtus is enclosed in the womb, till the most advanced old age. It has
been observed, however, that certain affections are more frequent at
certain ages than at certain others, and at a different epoch of life;
hence, it is not age that is the cause of this or that disease, but its
frequency is only greater at certain periods of life than at others.
Thus it has been observed by physicians that Typhoid fever is rare
during the first year of life and, especially, in the first four years.
However, after physicians became interested in diseases of children
and studied their symptoms with much care, they observed a certain
number of examples of this disease, in the first months of life.
Manzini and Charcellay report ten cases of congenital Typhoid.* The
first was a case of congenital dothinenteritis, in a new-born child,
which died the eighth day of its life and the fifteenth of the disease.
The second case was a child fifteen days old, who died the eighth day
of the disease. There was no doubt about the first case: the charac-
teristic anatomical lesion was observed. Rilliet, Marc d'Espine,
Bricheteau and Abercrombie have seen Typhoid fever in children of
from seven to twenty-two months. Valleix says that he saw a case in
a child three and one-half months old, which was cured, and, in another
one, twenty-three months old which he could not save. Observations
upon children are very difficult and perhaps this is the reason why so
* Bouchut says: "Maladies de Nouveau nes," 1873, p. 1,001. Typhoid fever does
not exist in new-born children nor in children at the breast, and does not appear
till between the first and second year. Trans.
ETIOLOGY.
33
few cases are noted, and perhaps it may happen, too, that when the
'fever is not very severe, it passes without being recognized. Be that
as it may, the disease has been but seldom observed in the first
year of life and it increases in frequency as age advances. The
periods from five to eight and from eight to eleven offer little differ-
ence; it is less frequent from five to eight than from nine to fourteen,
and is most frequent from eighteen to thirty. Prus observed Typhoid
fever in an old man of seventy-eight, and Lombard and Fauconnet in
an old woman of seventy-two. These cases are rare and the fact
remains established that the disease chiefly attacks the young.
Pategnat observed that old men enjoyed immunity in these epidemics
and that it attacks adults rather than infants and old people; this
may be because they are often able to avoid the disease and thus
happen to have it late in life, while, in old age, many are found who
have had it once. Hence it results from researches made in epidemics
that, as regards their intensity, Typhoid fever, without changing the
rule laid down, shows itself inside of certain limits; and, in truth,
when the disease is wide spread, the exhalations from the bodies of
the patients are greatly multiplied, and hence it is no wonder that
cases are noticed in those periods of life which are exempt when the
disease is not as wide spread.
II. SEX.
Sex does not offer any peculiarity regarding this disease, to be
noted, and it has been observed by all that the two sexes are about
equally predisposed to these affections, and whatever difference there
may be, should be referred to the kind of life rather than to the differ-
ence of sex. Some writers, however, affirm that Typhoid fever seems
a little more common among men than women; but we may add that
new statistical researches are necessary to establish this fact, beyond
doubt, as it is stoutly contradicted by some modern writers. We may
consider too that if women seem to be less subject to this disease than
men, it may be owing to the difference in dwelling, regimen, etc. In
fact, women are less exposed to morbific causes, but, when they are
exposed, as much as men, and are found in similar circumstances,
they are equally attacked with this fever. This is the result of
statistics made in women's hospitals. Rilliet, Barthez, Tapin and
Barrier consider the influence of age as well marked in the Typhoid
fever of infancy; boys are more exposed to it than girls.
III.
CONSTITUTION.
Nothing certain has been established regarding the degree of
•
34
A TREATISE ON TYPHOID FEVER.
influence of these organic conditions though causes have often been
assumed from theoretical notions rather than from severe observa-
tion; in most cases, if we begin by establishing the nature of the dis-
ease, the knowledge of its causes will follow, and hence the opinions
of physicians are very different. In fact, there are some who have said
that individuals of a feeble constitution, delicate and soft, those who
have a fine skin and easily perspiring, are more likely to be attacked
by this disease, while others have observed that the disease attacks, if
not in preference, at least most frequently, robust individuals, who,
for example, have been living in large cities but a little while, and
who have not had time to lose their strength by hard work, by intem-
perance or misfortune, while Louis affirms that the influence of con-
stitution is insensible, since the mortality is the same amongst the
robust and feeble.
IV.
TEMPERAMENT.
The name of organic system has generally been given by physicians
to the complex or re-union of a series of organs which concur in the
exercise of one and the same function. Thus all the organs which
produce circulation, as the heart, the arteries, the veins, the capilla-
ries, and the blood, constitute the system of the sanguineous circula-
tion; the vessels, the lymphatic ganglia and the lymph form the
lymphatic system; the brain, the medulla spinalis, the nerves, the
nervous ganglia and the unknown fluid which carries motion and
sensibility constitute the system of innervation and so of the others.
Now the name temperament has been adopted to express the pre-
dominance of one of these organic systems over the others, holding
them all under control.
Medical practitioners ought to take care to recognize and appre-
ciate this predominance of organs and functions, if they wish to
judge with exactness of the nature, the gravity, the complications and
the intensity of the symptoms of diseases of individuals of a given
temperament and to notice to what diseases they are most readily
subject, and how they bear them, that they might thence reason con-
cerning the employment of the remedies which they use to resist the
disease, and might learn which of them is most efficacious and useful
in certain temperaments rather than in others.
For lack of this attention we can say nothing positive regarding the
influence of temperaments upon Typhoid fever, not having sufficient
data on this point. We can only say that sanguine, bilious, nervous
and lymphatic constitutions are alike attacked, and that according as
ETIOLOGY.
35
,
the various epidemic influence prevails, whether rheumatic, bilious or
nervous, so, in each case, it attacks, with most frequency and violence,
individuals of a corresponding temperament.
V. HABITS.
Habits which arise from the frequent performance of the same acts
in a given time, are generally hurtful to those who are in their power
and are properly reckoned among the causes predisposing to the
disease. The force of habit, and, hence, the danger of interrupting
it, are in proportion to its age and the number of its exercises which
have taken place in a given time. This force is such that one cannot
pass without danger from a very poor regimen to another that is
better. Now as there is no habit which a man can be sure of satisfy-
ing, at all times, of his life, it is wise for him not to subject himself to
the force of any habit without an absolute necessity. But we have no
precise data to show what relation habits have to Typhoid fever as
physicians have not heretofore considered the subject.
VI. PROFESSIONS.
Professions may become predisposing causes of the disease by con-
currence of circumstances in which individuals practising them are
found.
I do not know, however, that Typhoid fever attacks any profession
in preference to any other. It seems that all may be attacked by it.
But it may be asserted, in a general way, that those whose occupations
bring them in contact with the products of the disease or who have to
handle the clothes or furniture, used by patients, contract the disease
more readily.
From this it appears, therefore, that all persons may be attacked
with Typhoid fever and suffer from it, more or less severely, accord-
ing to the particular condition in which the patient happens to be,
since it is very clear that amongst many persons in the same con-
dition, some will be particularly predisposed to suffer and that
severely, from this fever, and hence it suffices to admit that the
idiosyncrasy, that is, the peculiar life which each one certainly has,
has a special relation to the origin and violence of the disease.
But we do not know whether the many who pass their lives without
contracting Typhoid fever are naturally indisposed to it, or, whether
they escape the cause accidentally; it is true that, very seldom, any
escape who are exposed to it by reason of their occupations. Hence
we are obliged to admit a predisposition very favorable to the disease
36
A TREATISE ON TYPHOID FEVER
in some and very slight in others without the intervention of other
manifest causes. Some physicians, however, declare that there are
persons who are never attacked. Amodei scarcely admits this immu-
nity at least as far as it might be the result of any particular con-
dition of the individual; in fact, admitting such an immunity, an
error of judgment is very easy by reason of which one would not
seek to determine the proportions according to which men enjoy or
are deprived of. There are certain who can avoid it; others, in great
numbers, are affected with difficulty and imperfectly, such are, as has
already been said, children and old people, and, to a certain extent
workers in oil. Finally there are great differences as regards age in
different epidemics.
men,
These same differences exist also as to the sex as, at one time,
and, at another, women are affected, in preference, while in both
cases the sexes are equally exposed. The same may be said regarding
the bodily constitution, since the most robust, as well as the weak, the
delicate, the relaxed are attacked at the same time. The question is
raised if people attacked by other diseases are liable or not to contract
this Typhoid fever. Those attacked with intermittent fever, phthisis
pulmonalis, scurvy or syphilis contract it easily. But this is not the
case with those attacked with chronic diseases, except, to a certain
point, those of the nervous system. We cannot judge of the greater
or less predisposition of any individual in particular to the Typhoid
fever except by considering, at the same time, all the occasional
causes which may render one capable of contracting it. Thus we
observe that those most likely to be attacked are priests, physicians,
surgeons and other persons who lend their aid to the sick; sailors,
lodging house keepers, warehouse keepers, pawnbrokers, and the
poor, because hunger, filthiness, confined dwellings, cold, watchings,
discouragement have a great part, as will be seen in subsequent
pages, in the production of this disease. Those do not contract it,
and are exempt all the rest of their lives, who have had one attack,
and, experience has constantly shown, in the Hospital della Pace, and
all those excellent and charitable fathers abundantly testify, that all
the novices, without exception, are attacked with typhoid fever,
though hardly any sick had been received into their hospital, and that
those who have suffered it once, and survived, can assist, with immu-
nity, in the care of those recently brought in. Hence it is clear that
with whatever avidity the human system absorbs the principles and
the producing substances of this fever and manifests the greatest
ETIOLOGY.
37
susceptibility to take it when it has never had it, yet on the other
hand it is, so to speak, saturated and, in fact, insensible to the
diseased action when once it has been overcome. Thus we can see
many persons who defy this disease and are not attacked by it, as
they have acquired the right of immunity by having once overcome it.
II. NON-NATURAL CAUSES.
The non-natural causes of disease are the same six non-natural
things with which we have to do in living, and which, according to
the use or abuse made of them, remain conservators of health or pro-
ductive of disease, air, food and drink, motion and rest, sleep and
watching, excretions and retentions and the passions of the mind.
Ordinarily these remain occasional causes of the disease, or rather,
the most common origin of diseases arises from such causes operating
as occasional, under those already mentioned operating as disponents.
Nevertheless, among the many non-natural causes which have, per-
chance, concurred in the production of a disease, those which, by
previously and slowly operating, have only contributed to prepare the
constitution to receive it, may well be remembered among the prepara-
tions; while those which finally and openly have developed it, are
generally and properly called occasional causes.
Often, among these things, the true efficient cause of certain dis-
eases is found, which diseases are therefore called accidental; these, by
their constitution, receive the mere aptitude or a certain impetus to
grow, but they have their very existence and nature from the improper
use of one or more of these non-natural things. The empire which
art has over accidental diseases is much greater than that which it has
over constitutional diseases, and, in such encounters, it may be exer-
cised as absolute.
I.
ATMOSPHERIC AIR.
Thus we call the mass of elastic fluid, invisible, by reason of its
transparency; in which we live and which surrounds the earth to a
certain height not yet determined. It is indispensable to the main-
tenance of life. Introduced into the lungs, in the act of respiration,
it affects the transformation of venous blood into arterial or of the
non-nutritive blood into nutritive (sanguification, hæmatosis).
Touching the exterior of the body it takes charge of the matters dis-
charged from the skin, maintains the equilibrium of the circulating
fluids by its pressure and guarantees the resistance of solids. Its
temperature and hygrometric state, vary according to a multitude of
38
A TREATISE ON TYPHOID FEVER.
circumstances; the aqueous vapor which it contains may hold in
solution different gaseous products, and in, these different states, may
predispose to different diseases. According to the relation of the dis-
tance which the earth, which we inhabit, and consequently, the air
which surrounds it, is from the sun, is the state of heat. And because
this distance is not always constant, on account of the revolution
which it makes upon its own axis, and about the sun, the atmospheric
caloric also varies; hence the variety between night and day and the
variety of the seasons and climates. The heat of the atmosphere
comes from the sun, but the air is not directly heated by the solar
rays, which warm the surface of the earth and this communicates its
heat to the nearer atmospheric strata; hence the temperature lowers
as we rise above the level of the sea. The quality of the soil too, and
its inclination, influences the temperature more or less according to
the greater or less reflexion which it gives to the solar rays.
Under ordinary circumstances the air which we breathe may vary in
course of the year from 17° to 90° F., and thus the air is distinguished
as cold, temperate and hot; the first extends from 17° below to 32°; the
second from 32 to 59° above, and the third, from this point upwards.
The same holds good as regards the hygrometric state; the air may
be dry or humid as the quantity of aqueous vapor which it contains is
more or less sensible to the hygrometric instruments.
Some physicians assert that Typhoid fever abounds more in a warm
atmosphere, suffocating and full of moisture, than, in a temperate
and dry air; in this case, the fever presents a bilious character rather
than otherwise. Then they explain this fact by saying that, in hot.
and moist climates the heat of the day is very great and the nights
are quite cool; hence the suppression of the cutaneous transpiration
is easy and this is one cause of this fever.
More; the aqueous vapor which the warm air contains is seldom
pure, often containing volatile emanations, arising from the decompo-
sition of vegetable or animal matters, and being thus introduced
into the animal economy, easily generates this fever. I cannot say,
however, that Typhoid fever is observed only in this kind of atmos-
phere, for, with us, it is seen to prevail at all seasons, and some years,
it prevails more in the winter and spring than in the summer and
autumn, and, occasionally, is seen complicated with pulmonary inflam-
mation or cerebral, and has a more acute course.
Some physicians say that the cold, that is, cold air, often figures
among the causes of this disease, since it is often seen that the pas-
ETIOLOGY.
39
sage from hot to cold irritates the skin and contracts it with a sense
of pain; this irritation shakes the whole nervous system and
influences chiefly those parts which are most sensitive and most.
disposed to receive the attacks of this irritation; its action is instan-
taneous and is felt at the extremity of the sentient nerves, which are
at the periphery of the body; if a strong and vigorous individual
resists its action, it is not so with the weak, exhausted, wearied or
relaxed, upon whom the impressions of cold produce formidable
effects and sometimes even fatal. Hence it has been observed that.
while Typhoid fever prevails, a chill may be the occasional or predis-
posing cause of its manifestation. Graves, in his clinical lectures,
speaking of the epidemic of fever in Ireland, says: 'There has cer-
tainly been nothing more noteworthy than the facility with which the
cold, which would have been attended with no danger in England,
produces the spotted fever in Ireland, even in individuals whom no
one could have supposed had been exposed to contagion, and that
reaches such a degree, that, outside of the time of epidemics, cold is
the most common cause of the disease." Chomel in 115 cases of
Typhoid fever found five who attributed their disease to the sudden
impression of cold while the weather was very hot. Moreover, they
say, that, in very cold climates, this fever does not fail to manifest
itself and always with more intensity than in hot or temperate
climates. Other physicians, however, say that cold air opposes the
progress of this fever relying upon this passage from Huxham: "I
have also often known putrid and malignant fevers very much
increase in hot and cloudy weather, both in violence and in numbers,
but quickly and entirely disappear when a dry and cold north wind
blew." Barbier, in his hygiene applied to therapeutics, says that,
"Cold air may be a preservative in febrile diseases such as a dynamic,
ataxic and putrid; the instantaneous impression of this fluid develops
the tonic forces of the living system, and hence, will concur effica-
ciously to diminish the accidents of the disease.
The refrig-
erant action which it exerts, when the whole body is subjected to its
contact, may calm, in a sudden manner, that morbid agitation and
also produce in consequence a useful increase of the organic vigor of
the body." Hippocrates, too, upon the strength of his experience in
the treatment of popular diseases, says: "The following winter dis-
pels the diseases of summer."
All practitioners agree in saying that we should not consider in
what temperature Typhoid fever prevails more or less, being found in
}
40
A TREATISE ON TYPHOID FEVER.
all, but, we should consider its variety, and there are no writers upon
epidemics who have not observed a constant variety in the form of the
same epidemic in a warm climate and in a cold, in a humid and in a
dry, or when a cold spring may have followed a mild winter or a rainy
summer, a dry spring, etc.
Lombard and Fauconnet agree, in their new researches, in confirm-
ing the assertion that the greatest number of Typhoid fever cases
have been observed in autumn and the least in spring, while the
greatest number of bilious fevers are met with in summer and the
least in winter, that is to say, heat has a great influence in producing
bilious fever, while cold has a contrary influence. In Typhoid fever,
summer has an influence of the second rank, and winter of the third.
Nevertheless, these authors declare that the six warm months of the
year furnish a greater number of Typhoid fevers than the six cold.
Many causes of various kinds act contemporaneously with the rigor of
the season upon the unfortunate ones who habitually fill the hospitals.
How would it be possible, among so many complex influences, to
attribute to each modifier its share in the action? Thus, for example,
the misery and privations of every kind, induced by the want of
work, and the crowding of operatives in large cities, are they not per-
haps as much the causes which intervene at the same time and which
exercise an influence even more fatal than the atmospheric conditions!
Nothing positive, in fine, is known about the action exercised by
climate.
It has been affirmed that this disease reigns with more frequency
during the summer on the equator, but before this assertion can be
accepted, it would be necessary to state, accurately and distinctly, the
very one, among many kinds of fever, which have been called
typhoid.
Those who have read the ancient writers, with attention, have
found that, from a remote time, they studied the influences which the
atmosphere might produce upon the constitutions, the characters, the
health of men, and upon the development of disease, as is seen by
the excellent work of Hippocrates upon the air, the water and locali-
ties. All the later observers and especially Sydenham, Stoll, Baglivi,
Gand, Rammazzini, Hildebrand, Frank, Tissot, Zimmerman, etc.,
have followed in verification of the truth of this fact, and have left
most useful precepts in relation thereto.
This series of ideas, gave rise to the mode of observation to many in
the profession relative to atmospherical constitutions and medical: each
to be properly distinguished, and not mistaken one for the other.
ETIOLOGY.
41
The atmospheric constitution is nothing else than the complex of
those external agents which concur in the formation of the atmos-
phere, and, whose action is considered in relation to the organism.
Thus we have cold constitutions, hot, humid, dry, electric, etc.,
according to the different circumstances of temperature, of moisture,
of electricity, etc., and the succession of those different conditions
and the predominance of one over the other in a given time. This
atmospheric constitution has, for its principal effect, to act upon a
certain order of organs; thus cold modifies, very strikingly, the
respiratory apparatus; heat, the bilious secretion, etc. Thus we see
inflammatory diseases of the respiratory passages and organs in the
winter season; bilious fever, hepatitis, diarrhoea in summer; inter-
mittent fever in autumn, etc.
If then, this atmospheric constitution acts less sensibly and is not
capable of producing diseases, or, of prolonging their duration, in
this case, it impresses upon the constitutions graduated modifications
which end in producing, in nearly all individuals, but, in different
degrees, a general state, the first terminus of which is called the
medical constitution and the last the epidemic constitution. Hence the
immediate and spontaneous action of external agents, carried to an
unwonted activity, gives rise to a greater number of diseases, but not
differing in nature from those which follow the ordinary impressions
of these agents brought into relation with the debilitated organisms.
On the contrary, the prolonged action of a special atmospheric con-
stitution, in which, besides the ordinary element of the atmosphere,
there might be, or not, a certain new element of new formation,
determines the successive changes of the economy, and a new manner
of being, and this is called the medical constitution. In fine, when
such changes are carried to a pitch, high enough to determine a com-
plete pathological state, they end in realizing the same disease, at the
same time, in a great number of persons and creating an epidemic.
The medical constitution manifests itself still more by its effects
than by its causes. In this case, a particular attack may begin,
directed against the entire organism, which, while it is not in a state
of health, does not, in the meantime, constitute disease. A certain pre-
disposition to such or such other kind of suffering exists and it would
be said that there is a kind of slow and special impregnation of the
economy brought about, whether by the atmospheric constitution
anteriorly or manifestly by some unknown cause. It is precisely in
30
42
A TREATISE ON TYPHOID FEVER.
this manner, that, during the Typhoid fevers we admit a kind of geu-
eral disposition existing in the economy and which prepares the way
for this fatal affection.
There are, without doubt, in all the opinions regarding medical con-
stitutions, many hypotheses or points of vision, more ingenious than
solid; and, most true it is, that certain facts reported here are unim-
pregnable; that, often, we see diseases prevail at one time rather
than at another, while the actual state of the atmosphere explains, in
no manner, the opportunity or the frequency of their appearance;
that, often, the character and the course of diseases are influenced by
general circumstances independent of a preceding cause. Such
inflrences must be very complicated. It is certain, primarily, that the
state of the temperature, and the atmospheric conditions which exist
in the stage anterior to that in which they are observed, have a power-
ful influence upon the actual state of the organism. Heat, moisture,
dryness, etc., act differently upon the animal economy, and, it is cer-
tain, as Hippocrates has verified it, that the manner in which winter
comports itself has an influence upon the health of men in spring;
that the climatic conditions of the spring modify the diseases of the
summer and, thus, through all the seasons of the year. It is often
observed, too, that, affections in one of these seasons propagate them-
selves to the following seasons; the catarrhal diseases of winter
continue during the spring; the chest affections of the spring are
prolonged into the summer; the gastro-hepatic sufferings of the
summer extend into the autumn and so on.
Independently of these causes of medical constitutions we must
admit, further, the possibility of some special poisoning, existing to a
feeble degree, and resulting from the possible action of some agent or
some matter, diffused through the air, or, elsewhere, and which may
produce, upon the general health of men, a particular disposition.
It is impossible not to believe, up to a certain point, in the reality of
medical constitutions when we observe the frequency of such and
such diseases, at such and such times, while there is nothing which
can explain, at this period, either the frequency, or, the common
character of the disease or whence the parentage which they seem to
to assume. It is difficult not to believe it when we see ancient
authors, such as Sydenham, ascribe to it so great importance, while
men eminent for judgment and intelligence share, to so great an
extent, in the opinion of this great master.
ETIOLOGY.
43
14
We may then assert, without any danger of contradiction that the
atmospheric air displays great influence in the production of Typhoid
fever, by the changes of its physical qualities, and that, in the actual
state of our knowledge, we find it impossible to account for this fact
or how it produces various modifications in the character of the fever.
But, besides its physical quality, the air may vary also in its
chemical qualities, and instead of being composed of seventy-nine
parts of azote and thirty-one of oxygen, combined always with the
minutest quantity of carbonic acid gas, and a variable quantity of
water, according to its temperature, it may vary in these proportions
of gas, and contain others besides, which come from divers exhala-
tions. In fact, the respiration and transpiration of animals diminish
the proportion of oxygen gas and increase that of carbonic acid gas
and water. Combustion produces, in the constitution of the air,
alterations analogous to those arising from respiration. The combus-
tion of carbon produces also a certain quantity of carbonic oxide gas.
Alcoholic fermentation developes a considerable quantity of carbonic
acid gas; acetic fermentation absorbs a certain quantity of oxygen;
the putrefaction of vegetable and animal matter developes, not only
carbonic acid gas, but also azote, ammonia and, sometimes, hydrogen,
both pure, and carburetted or sulphuretted, such as comes from the
marshes. Divers other chemical operations greatly diffuse, in certain
rarefied states of the air, gases, foreign to its composition, as nitrous
and sulphurous vapor, hydrogen gas, carburetted hydrogen, the
oxide of azote, etc. The emanations arising from the surface of the
earth, from certain mines, from odorous bodies, from the evacuations
and transpirations of the sick, diffuse themselves in the air, producing
changes in it, which become potent causes of disease. Hence,
authors on typhoid fever have noticed, among its causes, the emana-
tions of putrefied animals and vegetables, of carcasses and unburied
carrion, of putrefying blood, of excrements, of the dirt of the streets
and, in fine, of any sort of filth. The atmosphere, impregnated with
human exhalations, even of healthy men, living in confined spaces as
in prisons, in houses of correction, in the narrow quarters of ships,
and, in every community where too great a quantity of people, even
if healthy, sleep together in apartments not suitably ventilated. But,
much more, may the fever be produced by the exhalations of indi-
viduals affected with acute continued fever, and lying one above the
other in narrow spaces, as is the case in nearly all the hospitals, where,
in confined quarters, many fever patients are collected, and still more
44
A TREATISE ON TYPHOID FEVER.
easily and more frequently in the field-lazzaretti, where also, crowded
together in narrow quarters, are wounded and fever stricken soldiers.
What occurs or what changes take place in the air of these places,
chemistry has not yet been able to discover; in the meantime, it is
certain that Typhoid fever is developed, especially by these circum-
stances, as will be more fully set forth in the section on unnatural
causes.
II. FOOD AND DRINK.
are essentialy necessary to man, as well as to all other animals, being
required to restore, to the blood, the materials consumed by the
vital processes, and, to insure the integrity of the substance and
composition of the body; in other words, they are needed to sustain
the growth of the body and to repair the losses of solids and fluids
which are experienced.
Food, taken in proper quantity, at a proper time, and of good
quality, produces the pleasurable sensation of a want satisfied, the
disappearance of a general lassitude which gives place to a sensation
of a renewal of the strength and of pleasant well-being. Taken,
however, immoderately and, of poor quality, they produce a sensation
of distress in the stomach, marked by a feeling of fullness and weight;
its motions produces nausea, and even vomiting; the diaphragm is
crowded upwards, impeding a free respiration and always accompa-
nied by a painful tension of the abdomen; digestion is incomplete,
difficult, often febrile and developes gas which ascends into the
œsophagus; the concentration of energy towards the stomach
enfeebles the muscular and cerebral force, and hence inertia and
oppression take the place of the comfort and activity which follow a
moderate repast.
The good or bad state of the body, the harmony or discordance
which prevail in the functions depend, in great part, upon the food.
There is, properly speaking, but one food, but there are many species,
as Hippocrates says, “Alimentum unum et species ejus multœ." It is
not easy to determine, in particular, what is suitable to each indi-
vidual, since men, possessing the same constitutions and placed in
similar circumstances, are not impressed alike, and are not equally
affected by the same alimentary substances, so that experience alone
can determine what is useful and what injurious to each one. In
fact, the gastric sensibility and the dissolving power of the digestive
juices are very variable in individuals who are much alike in tem-
perament, that is, food suitable for one, is, in a measure poison for
ETIOLOGY.
45
"Nullum
another, as has been excellently observed by Boerhaave:
alimentum universali titulo salubre dici potest; et qui rogat, quodnam est
salubre alimentum, idem facit, ac si quaereret, quisnam sit ventris secundus,
non cognito itinere. Besides, circumstances, not always being the
same, the sensibility of the stomach and the dissolving quality of the
gastric juice are modified thereby. It often happens that a certain
alimentary substance, which one digests very well to-day, cannot be
borne another day, while some other food, more difficult to digest, but
for which there is more appetite, produces no inconvenience. Hence
in the choice of food and drink, we must consult the appetite, which
is variously excited by this and that, which is brought to its notice.
Accordingly we cannot establish regular rules in this matter, and
there must be many exceptions, not only as regards the different con-
dition in which the organism may be found, but, also, as regards the
habits which render the use of certain aliments less salubrious or
should make them preferable to others. Finally, we must, to a cer-
tain point, obey nature, which, in the different conditions of the body,
seems to say, with a species of instinct, or spontaneous appetite, what
are the substances which should be used to prevent threatening dis-
eases or relieve those which exist. This same nature, in certain sick-
ness, inspires disgust for all animal food, and produces an instinctive
inclination for vegetable substances, especially acids. In other cases,
on the contrary, it excites a vigorous appetite for bitter, sour, absorb-
ent things and the like.
The improper use of food cannot produce a specific disease, like
Typhoid fever, but, rather a gastric embarrassment, which, if it hap-
pens during the prevalence of a fever, easily exposes one, who has
thus transgressed, to its attack, and physicians have noticed, that,
derangement of the stomach and worms are the most powerful causes
to develope or increase such disease.
Many physicians affirm that they have observed as a cause of
'Typhoid fever, eating flesh without vegetables, bread or wine, eating
the flesh of beasts who have not been thoroughly bled, of carrion, of
sick animals, of fish spoiled and putrid, or rotten eggs, or poor bread
or that made from mouldy wheat, or decayed vegetables, also the lack
of fresh and pure drinking water and other similar things. Expe-
rience, however, shows that such kind of food, though sometimes the
cause of disease, does not always generate Typhoid fever and hence
we should not believe that this disease may be artificially and arbi-
trarily produced by the use of food or drinks of poor quality.
46
A TREATISE ON TYPHOID FEVER.
It cannot be denied, however, according to the observations of wise
practitioners, that the use of insufficient or unwholesome food pre-
disposes to Typhoid fever by reason of the debilitating influence
exerted on the economy; when an epidemic exists, persons who are
scantily or poorly fed are more susceptible to an attack of contagion,
though we cannot admit that such a cause may suffice to generate
an epidemic; hence we cannot admit as true, the maxim accepted as
an absolute law," If there is no scarcity, there will be no epidemic." In
115 cases Chomel found but five in which the disease was attributable
to the lack of food or its poor quality.
It has been observed, however, that, during an epidemic of Typhoid
fever, a change from the usual food rendered the system more inclined
to take the disease. In his work, already quoted, Graves says:
"When the poor were admitted into the asylum, they stepped at once
from an insufficient and unwholesome diet, to one which was whole-
some and abundant.. Now, although a change of that kind might
have been an improvement, it became dangerous, by increasing the
morbid susceptibility. At Cork, during the epidemic, it was necessary
to make a camp for the troops, because those who came, well nigh
starved, had to suffer much by the change of regimen and fell sick.
One of the finest regiments of Sweden, composed of men from Dale-
carlia, lost from such causes, some years ago, about half of its num-
ber. These soldiers had to leave their country life to go to the
capital; in place of black bread and peas, their ordinary food, they
had the more nutritious food of Stockholm and such a change, so
affected their health, that, to save the survivors, they had to return to
their previous diet." Hence we conclude that the use of spoiled or
unwholesome food, the long martyrdom of hunger, frequent and long
fasts, excess in narcotic and spirituous drinks, the abuse of warm
drinks as tea, coffee and the like, irregularity in meals producing
gastric disturbance are powerful occasional causes, in the develop-
ment of this disease.
III. MOTION AND REST.
Regular and moderate motion is the corner stone of good health
and nothing conduces thereto more than suitable exercise. It is com-
monly said, live and act, and all the organs of the animal economy are
made to be exercised. In fact, health cannot be inaintained except
by the free circulation and the proper division of the forces and
humors; everything which favors the regularity and harmony of
ETIOLOGY.
47
these, by maintaining the proper equilibrium of the principal phe-
nomena of sensibility confirms the health. Now such are the effects
produced by motion and rest; the latter concentrates action and the
forces and debilitates, while motion distributes each alike to the
organs and gives strength. Thus Celsus says, "Inaction weakens
the body and labor strengthens it; the first brings premature old age
while the second prolongs youth."
A slothful life not only produces disease but also makes man useless
in society and gives rise to every vice. Inaction is the fatal source
whence flows the greater part of the calamities which afflict the
human species.
An active life is the source of prosperity and changes the poorest
constitution into a good one; it makes the body but little sensible to
the impressions of the atmosphere and the changes of the seasons.
Weak and delicate children, who have been obliged from their earliest
years to exercise in the open air and to endure great heat and cold,
become strong, robust, and capable of resisting the action of the most
potent causes of disease.
Plato relates, that, in his youth, children were brought up severely
and knew but little then of the diseases which afterward became very
common, after they had departed from the austere life of the ancient
Greeks. This philosopher also thought that customs, had so great an
influence upon the health, that he could judge of the corruption in a
city by the number of doctors. He noticed, also, that those men,
whose manner of life approached the most to that of the people who
lived in simplicity and innocence, are much less subject to disease and
attain a much greater age in comparison with those who dwelt in
great centres of population, notwithstanding the conveniences in
which they lived.
It cannot be denied that, irregular and immoderate exercise weak-
ens the physical, emaciates and renders it incapable of any proper
function; it always leads to a premature decrepitude, the culmination
of a thousand painful indispositions. Hence to live well and long we
must often intermit severe labor and learn to repose those organs
which are daily too much exercised. And reading the etiology of
Typhoid fever, in the writers who have given it attention, among the
occasional causes which figure with all these we find excessive labors,
long races, forced marches, etc.
IV. SLEEP AND WATCHING.
Sleep is the repose of the senses and of voluntary motion; it is one
1
;
48
A TREATISE ON TYPHOID FEVER.
of the great blessings of nature; it procures, in a certain measure,
the happiness of being renewed every day and of enjoying, so to
speak, a new life. Without sleep, how little pleasure would there be
66 Take
to life! how rapidly would the sensibilities become enfeebled !
from man sleep and hope," said a philosopher," and he would be the
most unhappy of beings."
Watching consists in the exercise of the senses and of motions
dependent upon the will. In such a state the spirit enjoys all its
activity; receives impressions which every sense transmits to it, pre-
serves and prolongs them. To the faculty which we possess of
retaining sensations we owe the power of comparing and making
judgments.
These two states of man should be regulated with the greatest pos-
sible care, if we wish to enjoy good health and a long life.
Sleep, when too prolonged, stupefies both body and soul; if too
short, there is insufficient repair and violent and febrile excitements
soon destroy the health.
To retire in good season, to sleep seven or eight hours, to rise early,
should be the rule for persons desirous of preserving themselves in
their normal state. But, in great cities where everything is reversed,
the silence of the night is broken, they go to bed when they ought to
be getting up, they sleep in the daytime a febrile, unrefreshing sleep
which does not restore the strength, leaving the organs deteriorated
and disposing to the gravest accidents. Too long waking ruins the
most robust temperaments and begets weakness in those whɔ, accord-
ing to the old proverb, "turn day into night and night into day;"
their pale and squalid looks denote the grave affections of which they
soon become the prey. We cannot with impunity depart from nature,
nor, violate her laws, without exposing ourselves to a real calamity.
We should avoid, then, prolonged watchings and know that the
sleep of the first part of the night is more pleasant and more repara-
tive; that it is also the most powerful means of restoring and
preserving life. The blood becomes enlivened, the brain rests, the
physical sufferings are soothed, the pains of the mind are removed,
the organism is relieved, hope returns to the heart under the influence
of sleep according to nature and the laws of health.
From disregarding the laws of sleep and waking, spring many dis-
eases, and those who treat Typhoid fever do not fail to notice the
continued and protracted watchings or labors or profound medita-
tions, or excessive diversions among the abuses of other non-natural
things.
L
F
૬.
49
V.
ETIOLOGY.
EXCRETIONS AND RETENTIONS.
The excretions serve for the purification of the blood, for the relief
of the organs, for the maintenance of health. Whenever a secretion
which should be evacuated, is retained, or is evacuated in too great a
quantity, this constitutes a retention or a discharge. In the first case,
from the matter abnormally collected, morbid effects arise from the
mechanical compression excited by the fluid retained in its receptacle;
irritations, congestions and inflammations, more or less severe, and,
often fatal; in the second, we have loss of the motive power, pros-
trations, faintings, pallor, cachexy, etc.
Man enjoys health when every organ performs, in proper relation to
age, sex, and temperament, its proper functions. The secretions and
excretions are functions most important for the preservation of
health: a change in them announces more or less disorder in their
movements and actions, and, in the chief centres of sensibility there
is a lack of harmony which constitutes disease.
All practitioners agree that, by the alteration of these acts, many
various diseases, according to circumstances, may arise and hence
figure in the etiology of all the alterations of the animal economy,
and, it is no wonder, that we find set down, as causes of Typhoid
fever, the excessive and sudden loss of humors of every kind and
chiefly of blood, semen and milk. And among these causes onanism
is the most destructive of all.
VI. MENTAL PASSIONS.*.
All the passions, in fine, when pushed to excess, are the cause of the
most violent diseases which are often fatal, and, from these diseases
we should not exclude those which concur in producing Typhoid fever.
If we pass to review the non-natural causes we shall see clearly,
that, no less than the natural, they concur in bringing individuals
under the influence of Typhoid fever. In fact, we constantly observe
that the same person has nursed patients, in this fever, in various
epidemics with impunity, but, in a following epidemic has been
attacked. To understand this we ought to admit, as is reasonable,
that, in the origin of Typhoid fever, there is of necessity a two-
fold disposition, the natural, already spoken of, and, an eventual,
consisting in the particular condition in which the person finds him-
self, from the abuse which he has been making of things non-natural;
* Several pages are omitted here to make room for matter mere practically
important.- Trans.
50
A TREATISE ON TYPHOID FEVER.
since experience has demonstrated, that, at the invasion of Typhoid
fever, there must be the concurrence of an abuse of things non-
natural and of a gastricism. Hence it happens, that, unreflecting
physicians are often ignorant of the true efficient cause of this disease,
for, among the non-natural causes and gastricism they find the usual
cause of its being; however they believe it to be, at the beginning, a
common fever and are consequently obliged to retract, not finding it
to be what they say.
But the concurrence more or less hurtful of things non-natural, not
only contributes to the origin of this fever, but adds also powerfully
to its severity; all practitioners have noticed this truth. and no one
ventures to deny, that, among the patients whom they have seen suf-
fering from Typhoid fever, none suffer more severely than those who
have most abused the six non-naturals, and no cases are lighter than
those where less abuse has been committed, this abuse being necessary
to the origin of the same; and this is why some say that they have
not observed Typhoid fever in persons who are very careful and exact
observers of hygienic laws, and, that if any have been affected, it has
been so slightly that physicians with difficulty, and unwillingly, have
acknowledged that they had Typhoid fever, so mild were the symp-
toms presented.
III. UNNATURAL CAUSES.
The causes which are called unnatural, because they succeed, under
proper influences, in changing natural causes and non-natural, are the
epidemic, the endemic, contagions and poisons.
The epidemic cause must be universal, if it is considered to be in
the atmosphere. The endemic cause, may arise from the physical
condition of the place and from the ordinary habits with which people
live in such countries. The contagious cause is a morbific entity,
enclosed in some sort of atom, and transported from one body to
another and, reproduces in the healthy, the same disease which the sick
have who have furnished it. The poisonous cause is anything imme-
diately fatal, not from abuse, but, from its essentially destructive
nature, without other diseases preceding and which may produce
fatal diseases of various forms. The epidemic, endemic, contagious
and poisonous causes are always specific and each one, over against its
proper disease, always figures as an efficient cause. Nevertheless, the
relations which these causes have among themselves, and, with the
other causes, are three. The first consists in the difference which
ETIOLOGY.
51
#
epidemic, endemic, contagious and poisonous diseases sometimes have,
from natural causes which lend to them the aptitude to occur, while,
from the non-natural, is given the opportunity for development. The
second consists in the dependence which the common constitutional
and accidental diseases have upon the unnatural causes and, especially
upon the epidemic and endemic. The third consists in the corre-
spondence which diseases, produced by such causes reciprocally exert.
I. ENDEMIA.
Endemia is a word derived from the Greek & in and dɛuos people
and, from ancient times, usage has sanctioned this expression to indi-
cate diseases which reign in a certain locality and, which are proper
to certain countries, and, in this sense, it was used by Hippocrates and
Galen. Van Swieten concurred in this idea, saying that the endemy
might exist outside of atmospheric influences. The definition which
Ferrus has given is but little removed from this mode of considering
endemy; he admits, however, that it is owing to local causes. Other
authors have added that such causes were ordinarily permanent and
more active at certain epochs. It will presently appear that it is very
difficult to separate, exactly, endemics from epidemics, and, the
influences which give rise to the first, cannot be at all distinct from
those of habitation and climate. Endemy has relations with such
circumstances as food, drink, customs and with all the circumstances,
finally, which can modify man in one country rather than in another.
In the number of the causes which concur in generating such a par-
ticular condition, we should remember the nature and exposure of the
soil, the water, the food, the atmospheric changes with the tempera-
ture, the dryness and humidity, the habits and customs of the inhab-
itants, every attractive substance diffused through the air, or, in a
certain locality; in a word, every agent capable of modifying human
life. Endemy is nothing but a local and permanent epidemy, and,
accordingly, some writers recognize two distinct orders of causes,
that is, the above indicated hygienic causes, and, certain accidental
influences, which return at given periods, but it would be impossible
to say exactly to which we should attribute one epidemic rather than
the other, as the opinions of such authors can only be taken as simple
conjectures.
Thus, to a moist atmosphere, they attribute the frequency of
catarrhal diseases, intestinal fluxes, endemic scrofulous affections; to
stagnant water, the periodic fevers and the miliary eruption of many
52
A TREATISE ON TYPHOID FEVER.
parts of Italy. Thus, also, to causes not well known, are attributed
the endemics of Typhoid fever, observed in certain countries, and
which prevail especially in great centres of population, and, perhaps,
more than in any other place, in Paris, where every family pays it a
sad tribute, and where country people are very soon attacked when
they go there to live. This fact has arrested the attention of hospital
physicians, for they noticed that the fewest patients were from the
city and that the rest had lived there only a few years or perhaps
months.
But if we consider that what has been observed regarding Typhoid
fever has also been observed as regards variola and scarlatina we shall
be less inclined to number among the predisposing causes the lack of
being acclimated. One would consider, and with good reason, that,
among the youths of both sexes who repair continually to populous
cities like Naples, Paris, etc., some to complete their education, but
the greater number to learn the various professions, the greater part
lived in the country where Typhoid fever prevails only accidentally
and, thus not having paid tribute to the disease, they are consequently
subjected immediately to the contagious influence, met everywhere, in
a large city, where the disease is permanent. If it is said that adults,
born in a large city, were relatively less frequently affected than those
recently arrived, this depends upon the fact that the former have, in
greater part suffered in their infancy, or, in the first years of their
lives, from dothinenteritis. Louis studied diligently the effects of a
longer or shorter residence in the city and found that, among seventy-
three individuals who had lived in Paris, from two weeks to six
months, twenty-eight or more than two-thirds, were dead; while, in
case of fifty-six who had lived there a longer time, the mortality
was sixteen or a little more than a third. Chomel also observed a
slight difference in mortality in favor of those who had been accli-
mated at a somewhat remote period. Others, however, agree with
Chomel that new researches, made on a greater number of cases,
would be the only means of obtaining more positive results, though
they consider that those who have been but a short time in a large
city are more disposed, than others, to contract Typhoid fever, and
those who pass a great part of the day in confined air and in the midst
of a great gathering of people.
As we are entirely ignorant of what are the conditions which deter-
mine an endemy, it is necessary for the progress of science to clear up
these obscure, and litigated points, and to physicians living in differ-
1
+
ETIOLOGY.
53
ent places, it belongs to inquire, which, among hygienic modifiers or
other agents, are chiefly influential in producing the diseases which.
they observe.
II. EPIDEMY.
The word epidemy is derived from the Greek ε upon and deμos
people and expresses the influence of disease which attacks a number
of people in the same country, and, at the same time, from any acci-
dental cause or from the junction of many causes which seem to con-
cur at that time. An epidemic always consists of an acute disease,
which, at first, manifests itself in isolated cases and then, in a degree,
invades the great part of the population. The disease is more violent.
at the beginning of the epidemic than at the close; it also attacks a
small number of individuals, sometimes in a most terrible manner
and, at others, with a rapid death. Subsequently there is a gradual
and successive increase of cases while the disease continues to be
intense; arrived at a certain degree as regards numbers and severity.
it seems to become less violent and fewer persons are attacked; the
cases of the disease become rare and finally disappear; sometimes,
from time to time, a few scattering cases appear, but these are light
compared with those first observed; sometimes it afterwards breaks
out afresh and these too are less severe than the earlier cases. Some-
times it is confined to one city or country, while, at others, it diffuses.
itself successively over an immense space, carrying destruction to.
many nations. During the course of an epidemic, all other diseases.
seem to cease, or, at least, they become less common. And it has.
been observed that intercurrent diseases, which are developed, during.
an epidemic, readily take on its character and present, in their course,
in their progress, and in their complications, whatever is peculiar to
the prevailing disease. Sydenham has particularly insisted upon
these facts and all other observers have verified, in this respect, as
well as in others, the opinions of this great practitioner.
ra
The duration of the epidemic varies from twenty days to more than
that number of months, and often, when it has run its course, it
ceases spontaneously, on other occasions it re-appears from time to
time, and, finally ends by disappearing entirely.
This duration is independent of external influences, as it has been
observed that many diseases have ceased even when all the causes,
suitable to their development, still exist, while others begin their
f
.54
A TREATISE ON TYPHOID FEVER.
·
attack when nothing of the kind is present. Certain epidemics appear
at fixed and regular epochs; others, at times, run over an immense
extent of country in a little while and develope themselves simulta-
neously, in many lands; others pass from one country to another. It
was observed by Pliny, and confirmed by subsequent physicians, that,
in general, the course of an epidemic is from East to West and that
their frequency is greater as the lands in which they prevail are nearer
the equator.
The causes of epidemics consist in the dryness of the air, in the
moisture of the summer, in the nature of the winds, in the heat
in intense cold, in atmospheric electricity, etc. We can not positively
affirm that it derives its being from an epidemic influence, since the
same circumstances prevail at other times, without being followed by
like effects. We do not wish therefore, to deny that many epidemics,
more circumscribed, do some times acknowledge evident causes
either in miasms or in the food or in other similar circumstances.
Typhoid fever is frequent in great cities, with a numerous population;
indeed the disease is never completely extinguished; hence, it may be
said to be endemic and, from time to time, acquires a considerable dif-
fusion from the enormous decomposition and putrefaction of organic
substances, vegetable and animal and by the mixture of the final pro-
ducts of the same, which are introduced into the organism in food and
drink, or in the air respired, or by cutaneous absorption. It cannot be
denied that many other causes may contribute to this and the greater
part of them is unknown, on which account it can not be explained
how, from time to time, this fever is seen to be diffused in epidemics
while, with others, it is only observed in sporadic cases.
[The facts here given are borne out by the following summary of
deaths from Typhoid fever, in Chicago, by months:
Jan. Feb. Mar. April May June July Aug. Sept. Oct.
Aug.
Nov. Dec. Total
1870 6 8 16
8
1871
8
8
10 14
38 58
49
35
18
268
Part'l
7 8
9
10
1872 19 11
13
12
22
19 10
1873
17
8
6
11
12
13 12
21 2
18
75
57
Rep't
17
94
140
107
49
33
524
31 52
1874 13
11
11
11
5
7
28
10
13 883
*
55
38
17
270
36
25
21
211
1875
11 8
10
10
9
4
12 19
46
44 17
17
207
It will be observed that typhoid is always present in this city.
ETIOLOGY.
55
Three cases of typhus were reported in 1870.
The great fire occurred
in October 1871. Many people were crowded together in barracks and
we note the sudden and great increase in the deaths from Typhoid
fever; 1872 was the most fatal year, caused largely no doubt by the
suffering condition that many had passed through the previous year.
T. C. D.]
The circumstances of locality, too, must have a remarkable influence
upon epidemic diseases, for there are quarters in certain cities, where,
during the reign of an epidemic, the inhabitants are more particularly
attacked; this is the case in Paris in the Rue de la Mortellerie, whose
very name seems to remind one of the sad privilege which they had of
being attacked above all others, by this severe disease. The annals of
public hygiene present many reports demonstrating this fact which
was notably manifest when the cholera invaded the capital; the same
occurred at Geneva; according to the researches of Odier it was
chiefly the lower city which was attacked by the epidemic and it was
chiefly that part of the city which was the least airy, and where the
population was most dense, that the popular disease raged the most.
Frank says of Quercetano, which was a large city, whose streets were
very narrow, that it was frequently the seat of fatal epidemics, and
that they ceased only when these streets were enlarged, thus favoring
the circulation of air.
In the cities of the Middle Ages, which combined, in the highest
degree, the conditions of insalubrity just enumerated, by reason of
the necessity imposed upon them by the barbarism of those unhappy
times, to surround all their cities with walls, which impeded the cir-
culation of air, contagious diseases every year had a multitude of
victims, and that chiefly in the most unhealthy quarters. The same
thing is seen even now in the city of Naples. The lower part of this
city embraces the large extent between the Rue Catalana and the
Piazzetta di Porto near the Porta-nova and the Pendina, as far as the
Carmine, embracing a large portion of the populous quarter of Porto,
Pendino, and Mercato. Here the air is well-nigh stagnant, the streets
generally narrow, and full of manufacturers, of silversmiths, gold-
smiths, cloth and linen merchants, dealers in provisions. Here, also,
dwell the most laborious and most numerous classes of the city,
rendering the population very dense; here, too, the heat of the sum-
mer is very oppressive; moreover, the narrow streets of these portions
are seldom exposed to the sun, while the pavements are wet during the
whole year, and the dwellings are very few which command a view of
56
A TREATISE ON TYPHOID FEVER.
the horizon, while the most of the inhabitants have to ascend the ter-
races to get a little air. These places are partly bounded by the sea,
which reaches to the Piazzetta di Porto, and to the skirts of the projec-
tion of Mezzocannone; the remainder takes in the ancient Palepoli,
which, in later times, was so neglected that up to the times of the
Anjou (1270,) the rivulet Sebeto was stagnant in the section called,
even yet, Fusariello, and had formed a lake called Fusaro, devoted to
the rotting of flax. Charles I., of Anjou, finally destroyed this, and
carried the water to the plain between the Ponte della Madalena and
the Tre Torri, towards a corner of the marsh. The inhabitants of this
low part of the city, especially those engaged in sedentary occupations,
and who had followed them for a long time, are pale, fleshy, of lymph-
atic temperament, and inclined to lymphatic congestions, and to indi-
gestion, while the women are subjects of cachexia, chlorosis and
amenorrhea. "And if you wish to complete the picture,” says Marino
Turchi, in his Observations upon Public Hygiene," it is not enough to
go through the most frequented streets, but you must penetrate into
those filthier and darker portions, into the houses of the poor, and see
what happens in those wretched abodes, where a single bed, and that
of the poorest, is occupied by both sexes, of all ages. Enter the
houses of those drapers, which you might better call the dark abodes
of hell, and of these you will find so great a number in the quarter
called Porto, that you will hardly believe it possible. In an apartment
not very large, I counted twenty-nine; here the cholera of 1837 com-
mitted fearful ravages, and it was then that these sepulchres were
whitewashed, by order of the authorities !!
"I have had the courage to visit those tombs, in which were com-
bined and multiplied the horrors which are scattered, here and there
in the different quarters of Naples. Quaeque ipse miserrima vidi. And
plucking up courage, I penetrated where poverty pines away in
wretched abodes, without air and without light, poisoned by the
mephitic vapors of filthiness, and made frightful by the annoying and
filthy insects, more pestiferous than the tents of Arabia, and more
unclean than the thatched cottages of Polynesia."
Whoever penetrates those ditches, those dark alleys, those inex-
tricable labyrinths, those filthy dwellings; whoever sees the caves of
those animals, those gloomy caverns, those walls, dingy and black
with mud, and plastered with mould, or falling down from old age,
and those few rays of pale and sinister light, hardly sufficing, at any ·
ÉTIOLOGY.
5
hour of the day, to discover all the horrors of the place; whoever sees
those rags, those tatters, those straw beds, that filthiness, that mud,
those open drains; he who perceives the mould, the stench, the pesti-
lence; he who has looked into those squalid faces, into those grievous
troubles, must have felt his heart oppressed with sorrow, his limbs
shiver with fear, as, utterly amazed, he can scarcely believe his own
senses, nor dream that it could be possible that, amid the beauty of
the nineteenth century, so many human beings could live in putridity,
where beasts would not stay, and in the meantime, no succoring hand
is stretched out to save them!!!
In these wretched quarters, then, the air, so unwholesome from its
humidity, and infected with various kinds of emanations, is inter-
cepted, and cannot circulate freely, and disperse these principles of
putrid exhalation. The dwellers here eat whatever they can find;
their food is but little nutritious, and it is no marvel that all epidemics
take up their abode there for the greater part of the time; with their
growth, the violent passions of the mind increase, anger, terror, sad-
ness, etc., hence the mortality produced here is excessive, compared
with that observed in other parts of the same city. On this account,
the wisdom of those who control public affairs should be directed, as
much as possible, to improve these quarters, by opening wide streets,
by the demolition of those vile dens, and by the amelioration of the
lives and homes of those unfortunate inhabitants, whence arise the
exciting causes of so many destructive diseases, remembering that
salus populi suprema lex esto.
Physicians who have observed hospitals and large cities, know that,
at certain epochs, Typhoid fevers become too frequent to admit of a
doubt that the atmospheric constitution has no slight influence upon
the development of the disease. This doubt cannot be resolved in the
actual state of science, except by suppositions and by analogies, more
or less probable. It is said, however, that the influence exerted by
the epidemic constitution has, in its favor, the facts, already cited, of
a very different mortality in different seasons.
III. CONTAGION.
Contagion is that imperceptible substance by means of which the
contagious disease passes from one individual to another. Sometimes
this word is used to express the mode of propagation of diseases by
which one individual affected communicates his disease to one or
more, who are in a proper condition to receive it and which, in their
4D
58
A TREATISE ON TYPHOID FEVER.
turn, serve as propagating elements for the disease of a peculiar dis-
position, the characters of which always remain the same.
The origin of contagions is distinguished by pathologists as two
fold; transmitted and spontaneous. It is said to be transmitted when
diseases are constantly seen to come by contagion, and not otherwise,
so that we do not know in what way the first patient had to suffer,
from whom the contagion came which was transmitted to posterity.
They are called spontaneous when diseases arise from common causes
in patients who first suffer from them, in whom they generate the con-
tagious efficiency, so that they can transmit the sames disease to
others.
Some practitioners would deny this second origin of contagion by
saying that the disease, which gives contagion, must have come from
contagion. But if we reflect that some contagious diseases, and those
considered such by unanimous consent, lack all evidence of trans-
mission, which has been abundantly demonstrated, we find it neces-
sary to retain the spontaneity of contagion. Thus Typhoid fever
which, at first, arises from the mere abuse of things non-natural,
becomes contagious when patients are multiplied and are constrained,
for want of room, to remain, piled up almost, in narrow apartments;
whence the effluvia exhaling from diseased bodies, not being decom-
posed by the air, give rise to the formation of contagious matter. In
some epidemic, and endemic diseases, contagion may be generated
and then they become contagious. In those places where putrefaction
exists some contagions may find circumstances proper for their
development and multiplication, since organic matter, when released
from its aggregations, by putrefaction, is more disposed to enter into
new combinations. Hospital gangrene becomes contagious in the
same manner as Dr. Ollivier has established, by indisputable facts, and
has finely set forth, in his work on traumatic typhus. A body of
armed men, not in communication with others, nor wounded, have no
nosocomial or traumatic gangrene. Now, in consequence of a battle
a hundred wounded enter a hospital, poorly ventilated, and where the
wounds are poorly treated. The disease breaks out and the pus, pro-
duced by it, communicates it to others. A man is attacked with
gangrenous ulceration of the intestines, in consequence of crowding
many persons into a place not well ventilated, and the fæces mixed
with sanies from these ulcers, touch the little folds about the anus and
form eschars there, in which case we have again contagion, in the
same individual, of a disease which was the result of an infectious
ETIOLOGY.
59
cause. The facts adduced by Gendron, Putegnat and a goodly
number of other writers prove that Typhoid fever, which as very
numerous facts demonstrate, is the product of the re-union of many
individuals or of infection, may, in other cases propagate itself from
one individual to another by true contagion. It is generally acknowl-
edged, to-day, that the vapors continually arising from the bodies of
living men, although in perfect health, if retained a long time in the
same place, without being scattered by the atmosphere, acquire a
remarkable virulence, and become the cause of the most contagious
fevers. Such is the cause of poison and hospital fevers. It is useless
to cite cases, in support of this truth, so generally acknowledged,
since it very often happens that such fevers are produced by the
crowding of individuals into small and illy-ventilated apartments.
Such, moreover, is Typhoid fever which, in armies, arises first from
atmospheric circumstances, and infection is, meantime, very soon
reproduced by contagion; in these cases a virus is formed, a germ, a
principle susceptible of producing the same disease as that which has
given it origin although the aforementioned germ may not have been
communicated, at first, to individuals attacked by this fever. We
should not hence infer, as some practitioners seem to do, that this
multiplication is made by means of worms, which, as every one
knows, are generated in putrefaction springing from the egg which
the insects, already existing in the atmosphere, deposit in the putrified
substance.
The propagation of contagion must occur, without doubt, by means
of a material agent, which is called contagious principle or virus, the
existence of which, though it eludes all the researches which have
been made, may be maintained as a positive fact. This propagation
does not always happen in the same way and hence it is said that it
may occur by inoculation, by contact, by effluvia, and by vehicles.
1. Inoculation.- It occurs by inoculation when the passage takes
place by visibly transforming the contagious efficiency under the form
of morbid matter from a diseased part to a healthy one. Every one
sees this alone to be the chief and irrefragable argument of contagion
in a disease because it falls under the senses and leaves no room for
doubt. But not all contagious diseases are from a fixed contagion, as
they can be transported by means of inoculation, as variola, vaccina-
tion, tinea, syphilis, hydrophobia, etc. The visible matter of inocula-
tion in some diseases, is a morbid product like the pus of small pox,
vaccination, etc. Sometimes it is a natural humor, infected by
60
A TREATISE ON TYPHOID FEVER.
contagion, like the saliva of the mad-dog; sometimes it suffices that
it should be a body that has touched the infected place and is quickly
transported to a healthy one as the head dress of a child with tinea
and the glove of the patient with itch. Hence it happens that it is
not yet determined whether the matter of inoculation is itself the con-
tagion or the mere conductor of an efficient contagion. It is sure that
not all substances, from the patient, not even his blood will communi-
cate the contagion; but this cannot be transported except by the
given morbid matter or humor, while the rest of the body remains
exempt.
It is known that the contagions or conducting matter of contagion,
by inoculation, must be taken in a given time, in a certain quantity,
kept with great care from the air, not changed by variation in tem-
perature, not spoiled by age. But, even in this respect, certain par-
ticular contagions present particular exceptions; science has not yet
attained such precision as would be required to make it general. The
conditions which the human skin presents, on receiving the inocula-
tion of various contagions, are very various and singular. For some
contagions the epidermis is a powerful insulator, as for syphilis,
variola, vaccinia, rabies, etc., which remain inoperative when placed
upon a skin covered with a healthy epidermis; it is necessary that this
should be removed or artificially incised or scarified. For certain, in
which the epidermis is an insulator, the epithelium is not; since
inoculation, as in syphilis, takes place when the contagious matter is
applied upon the spots which are in contact with the air under the
cover of the epithelium. For some, as in rabies, it is absolutely neces-
sary that the epidermis or epithelium should be removed, so that the
contagion may be applied to the skin or the flesh wounded or exco-
riated or already laid bare. Finally we have some contagions like
small pox, aphthæ and some of the prurigines in which it seems
probable that, it is necessary for the absorption of contagious matter
to take place before the disease is developed; hence, in such a case,
besides the other conditions necessary for the immediate success of
the inoculation, certain acts are needed to favor and effect the
absorption. Now such an absorption, which is, however, nothing but
a probability, for it has not yet been fully demonstrated, some wish to
make use of as the basis of a general hypothesis, that contagions,
even when inoculated, cannot develope the disease till they have been
absorbed. On the contrary, we should conclude that the science of
the transmission of contagion by inoculation should be considered as,
F
ETIOLOGY.
61
in fact, in its infancy, since we cannot establish any general maxims
without more exact observations, yet in the future.
2. Contact.- Contagion occurs, by contact, when by touching a well
body with some part of a sick body the disease of one is transported
to another. This manner of transmission has received the name of
contagion from the Latin contingere, to touch, because the power of
such diseases is transmitted by contact; thus whooping cough,
mumps, yellow fever, Typhoid fever, cholera, etc., are propagated,
since it was never known that they could be transported by inocula-
tion or by what humor or material the transportation could be
affected. Hence it follows, that, the transportation of a disease by
inoculation is, as we have said, an irrefragable proof of the contagious
nature of the same, but, that it cannot be transported by inoculation,
is not, in fact, proof that it is not contagious. And this word contact
should not denote the true and actual contact of body with body, but
also that excessive proximity, in which the atmosphere from two
bodies may meet and commingle and the activity of the effluvia from
the contaminated body alters that which is healthy. Thus there are
contagions which are not found in a fluid state, mixed with the humors
of the body, but which constitute a vapor, and hence are called vola-
tile, which exhales from the surface of the diseased body forming a
contagious atmosphere extending a few feet, so that, though the
healthy body may be at a certain distance from the sick one, the com-
munication of the contagion takes place. The air which always
intervenes between bodies never presents any obstacle to this com-
munication, but, rather, acts as a medium of contact. And this may
happen as long as the atmospheric air which surrounds the contagious
body, and which tends to destroy the contagion has not produced this
salutary effect. Thus it may be established that the air is not the
vehicle of contagions, but that the atmospheres of contagious matters
may pass through it, when the quantity of the molecules of contagion
exceeds the decomposing force of the atmospheric air. It may happen
that the wind may transfer, from one site to another, an air pregnant
with contagious molecules, with such velocity that the successive
strata of atmospheric air have not the time necessary to affect the
decomposition of the principles of contagion. In such a case we see
a contagious malady, rapidly passing from one point to another, quite
distant. Hippocrates, in his times, knew this truth, for, while the
plague was prevailing in Illyria he advised his fellow citizens to take
care when the wind blew from those countries passing over the inter-
62
NATURE OF THE DISEASE.
mediate mountains. And who has not seen periodic miasmatic fevers
prevail in autumn in elevated places, where the air was salubrious,
just because the people had breathed winds from the country in which
there were marshes? Who does not remember that, in some years,
the malaria from Lake d'Aquano is transported north as far as Cam-
aldoli and to Mt. Posilippe to the east and forward to the Casino
Patrigii? From what has been said it results that only volatile con-
tagions can diffuse themselves to such a great distance, while fixed
contagions absolutely require the real contact of contagious and
healthy bodies.
3. Effluvia.-It is said that propagation is made by effluvia when
the disease is communicated a certain distance, from a sick person to
a well one; while the latter did not touch the body of the sick, nor
even his clothes, which might in such a case have been the vehicles of
contagion.
All practitioners are not agreed in their manner of explaining this
fact. The most think that it happens through the effluvia which the
body of the patient diffuses through the atmosphere, some, through
special modifications which the atmosphere undergoes, and, others
that a real projection, like that of electricity, is the efficient contagious
cause of the disease. Hence arise various opinions upon the proba-
bility, possibility, or necessity of this propagation. But, from all this,
it may be held that, in the most cases of contagious diseases, the
diffusion of the effluvia is favored and fomented by miasms, and
by impure air, whether by reason of the exhalations of marshy
places and of those where putrefaction has taken place or from
many men being crowded into narrow limits, as in hospitals, prisons,
camps, ships, etc. Under all these circumstances, by neglecting
cleanliness and ventilation, it seems that the air, laden with putrid
exhalations, multiplies the exciters of the contagion and becomes
susceptible of spreading it to a great distance, which happens but
seldom when the air is very pure and freely moving. To this kind
belong the contagions of pest, of typhus, of yellow fever, of spas-
modic cholera. Volatile contagions, being conveyed rapidly from
individual to individual, may attack many men in the same time.
Hence it is said that a certain disease is contagious or epidemic. But
let us reflect that epidemics depend upon universal causes, which act
upon many persons, at the same time; such causes would be air, food,
etc. Epidemic non-contagious diseases cease with the cessation of
those causes which produce them; hence they originate amid the
heats of summer and cease with the causes that produced them, while
ETIOLOGY.
63
contagious diseases prevail in all seasons, in all climates as has been
observed in spasmodic cholera, called Asiatic cholera, which unhappily
prevailed in Naples in the years 1836 and '37, in 1854 and '55, in 1865
and '66.
4. By Vehicles.-The propagation of contagion takes place by
vehicles, when it occurs through bodies which receive the contagions,
from the sick, and convey it to healthy individuals, provided they touch
the bodies. This kind of propagation is also called contact by physi-
cians, but mediate contact, to distinguish it from immediate, as just now
set forth. Everything which has touched the sick body, or, if the con-
tagion has been volatile, has remained in the contagious atmosphere,
is, hence, a vehicle. For fixed contagions a vehicle is necessary,
which may retain, in itself, the humors or the visible morbific matter
of the sick. For volatile contagion, it is necessary that the surround-
ing bodies should have been able to preserve, within themselves,
the molecules of the contagion; such as shaggy bodies of wool, of
flax, of cotton, and generally all cloths and skins. The celebrated
Palloni of Leghorn narrates that a linen handkerchief, with which
the face of a small pox patient had been wiped, after having been
kept in a trunk, sufficed to produce this contagious disease in an indi-
vidual, who being at sea, made use of the same after eighteen days.
In such a manner it has happened that some individuals who have
been in the midst of a contagious disease without being affected by it,
having carried, with their clothes, the seed of the disease, have been
capable of communicating to others, with whom they have been
brought in contact, this contagious disease which prevailed in locali-
ties very remote. Pringle cites cases, where, from the tents used by
soldiers, sick with typhus, the disease had been communicated, a long
time after, to twenty operatives who worked there. Vaccine virus
may be kept for an indefinite time and Ozanam cites the case of grave
diggers who contracted the small pox from the corpse of a man who
had it ten years before. It should be noticed, however, that con-
tagions whether fixed or volatile, remain attached to surrounding
bodies, unless air, water or other disinfecting agents (such as Sulphuric
acid, Chlorine and the Chloride of Lime) have decomposed the con-
tagious matters which they hold. If they were not thus held, the
lazzaretti would be in vain and especially the cleansing houses in
which, by means of ventilation, the contagious molecules contained
in goods are destroyed.
•
It is a property common to all contagious diseases to multiply the
64
A TREATISE ON TYPHOID FEVER.
efficiency of the contagion in an indeterminate manner. That is, we
cannot say that one contagious disease multiplies itself more, and
another less, because each may communicate itself to an indefinite
number of persons. If one wishes to have this explained it cannot be
done in a positive manner, because we do not even know what is the
contagious principle or specific virus endowed with this property. It
is certain that virus exercises a chemical and poisonous action, but
what is it? in what does it consist? what is its nature? here are
points about which we know nothing. Modern chemistry is not at all
content with the erroneous explanations of the middle ages touching
the acidity, or alkalinity by which they sought to account for the
action of the virus. If one would wish anything more positive,
unhappily it is not to be had. We can no more explain the mode in
which virus acts than we can explain the method by which an anti-
dote exerts its efficacy to destroy poisonous effects.
It is to be hoped that the recent advances of organic chemistry will
tend to raise the veil in which the history of virus has been enveloped.
It is vain that we compare the essence of the contagious principle
to sulphuretted hydrogen (Thos. Trotter) or to the oxide of azote, to
which has been given the name of septon (Samuel Latham Mitchell). In
vain has this latter substance been studied carefully by many Ameri-
can physicians, who haye made it perform an important part in the
production of yellow fever, etc. All this has revealed nothing to us
of the chemical nature of virus. When we find, too, that these are
composed of carbon, oxygen, hydrogen and azote in certain propor-
tions, we have reason to think that we cannot, from this, explain their
poisonous action and the reason why each one acts in a special man-
ner. Chemistry knows nothing more than this of the manner in
which such poisons act, just as it cannot judge the various characters
of odors and flavors.
Unhappily, all this is much more true of the emanations which are
produced in certain circumstances, and especially of those which
emanate from the marshes. Although we know some of the circum-
stances, in which they are formed, we do not really know what is
their intimate composition. Chemistry has not yet verified all the
changes, which the air undergoes, in places where many people are
collected, and the researches of Bousingaut, while they demonstrate
that the air of marshes contains a hydrogenated and carbonated prin-
ciple (which might have been known a priori, as they are surely
vegetable substances), this has not given us to know the nature of
ETIOLOGY.
65
marsh miasms. We know, and can not doubt, from effects produced,
that there is, in many acute affections, a poisoning produced by the
virus, by emanations, by miasms; everything leads us to believe that
these substances act primarily upon the blood; we know well that
they differ from each other, since their effects are often very differ-
ent; we know that, in some of these, the phenomena which take place
follow their action almost instantaneously, while, in other cases, a
certain time must pass after their first influx and they are developed
by accident; we know that some of these poisons modify certain
organs, while some alter other parts, etc., etc. As regards the compo-
sition of miasms, the emanation of virus, as to their nature and the
explanation of their mode of action, our ignorance is well nigh abso-
lute.
Some, resting upon the faculty which virus has of developing
special diseases, which observe certain periods, have compared them
to the germs which accidents develope in relation with them in the
same manner as the development of plants is manifested; and thus,
if animalcules are found in certain humors, it has been thought that
special insects might have been the causes of the virulent diseases.
Linnæus maintained this opinion and it is, at present, that of Raspail.
This explanation is not positive, in the actual state of science, for,
though, in itch the sarcoptes is well known, yet, in other virus, the
presence of animalcules proves nothing and their admission is based
only on analogy or hypothesis. It is very true that, in the con-
tagious pus of vaginitis, special infusoria are found, to which has
been given the name of tricho-monas, while the vibrio has been found
in some other circumstances, but the author of these works himself is
far from believing that these animalcules were the cause of syphilitic
phenomena. No one has yet positively met special infusoria in the
fluid of the vaccine pustule or in that of small pox, in the saliva of
rabid dogs and no one has observed them in the poisonous substance
which produces scarlatina, measles and other diseases of that kind,
nor do we at all know any liquid or solid which can communicate the
affections of which we are speaking.
In the study of viruses there are some circumstances which separate
them from the action of other causes and which it is well to know.
1. In general, the virus, reproducing itself many times, remains sub-
stantially the same, that is to say, it is always capable of communi-
cating the same disease. Nevertheless, it happens that, with time, or
other circumstances, there is a kind of enfeeblement or diminution of
!
66
A TREATISE ON TYPHOID FEVER
!
energy of the phenomena produced by the virulent cause. This is
what has been supposed to have been observed in syphilis, in vaccinia,
and it is very certain that small pox, communicated from one indi-
vidual to another does not carry with it all the symptoms noticed in
the former; this proposition, however, has no general bearing,
because we often see slight cases of small pox produce severe cases of
the confluent. 2. It is said that virus is more active when communi-
cated at a period nearer the invasion of the disease. 3. Virus does
not act as many other substances, with an energy in proportion to its
mass, while the conditions of its composition, or its increase are far
from deciding the importance of the phenomena which supervene.
4. There is a kind of production of virulent diseases, of such a man-
ner, that, far from diminishing, as takes place from the movement in
which the producing cause has acted and, as happens in many other
affections, they are developed in degree as they leave the epoch of
invasion, taking on a certain increase and diminishing subsequently
in a regular manner. 5. Virus often determines local effects, which
are followed by general phenomena, while, at other times, the contrary
is observed, etc., etc.
Speaking of the propagation of contagious, or virulent diseases, we
adopt the expression infection which has various significations and is
almost a synonym of contagion, as it signifies a disease received from
another, an impure disease, a disease arising from causes foreign to
and corruptive of the body. In a more restricted sense the term infec-
tion is given to those contagious diseases alone which arise, or which
are repeated, or which exist in places filthy and crowded, as prisons,
ships, hospitals, producing these decaying and spoiled and fetid sub-
stances, which, by hypothesis, are supposed to be the nidus or source
of contagion. In another signification, still more restricted, the title
of infection is given to any contagious disease when we find a popu-
lation so extensive and multiplied that we can no longer discern by
what particular contact it passes from one to another, for it seems as
if nearly all the people in the country were affected; and, in such
circumstances, some, without necessity, suppose that the atmosphere
is infected with a contagious efficiency and use the more restricted
signification of this word to express such hypothesis.
Some say that, by infection, we should understand the principal
cause of disease and of the action exerted upon the surrounding air
by men crowded and massed together in low, confined, obscure or
filthy places and of animal or vegetable substances in decomposition.
ETIOLOGY.
67
The emanations with which the air is saturated act as a deleterious
gas. This does not happen in contagion; in this case, to reproduce
the disease, we no longer need the action of the causes which have
given it being. It is reproduced, in some manner, by itself and inde-
pendently, up to a certain point, of atmospheric conditions. There is
developed, in every patient, a kind of germ, of virus, indeed there is
formed about him, an atmosphere, super-charged with the principle of
the disease and, by means of this germ, this virus, or this principle,
the disease may be transmitted to another individual.
This distinction seems, at first view, to be very clear and well
adapted to show the difference between this mode of propagation of
many diseases. Non-contagionist physicians insist upon it, in these
latter times, and, upon it, they rest questions of public hygiene rela-
tive to quarantines and the like the discussion of which cannot
enter into this work. Unhappily this very distinction is not easy to
establish, in particular cases which present themselves, since, a cer-
tain disease which, in certain cases, is transmissible by infection, may,
in others, be capable of transmission by contact, so that opinions, the
most opposite, may be sustained by the two parties and with reason,
from the particular cases which have been observed. In this regard
contagious diseases may be distinguished as coercible and incoercible.
There are certain contagions which, perhaps because they require
many conditions in the transmission by contact or by inoculation, are
so slowly diffused, before they amount to a general infection, that,
with proper sanitary precautions, they may be restrained, and their
progress checked and, by isolation, people may keep themselves
intact, even in midst of a general infection. Such are all the con-
tagions which spread by inoculation, such are aphthæ, petechiæ,
whooping cough, plague, miliaria, yellow fever among those which
spread by contact. There are other contagions which can not be
restrained, in any manner, neither in their invasion, nor, as regards
their spread, whether because contagion progresses with inconceivable
rapidity or because they advance by some other impulse; such are
mumps, variola, measles, scarlatina, and, beyond all others, cholera.
Some contagious diseases always have possession of a certain number
of patients, which number does not vary but with the external causes
which have relation to the contagion; such are syphilis, itch, tinea,
etc., but others, from time to time, are so entirely concealed that they
seem extinct, but re-appear again, at various intervals. Among these
diseases, called spontaneous, it is easy to see how they cease and how
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A TREATISE ON TYPHOID FEVER.
they may spontaneously re-appear, either in our midst, or in their
own country; it is from this reason, too, in the main, that we have to
admit a spontaneous origin, that is, so complete is the extinguishment
and so rare and tardy the re-appearance, that it does not seem admis-
sible that a contagion which is so slow to appear could only have been
concealed. But neither is it easy to understand, at the time of the
extinction of the most common contagious diseases, how the conta-
gion can be concealed and then re-appear again. In such a case the
most think that the contagion remains concealed in garments which
there has been no opportunity to disinfect; these garments having
been laid away at a time and place when the natural, non-natural,
unnatural, radical and hurtful causes concurred to their multiplica-
tion and to the spread of the disease, thus it happened that the disease
re-appeared: others, perhaps, more reasonably and conveniently,
believe that such diseases wander like vagabonds through various
nations and various parts of the earth, and never leave one place but
to appear in another, according to the concurrence of causes which
favor its multiplication or its spread. In such an uncertainty we
ought not to cease investigating what are the goods which can retain
the contagion, that we may if possible prevent the return of the same
diseases.
Epidemic are often confounded with contagious diseases although
there is a difference between the two classes of disease. It is proved
that contagious effluvia do not act but at the smallest distances from
the bodies whence they emanate, and that, on reaching the air, they
become rarified and entirely dissipated. Some diseases owe their
indirect action to an atmospheric air, not renovated, and hence
vitiated by exhalations of different kinds, or to foods or drinks of a
poor quality. The atmospheric variations have a general influence
upon the course of the disease, but rarely do they interrupt or arrest
contagious maladies.
The usual epidemic diseases generally appear at certain times of the
year, as catarrhs in winter, pleurisies in the spring, abdominal fluxes
in summer, and intermittent fevers in autumn, while contagious dis-
eases appear, indiscriminately, at all times of year. The epidemic is
then general and sudden, now wandering and transitory, now limited
to a single locality; it attacks, at the same time, a great number of
persons and, very often, takes on an insidious form. Contagious dis-
eases have their invasion less rapidly; they are more limited; some
present themselves under their natural character, continue under the
ETIOLOGY.
69
same form and physiognomy and cease when all communication
between sick and well is interrupted; others take an insidious form.
Epidemics have no fixed course; they prolong their existence, or,
they cease suddenly, or, in fine, change place without any possibility
of explaining these anomalies. Contagions are only propagated
according as the points of contact are multiplied, and as many indi-
viduals are found exposed, at the same time, to their immediate
influence. Prevailing epidemics frequently cause intercurrent mala-
dies to cease, or at least make them participate of their nature, a
property which contagious diseases do not have. Neither do epidem-
ics have a chronic course, unless we except raphania and some con-
vulsions and spasms. All, in general, are acute. There are contagious
diseases of one kind and another. All febrile epidemic and con-
tagious diseases are acute. The first have no determinate periods,
while there are few, among the second, that have not, as the eruptive
exanthematic fevers. Epidemics frequently attack men and animals,
at the same time; sometimes they attack only one sex, one age, one
single species of animal. Contagious diseases rarely attack animals of
different species at the same time, but, when they have manifested
themselves, in one class, they respect neither age nor sex, and, in gen-
eral, attack all persons exposed to their influence. Sometimes the
plague has been seen to extend to men, to dogs, to birds, to the car-
nivori, to swine and to whatever animals ate of the carcases of those
who died of the plague. The carbuncle of cattle is communicated to
men. Horses are subject to the glanders, to gangrenous peri-pneu-
monia; cattle to typhus; fowls to quinsy; dogs to catarrh, diseases
which are common to men like scabies and hydrophobia. Contagious
diseases seem sometimes to spare old people and those whose fibre,
condensed, and rigid, or stricken with atony, or paralysis, guarantees
them from the impression of the disease. These diseases have been
seen, sometimes, to attack the inhabitants of a country where it pre-
vails and to respect strangers. Two epidemics, like two contagious
diseases, may afflict a country, or a place, at the same time. Some-
times an epidemic disease associates itself with a contagious and vice
versa. A contagious disease takes an epidemic character as small pox,
measles and scarlet fever. All epidemic diseases are subject to
relapse, in the same individuals, and then re-appear again, at an
indeterminate time. A man who had been exposed to the epidemic
influence of a country, might contract the epidemic although he had
left the place as soon as the disease had declared itself. This is not
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A TREATISE ON TYPHOID FEVER.
the case with contagious diseases. But, if an individual had, with the
greatest care, avoided every means of contact, and every communica-
tion with the diseased, and with their effects, those things which they
had used would not be able to give him the disease if they had been
sufficiently exposed to currents of atmospheric air, or, had been disin-
fected in some other way. Contact with and visiting those suffering
from a disease purely epidemic, are not a sufficient condition for con-
tracting the disease, which attacks indifferently those who abstain
from visiting the sick and those who wait upon them; while in a con-
tagious disease, contact, or, immediate communication, or exposure to
the contagious effluvia, are a necessary condition to contract the
contagious disease. The contagious snbstance or contagion has the
property of attaching itself to certain inorganic bodies as wool, cotton,
etc., which receive it passively, hold it in charge, and, by means of
their conductive virtue, transmit it to living bodies which come in
contact with them; the agent or the epidemic miasm does not then
hold this activity exclusively. The epidemic diseases, which attack
the mucous membranes, are the most frequent and are those which
run over the greatest extent of country. Contagious diseases are
always more circumscribed.
Febrile contagious diseases, from the very beginning, are character-
ized by certain grave and imposing phenomena, which indicate their
severity; this is only observed when the disease takes a pernicious
form or, degenerates into contagion, a pathological truth confirmed
by experience. Marsh miasms, generate endemic diseases and not
epidemic. These differ, from the beginning, because they are only
temporary, while endemics are continuous and their convalescence is
more protracted than that of epidemics. The effluvia of many indi-
viduals, gathered in confined quarters, occasion diseases of prostration
which degenerate into contagious diseases. Epidemic diseases are
peculiar to climates situated between the tropics and the poles; the
contagious, however, belong more particularly to the regions situated
between the tropics, where they often take on an epidemic character.
These same diseases are more contagious in the southern regions than
towards the north, which shows that contagion is introduced by the
absorbent system which is more active under the high latitudes. An
epidemic disease, although exercising all its influence upon other
intercurrent diseases, has no power to neutralize them. Some con-
tagious diseases have also an influence upon certain affections, whose
locality corresponds with those which the former attacks by prefer-
ETIOLOGY.
71
་
1
+
•
ence; thus, the individuals who had been previously attacked by the
plague, or venereal bubo, will experience new pains in the glands,
when another plague presents itself. The same pains are felt in the
cicatrices of carbuncles. Intercurrent diseases often take on a more
serious character at such times. There are contagious diseases which
are able to neutralize others and to arrest their course. Thus, it is
observed, that, when there is plague in a country and when small pox
breaks out there, the former ceases spontaneously. Those attacked
with the small pox can not be attacked by the plague, while the former
disease is pursuing its course. The moral emotions such as joy,
maternal love, fortify one against contagion, while fear has a contrary
effect. Such are the general characters which distinguish epidemic
from contagious diseases.
CONTAGIOUSNESS OF TYPHOID FEVER.
It has always been and is now a vexed question whether Typhoid
fever is contagious or not. Physicians are divided into two parts,
some hold the affirmative, some the negative. But all agree that
Typhoid fever is endemic in some places, that it often appears epidem-
ically and, sometimes, it can not be denied, that it is also contagious.
Meanwhile, a certain number of physicians, chiefly those who practice
in the country, are convinced that Typhoid fever is transmitted by
contagion.
Those who hold a contrary opinion are in greater number and
Chomel says that they are as 100 to 1.
All who have observed Typhoid fever in villages do not doubt that
it becomes epidemic there, after the manner of contagious affections.
Often, when brought into a village, we see it pass from a person
attacked by it, to some of those who have nursed him. It is trans-
mitted, successively, from the family affected, to another family and,
in general, it is observed that the disease communicates itself, not
indeed to all the nearest familes, but to those who have been more
intimate and have had more frequent relations with the sick. Practi-
tioners, in large cities, can not observe the transmission, by contagion,
as easily as physicians in the country. The families of country people
are numerous and crowded; the little children all sleep in the same
bed and often a single room serves for an entire family. Cleanliness
is a matter quite neglected. The parents and neighbors are the
attendants of the patients and fill this office with a zeal worthy of all
praise, though the consequences thereof are almost always deplorable;
this circumstance, more than any other, influences the propagation of
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A TREATISE ON TYPHOID FEVER.
the epidemic. Just the very opposite conditions obtain in large cíties,
where, if those who enter the hospitals were accurately questioned, it
would perhaps be demonstrated, that, if laborers are more affected
than others, it is because they are in direct communication with their
comrades, and live with them in narrow and dirty streets.
If a country, a village, a family, had been exempt from Typhoid
fever and each individual had enjoyed perfect health, up to the
moment when an individual affected with this disease came into their
midst, and that, afterwards, and always according to the succession
of the relations of divers subjects, with each other, Typhoid fever had
broken out, it would become necessary, according to the logic of facts,
well observed, to declare that there has been contagion and that the
disease, from the first case, had been contagious. Now, in this way,
precisely, Dr. Leuret, physician at Nancy, in his paper on Typhoid
fever in the Archivii generale di medicina, tom, XVIII., presents many
facts which have fully convinced him of the transmissibility of this
disease, by contact.
Dr. Ruef, in his history of an epidemic of the same disease, which
manifested itself at Bischofsheim, a commune in the department of
the Lower Rhine, in the months of August, September, and October,
1832, gives many facts in support of the contagious nature of this dis-
ease which are reported in the Gazette medicale, 1834.
In Bretonneau's memoirs, and, in those of many very skillful physi-
cians, many facts are recorded in favor of the contagion of Typhoid
fever as we may see in the different volumes, of the above cited
Archives, and sufficient to dispel all doubts on the subject. Dr.
Gendron, however, has sought to establish the fact "that the real
cause of the disease was the more frequent passing from village to
village and the continual renewing of imprudent visits." The new
paper, subsequently published by the same author, in the Giornale
delle conoscenze Medico-Chirurgiche, contains valuable remarks con-
cerning the causes of epidemics of Typhoid fever. He narrates, with
great diligence, the different circumstances preceding and accompany-
ing the development of dothinenteritis in villages, in towns, in small
localities, where it is easy to find the first patients and the cause which
has provoked the disease. He found that it was always transmitted
in one of four ways:
1. By direct immediate contagion, when the patient is attended
by his parents, by his friends or by a servant; with whom he has
necessarily direct relations.
ETIOLOGY.
73
2. By direct mediate contact which takes place when one is in the
atmosphere of the sick.
3. By indirect mediate contagion when those who have contracted
the disease have had no relations whatever with the sick, but have
communicated, more or less frequently, with those who nursed or
visited them.
4. By indirect immediate contagion: this mode of contagion takes
place when one contracts the disease by having touched some object
used by the sick, has carried their clothing or slept in their beds.
The first mode of contact is the most powerful of all. Gendron has
observed that the epidemics of Typhoid fever have evidently their
origin in an importation of the disease and are the effects and not the
causes of contagion. Although it is not possible to make sure of this
importation, the disease is propagated from the first patients to their
attendants in a manner so constant, that it is not possible to deny the
existence of contagion. It is as much more active as communications
with the sick are more frequent and their number more considerable.
In whatever place an epidemic of dothinenteritis reappears, its return
does not depend upon a local insalubrity but upon the importation of
the disease or upon suspicious communications. An isolated dothin-
enteritis may propagate itself, supposing also that it was developed
spontaneously. Convalescents may transmit it. Those who have
been attacked by it once do not contract it the second time, and are
proof against it forever. Some seem refractory to the contagion, but
these are exceptions and the immunity observed is the consequence of
a loss of aptitude for the disease by reason of having suffered from it
already or from a particular and inexplicable disposition, examples of
which are furnished also by other contagious diseases.
The views advanced by Gendron, in his papers, have been sustained
by other physicians and among others by Putegnant and de Letalenet.
The latter, thinking that typhoid was not always contagious, observed
that, in the very same epidemic, we may meet many grades of the
typhoid affection and sometimes, even, a simple typhoid state, which
nevertheless preserved the individual from attacks of the disease.
Lombard and Fauconnet declared themselves partisans of the con-
tagion of Typhoid fever and affirm, that, the facts observed by them,
are all favorable to this opinion. These authors have been able to
follow the transmission of the disease from nurses to parents,
friends, etc. Nevertheless, they do not hesitate to declare that a cer-
tain number of Typhoid fevers are spontaneously developed.
"The
D5
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A TREATISE ON TYPHOID FEVER.
inquiries which we have made, whether in our private practice, or in
hospitals, have shown that in nine-tenths of the cases, the patients
had been exposed to contract the disease, in a contagious manner,
while those in whom the affection seemed to be developed in a spon-
taneous manner, formed but a very small proportion of the total
number of our patients. Louis has lent his authority to the doctrine
of contagion which seems to him demonstrated by facts. Gualtier de
Claubry is entirely of Louis' opinion.
It results from the different works, published in favor of contagion:
1. That Typhoid fever is contagious and spontaneous. 2. That it is
contagious to a great degree like variola, measles, scarlatina and even
the plague. 3. That it has a period of incubation, the duration of
which is variable. 4. That it preserves, from a new contagion, those
once attacked by it, and, that we have no example of a return of this
disease. Contagionists add still another deduction. 5. Persons not
acclimated, by quite a long stay in a large city, and who have not
paid tribute to this kind of acclimatization, contract the disease
oftener than those in different conditions. 6. Typhoid fever, under
the force of certain influences, may acquire the property of becoming
contagious.
care.
The anti-contagionists say, and among them are the physicians
of Paris, that, in the hospitals of that city, the disease does not seem to
be transmitted from one patient to another. Andral in his Medical
Clinic says: "Outside the hospitals, what circumstances are most
favorable to contagion among those who are gathered as students of
medicine, who nurse their comrades attacked with Typhoid fever?
Shut up in a small apartment they lavish on them the most assiduous
Were the disease contagious all would contract it and yet I do
not remember ever to have seen a single instance where the disease
originated in this manner in a healthy person." Chomel, who is still
in doubt about contagion, notices, nevertheless, that it is very rare in
hospitals where the beds are occupied by patients who necessarily
succeed to beds which have been occupied by those who had dothin-
enteritis. Students, physicians or nurses who are in continual rela-
tions with Typhoid fever patients, do not contract the disease, or, if
they have observed any cases, they were very rare. Chomel, after
having weighed the reason alleged for and against the contagion of
Typhoid fever, comes to the following conclusions:
"The opinion
adopted by the majority of French physicians, that is, that the typhoid
disease is not contagious, can not be admitted as demonstrated; if
ÉTIOLOGY.
75
this disease is contagious it is so only in a slight degree and, under
the concurrence of circumstances, as yet but indifferently settled.
When subsequent observations shall have demonstrated, in typhus,
similar anatomical lesions, to those seen in Typhoid fever, the identity
of these two affections will be placed beyond doubt, and the question
of contagion will be settled." From these facts, it results that this
question should not be settled from one side only; in fact it is impos-
sible not to give some weight to the numerous facts of contagion
observed by physicians who have practiced in small places. Besides
we ought to give proper consideration to the rarity of cases of Typhoid
fever in conditions in which the disease ought to make the greatest
havoc, if it were very contagious, for example, in large cities and in
hospitals. Could not Typhoid fever become contagious, should the
patients affected by it become more numerous, should they be crowded
into confined and ill-ventilated places, enfeebled by wretchedness, by
privations of any kind or by excessive fatigue, wasted with sorrow, in
a word, when the hygienic conditions should be just those which pro-
duce typhus? A disease which does not possess any eminent con-
tagious property, when it attacks isolated individuals, may become
contagious, under the influence of the particular circumstances which
render it epidemic. Contagion being the product of the elaboration
of a morbific agent, accomplished by the organism, this agent might
also produce a disease not contagious, which should attain a great
intensity from any cause whatever; in this perhaps consists all the
difference between Typhoid fever and typhus. This difference is
manifest in sporadic plague and in epidemic plague; because, while
the first is never transmitted when it prevails in that state, the second,
on the contrary. is held by nearly all physicians to be the only one
contagious. Prus has set this in a clear light with numerous observa-
tions in his Rapport sur la peste et sur les quarantaines.
Still other physicians, considering that the accumulation of men in
large cities has been held as a favorable cause for the development of
Typhoid fever, say that this fever is developed more by infection than
By contagion. In support of this opinion it has been assumed that
there is a greater frequency of the disease in individuals, lately
arrived at a large city, and among workmen who dwell in numbers of
from four to eight, and even more, in a furnished apartment, close
and illy ventilated, where they pass a part of the evening and the
night. If the vapors produced by a single man, though in good
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A TREATISE ON TYPHOID FEVER.
health, confined to a small space, may become hurtful to another man
who inspires them, for the first time, much more evident is the hurtful
influence of confined air and especially that of prisons, ships and
besieged cities, in a word, in every circumstance where men are
crowded together. But the complete conformity of symptoms,
whether the morbid process arises, in this, or, in that manner, forces
us to admit that the specific virus, found outside of the human organ-
ism, and reproduced within the same, that is, the Typhoid miasm and
the Typhoid contagion may be identical in nature. Those then who
do not find any difference between Typhoid fever and typhus, use, in
favor of the infectious origin of Typhoid fever the facts which prove
the development of typhus by infection; and there is not, some say,
any other difference than that derived from the intensity of the causes.
Numerous objections might be made to the supporters of this doctrine,
which we omit for brevity's sake, but the reader can make them him-
self, from what has already been laid down, upon the mode of propa-
gating the contagion; we will merely say that, as long as we do not
know what is the matter of contagion, nor, whether it may be trans-
ported at will, from one individual to another, that is, when the disease
is not propagated by inoculation, there will always arise, between the
contagionists and non-contagionists, these useless and insignificant
questions.
IV. RADICAL CAUSES.
The radical causes are all those species of virus which, penetrating
the human organism, infect its entire constitution and generate, not
the acute diseases which arise, are developed, and terminate, by the
sole forces of the vital power and have a limited duration, because
products of causes which gradually exhaust their effects, but those
chronic diseases, not proper to one organ alone, but to all the organism
and to the entire organic substance; therefore they are not cured by
the sole fact of the vital reaction, however favorable the hygienic con-
ditions in which the patient is placed may be, and, not being cured,
they transform, and, in their successive evolutions, invade, the greater
part of the organism, ever taking on more severe forms and finally
producing death.
All schools divide diseases, according to their duration into acute and
chronic; they call those acute which unite to a certain gravity a rapid
course and a short duration; those which last a long time and whose
symptoms develope and succeed one another slowly, are called chronic.
ETIOLOGY.
77
The Homœopathic school also admits this distinction but bases it
upon causes which produce the one and the other.
Acute diseases depend upon causes always accidental, which exist
outside the organism and which reach the organism, through the
media which surround it; such are atmospheric influences, changes of
temperature, chills, under whatever form they are produced; improper
diet and regimen of life, the passions of the mind, traumatic causes
and any acute miasms which are developed in the bosom of the earth,
or in the diseased human organism, infecting the atmosphere and
absorbed by individuals in good health with the air indispensable for
respiration.
Chronic diseases are always produced from a profound and lasting
cause, a chronic miasm, a special virus, infecting the organism gen-
erally and infecting it in a positive manner, so as to produce serious
diseases.
The cause of these chronic diseases according to Hahnemann are,
the three miasms or viruses, the syphilitic, the sycotic and the psoric.
The sgphilitic virus has been accepted by all practitioners, without
exception, as capable of generating an infinite variety of chronic dis-
eases, all differing as regards their location, and their symptoms, as
caries, exostosis, phthisis, alteration of the skin, ophthalmias, pains,
pulmonary and visceral catarrhs, etc. It is true, as experience
affirms, that parents can beget children infected with syphilis while
they present, at the moment of conception, no external symptom of
their condition.
The sycotic virus presents itself in vegetations generally called con-
dylomatas and is held by most physicians as making part of the cate-
gory of syphilitic diseases, properly so-called. Hahnemann was the
first who put this into a class by itself, assigning to it, as cause, a par-
ticular virus, since the remedy which would cure the ulcers, would not
cure the vegetations and therefore these might manifest themselves
without being accompanied by any of the ordinary forms of syphilis.
The psoric virus, which has the itch for its primary form, is laid
down by Hahnemann as the most diffused and most difficult to com-
bat, since it takes on new forms with the greatest facility and in the
most insidious manner.
Now, with the discovery of the acarus, most of the young physi-
cians refuse to retain itch among the radical causes, for, say they,
destroy the acarus and that is the end of the disease. But Prof. Biett
says, “Is it demonstrated that the presence of the acarus is the only
+
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A TREATISE ON TYPHOID FEVER
thing that constitutes the itch? may it not be an accident, a complica-
tion? and why is its chosen location between the fingers and on the
anterior part of the hand? Why the enormous difference between
the number of the insects and that of the pustules? Why do we not
find an egg for each pustule? Would it not be better to consider the
acarus as the conductor of the virus, which constitutes the disease?"
This is not the place to discuss all these questions. It is certain
that the experience of all the practitioners of antiquity has confirmed
the truth that the itch should be retained as a radical malady, capable
of altering the organization in a chronic manner so as to produce
chronic disease, and, for the most part, incurable, without the admin-
istration of the special remedy.
These radical causes, being in the system, make sad work of the
organism and always present an obstacle to the prompt and rapid cure
of any disease. It is these which constitute the so-called bad constitu-
tions and which are the cause that any small lesion suppurates and
that the suppuration continues a long time, if attention is not called
to it, and the proper remedy prescribed. Should this be the case
with those affected with Typhoid fever it can not be said that it
makes this either more or less severe, not having been studied with all
that attention which this matter demands of practitioners or that it is
the cause of bed sores, the suppuration of the parotids, sub-cutaneous
abscesses and any other suppurations which hinder cicatrization,
while, if it does not produce an unfortunate end to the disease, it
always prolongs the convalescence beyond what it would otherwise
have been.
V. LESIONS AS CAUSES.
Lesions are to be distinguished into internal and external. The
external injure by mechanically moving, distending, pressing, strik-
ing, wounding, deforming or by chemically corroding, corrupting,
cauterizing. The internal are vices or effects or morbid products,
which, generated in the body, offend, mechanically or chemically, the
part where they are located and the parts around; the mechanical
are all the anatomical destructions and that which may be considered
as causes of secondary disease and arising from mechanical disturb-
ance, distension, pressure which they make; the chemical are the
matters retained, collected, stagnating, absorbed and otherwise
deposited. Such are:
1. The blood enclosed in aneurisms, collected in ecchymoses and
ETIOLOGY.
79
effused into a eavity, in such a manner as that they may be placed
outside the influence of life.
2. The secondary fluids, stagnating in their canals, and especially
if they have been already changed by severe disease, as the dysenteric
flux, depraved bile and, abnormally retained urine.
3. Matters absolutely morbid as the serum of dropsy, the matter of
cystic tumors, the pus collected in abscesses or effused in empyema,
the ichor of malign abscesses, the sordes of wounds, the sanies of
cancer or of any other unhealthy sore, etc.
4. Worms, wherever they may be, and ordinarily in the small intes-
tines and in the indurated fæces.
These causes can not, of themselves, produce Typhoid fever but
they may cause much injury to patients suffering from it, as it has
been observed that, when this fever attacks the wounded, gangrene
sets in and the fever conceals its character under that of the gan-
grenous disease. Worms, by their motions, and excitements, pro-
duced in the intestines, are the cause of adding great and severe
nervous disturbances to the symptoms of the disease.
CHAPTER III.
SYMPTOMS OF TYPHOID FEVER.
To understand a disease thoroughly and to differentiate it from
others, we must know all the alteration which it presents during life,
whether in the quality of the body or in the functions, as well as the
sufferings which the patient endures and complains of. Such altera-
tions are called symptoms, which, falling immediately under the senses
are always evident and may be known by persons not professing the
medical art, while the physician only can know their importance.
Men are not all influenced, in the same manner, by morbid causes,
by reason of their diversity as regards sex, age, constitution, idiosyn-
crasy, habits, temperament, etc.; for diseases, although derived from
identical causes, always present a diversity in symptoms, and, hence
cannot always be considered the same disease, requiring the same
identical treatment.
We can not gain a knowledge of disease except by exact and com-
plete investigation of all the symptoms which it produces, which are,
to the disease, the same as the normal functions are to the life of the
body, by which it manifests its physiological state. The more intense
are the symptoms, the more intense is the disease, and, when we know
it all, in quality as well as in intensity, we shall know the disease
entirely, for this is made up of lesions of texture, of functions and of
sensibility, presented by individuals, and the physician must use all
the attention possible, and all his senses, armed with all needful
instruments, the better to observe, to study, and to collect, all the symp-
toms, without allowing any to escape. This having been obtained,
we proceed to question the entire organism, and notice every change
in each part separately; then the Homœopathist must compare these
symptoms with those produced by medicines upon the same parts,
when given to men in health, by means of which he can easily apply
the law similia similibus, and obtain a cure.
Now, that the physician may look for nothing but the prompt and
ensy cure of disease, thanks to the choice of the proper remedy, in
SYMPTOMS OF TYPHOID FEVER.
81
setting forth the symptoms of Typhoid fever, without occupying
myself with the order in which they are developed, I must first show,
in a general way, and, according to Jahr's method, the pathogenetic
symptoms of the drugs; this will not be difficult, if we compare the
symptoms of the disease with those of the respective remedies, by
which we may select, from among them that which is most suitable;
then I shall pass to describe the evolution, the duration and the mode
of termination of the disease. The true disciples of Hahnemann,
knew very well, and, wish that all other physicians knew, that what-
ever remedy will cure, will show itself indicated by symptoms, and
the best diagnosticator in the world, will never find, in that science
alone, any substitute for this examination. The order then, in this
exposition of symptoms, will be as follows: First the general symp-
toms, followed by those of the skin, the sleep, fever — moral symptoms to
be followed, in anatomical order by those of the head, the eyes, the
ears, the nose, the face and so on.
I. GENERAL SYMPTOMS.
Among the general symptoms are comprised the state of the vital
forces, tonic contractions, clonic convulsions, subsultus tendinum,
tremors, carphologia, etc.
1. Prostration, Adynamy.- One of the principal, if not the most
notable, effects of Typhoid fever is the prostration of forces, which
all authors, almost without exception, consider as one of the most
marked characteristics of the fever and which is more marked as the
disease is more severe. Even when the disease is slight, the debility
is such as is never found, in our climate, in any similar affection.
From the very first it seems to increase, from day to day, and according
to Louis, does not reach its highest intensity till the tenth or thirteenth
day. On account of this weakness and prostration, all the patients
have to betake themselves to bed and but few are able to leave it,
now and then, after the first day or two. Pinel, treating of this dis-
ease, under the name, adynamic fever, seeks thus to designate its
chief symptom. "Do not all the circumstances of this disease clearly
indicate a profound lesion of the vital force, a marked diminution of
the organic sensibility and of the muscular contractility ?" In this
respect, the title adynamic, given to Typhoid fever, is most appropri-
ate and would deserve to be retained, were it not used to designate
many different morbid states.
This characteristic symptom of the disease is present in many
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1
degrees, which we must study carefully and separately. When it is
quite moderate, some little attention is requisite to discern the dimin-
ution of strength. Patients seek repose and every movement seems
unpleasant. From the beginning, we observe a species of apathy,
physical as well as moral; every mental occupation is repugnant, and
the patient ceases to exercise his profession, if it requires any muscu-
lar force. If, in spite of the painful sensation, experienced from the
lassitude of the limbs, he persists in laboring, weariness promptly
ensues, and he can not work more than a quarter of a day. Soon his
legs tremble and bend under him; he drags them with difficulty; his
step is uncertain, like a man with too much wine and presents the
symptoms of that kind of typhoid inebriety which results from the pro-
found adynamic state of the nervous system. The stupor, the vertigo,
the expression of the face, concur in characterizing this compound
pathological state.
When the patients come to the hospital on foot, they are led by
their comrades who support them and even then they are often obliged
stop and rest. The step of these unfortunates has something special,
which, at once, shows that we have a case of Typhoid fever. The
expression of the face, and the position of the head, inclined to one
shoulder, or the other, completes the picture of this form of adynamic
fever.
When the prostration is still more marked
muscular contraction
is so much enfeebled that the patients are obliged to go to bed; they
sit up in bed with great effort; often, in fact, they need assistance
and soon they ask to lie down again, because they are taken with
vertigo and great distress. We can judge pretty well of the adynamy
by the manner, more or less rapil, in which he sits down upon the
bed. Some more courageous, or not so weak as others, continue to
rise from the bed, and some are seen who can sustain themselves, on
their feet, two or three days, before death. Most have such a repug-
nance, for any kind of movement, that they are utterly unwilling to
be raised up, while the physician listens at the posterior part of the
chest; when he is done they fall back, like a mass of inert matter,
upon their pillows, and, during the whole of the examination, their
features are contracted, and express distress and suffering; sometimes,
too, the patients bewail and utter inarticulate groans. These symp-
toms are usually observed at a more advanced period of the disease.
The prostration of the forces is attested even by the position which
the patient takes in bed; he lies, almost constantly, on his back, in
!
SYMPTOMS OF TYPHOID FEVER.
83
the most absolute immobility, with the arms stretched by the side of
the body, or, lying across the abdomen, and, when he changes this
position, he always takes that induced by the gravity of the body,
however painful it may be, on account of the ulceration of the integu-
ments and the contact of the urine or the fæcal matter escaping
involuntarily. Sometimes, the body, lying always on the back, obeys
the laws of gravity and slides towards the foot of the bed, a symptom
always noticed by the assistants, and which is generally taken as a
most unfavorable omen and of a very sinister augury. Generally
delirium exists too and then we see the patient thrown across the bed
or upon the anterior surface of the body with the head buried in the
pillows.
All writers on Typhoid fever are agreed that the enfeeblement of
the muscular action is so constant a symptom, that it never fails to
appear, and indicates, very clearly, the character of the disease. In
fact, this symptom appears early, and is well marked, in proportion to
the gravity of the fever.
The debility is considerable and of long duration, in nearly all the
patients, who are obliged to take their bed at the beginning of the
disease. This may go on, increasing, from the tenth till the thirtieth
day; that is to say, its greatest intensity is observed at very variable
periods. It rapidly attains the highest degree, if the disease is grave,
and generally does not diminish but very gradually; this is the reason
why convalescence is so long and often so painful.
The adynamia, in different degrees, is the first alteration which pre-
sents itself in Typhoid fever. The nervous system is primarily
affected, under the influence of an unknown cause, which produces
the whole of the typhoid symptoms and one must be very much
attached to a contrary medical opinion not to admit this truth; to
wish, for example, to subordinate the adynamic phenomena to the
intestinal lesion which might be inflammatory, or of some other
nature, and thus to conclude that, neither the state of the intestinal
tube, nor the diarrhoea, nor the other circumstances of the disease
could serve to explain this debility and that it is necessary to attribute
it to some cause or another which gives place to the development of
the intestinal lesion. The adynamy then, constitutes one of the chief
elements of the disease. To this adynamy we should, sometimes
ascribe the involuntary evacuations, and the incontinence, or, reten-
tion of urine which are observed in many patients in an advanced
period of the disease, when the skin of the sacrum or the nates,
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A TREATISE ON TYPHOID FEVER.
bathed with these matters, becomes red, inflamed, and gangrenous.
2. Tonic Contractions.- The tonic contractions, though they may be
much more rare, than the prostration and clonic convulsions, never-
theless, are almost always present as part of the train of the phenom-
ena of severe Typhoid fever. In the light form it is rarely observed.
In fact, Louis says that he has observed these contractions, in a third
of the patients who die and but six times in fifty-seven cases which
recovered. In the severe cases, they appear very early, often in the
first week but more commonly in the second or third, and, almost
always continue till death, constituting a very serious prognostic
indication.
These contractions continue to be more or less observed, in one or
more portions of the muscular system. Ordinarily partial, except in
case of complications, the tonic contraction occupies, most particu-
larly, the muscles of the neck and all the posterior part of the trunk,
of the eyelids and the flexors of the fore arm. Patients in whom these
contractions are observed present an immobility more or less complete
of the parts which are in a state of contraction. If the tonic spasm
has its seat in the muscles of the neck the head can not be flexed, nor
can it be carried to the right or the left, when the sterno-cleido mastoid
muscles participate in the convulsions. Most commonly, this spasm
occupies the extensor muscles of the spine; patients affected with it,
at such a stage of the fever, are generally a prey to delirium, and are
excessively prostrated; it is with great difficulty and only by the aid of
others that they can be raised to sit up in bed; the vertebral column
is inflexible like a bar of iron and the more attempts are made to
make it bend the more the patient resists, emitting complaints. This
same contraction is observed in the fore arms which remain applied
against the chest and resist whenever an effort is made to extend
them. If the convulsion has its seat in the eyelids, they remain con-
vulsively closed and it is with great difficulty that they can be sepa-
rated. Epidemics of Typhoid fever have often been observed in this
kingdom, accompanied by the most marked indications of contrac-
tion in various muscles of the trunk, and, from these contractions,
they received their name. In 1839, 1840 and 1841 they appeared in
Calabria where they were called by various names, as we gather from
the various monograms written, at this time, concerning this epidemic,
while many articles were written by Filiatre Sebezio in 1840-41.
We must not fail to speak in this place also of the contraction of
the motor muscles of the eye which is now turned upward and con-
SYMPTOMS OF THE DISEASE.
85
cealed under the upper eyelid and now turned towards the nose.
Strabismus only appears in the severest forms of Typhoid fever and,
when the lesions of the nervous system are considerable; sometimes
this symptom can not be relieved, which always indicates a fatal issue.
The spasms of the other muscles are much more rare. Spasmodic
contraction of the muscles of the pharynx and symptoms of hydro-
phobia have been observed. In some patients the great trouble to
swallow seems to be referable to spasm of the pharynx and, perhaps,
also, of the œsophagus. The diaphragmatic spasm is the cause of the
hiccough observed in many patients. Finally, though seldom, symp-
toms of catalepsy are observed, general tetanic shocks and opisthoto-
nus and trismus.
There are also observed, as symptoms of Typhoid fever, cramps of
the upper extremities or only of the fore arm and the neck. Hence
some say that, in cases where these cramps are observed, manifest
lesions of the membranes of the medulla are present. But it is also
the case that the cramps may manifest themselves, sometimes, in
Typhoid fever patients and not accompanied with any complication.
3. Fibrillary Contraction.-This name is given to a partial or tran-
sient contraction such as is produced in the muscular fascia when
pressed strongly with the finger or if one percusses a muscle
belonging to the life of relation. There results, then, at the point
irritated, a small tumor situated perpendicularly to the direction of the
muscular fibre and forming a species of nodosity which rapidly dis-
appears. Putting the finger on this nodosity, a hard tumor is felt,
resistent, in fact quite like that which a larger muscle presents in
which there has been a spasm. The fibrillary contraction is nothing
but a partial spasm, provoked by an external stimulus, exerted upon
a muscle. If the fibrillary contraction is relieved by the indicated
medicines, the patient feels a pain in the muscle which has been in a
state of convulsions, just as after a spasm.
These experiments should not be repeated, except with circumspec-
tion. The phenomenon is chiefly manifested in the brachial biceps on
seizing it transversely and pinching it a little strongly, then giving a
rapid blow above its middle part. This spasm is easily produced in
the pectoralis major as also in other muscles. Piedagniel, as far as is
known, was the first who observed it, in 1835. Since then it has been
diligently studied in many patients and has been observed much more
remarkably and frequently in Typhoid fever patients than in others.
86
REATISE ON TYPHOID FEVER.
A
It is necessary to say, however, that it is also seen in other circum-
stances, but in these it may be unimportant.
4. Clonic Convulsions.-The clonic convulsions which consist in
movements of flexion and extension, which succeed one another
alternately, are not rarely observed in these fevers in connection with
other symptoms and are not of good omen.
The face, in the severe form, is often agitated with slight convulsive
motions of the muscles of this region. In the face of these patients,
when drowsing, the corners of the mouth are seen distended, the lips
tremulous or contracted, the eyebrows, the eyelids, the lower jaw,
alternately convulsed and relaxed; in the midst of the painful
spectacle which the patient then presents, groans or lamentations issue
from his lips, and there is often a species of vacillation, of general
tremor, of all the muscles of locomotion. These symptoms, appear
singularly distinct when the patient sits up in bed. The members
and the limbs are affected with a tremor which does not cease, nor
diminish, till the patient lies down again. The morbid state, just
described, is almost always connected with other lesions of the
nervous system, and, chiefly, with a more complete adynamy.
5. Subsultus Tendinum.-The tendons and the muscles of the
body, especially of the limbs, experience jerks, which are called sub-
sultus tendinum. They hardly ever fail in Typhoid fever and take
their signification from the totality of the other symptoms. In very
irritable persons, they appear often, in the state of health, without
announcing any danger; hence, as an isolated symptom, they have no
especial value, but, appearing in this disease, in connection with the
ataxia, that is, the disorder of mobility, which is often manifested, in
clonic convulsons of the muscles of the fore arm, or, of the inferior
limbs, they acquire quite a different value. When they are universal
and connected with convulsions, delirium is certain and there is
reason to fear the death of the patient. Usually, the subsultus
announces itself the first time one feels the pulse; the radial artery,
being situated near a great many tendinous cords, the slightest move-
ment, produced in these cords, is readily made known in the corres-
pondence of the arteries indicated. Sometimes the movements are
so weak that it requires some attention to discover them, which
design is accomplished by taking all the lower part of the fore arm, as
one does the pulse, with the thumb and index finger. Another means
which also seems to make this symptom still more apparent consists
in raising the arm of the patient and extending it upon the bed.
SYMPTOMS OF TYPHOID FEVER.
87
•
1
6. Tremors.-The vacillating movements now interrupted, and now
continuous, in the extremity of the body, which appear in all periods
of Typhoid fever, announce the very worst condition of the motor
forces. In the beginning of the fever, the tremors indicate, either a
verminous complication, or a gastric congestion; those which are fol-
lowed by convulsions are ordinarily alarming. The tremors of the
hands, of the lower jaw, of the lips and, sometimes even, of the eye-
lids indicate the gravity of the disease and often are forerunners of
convulsions. It is very often observed that clonic convulsions of the
limbs manifest themselves by the uncertainty and tremor, apparent in
these limbs, when the patient wishes to drink or take any object, or,
when sitting up in bed, he wishes to make any gesture. If it happens,
in the midst of his delirium, that he leaves his bed, his whole body
vacillates, his trembling limbs support him with but difficulty, and
often he falls before he can be reached.
The tremor of the lips, of the lower jaw and of the tongue may be
considered as an effect of the clonic convulsion of the muscles. As to
epileptic convulsions, they are very rare and often precede contraction
and other lesions of mobility.
7. Carphologia and Floccilegia.- Carphologia is that continuous and
automatic motion of the fingers made by some patients deprived of
the use of reason, analogous to that which is made in health to pick
up any little object whatever. Floccilegia is said of that movement
of the thoracic limbs with which the patients, with arms elevated,
seek to catch something in the air, and it seems, as is said, that they
wish to catch flies or flying motes; they strive sometimes to pull their
hair and they often like to pull the bed clothes to pieces with their
fingers.
Both these symptoms announce a complete disorder of the muscular
system and of the intelligence, and they are generally manifested in
the last stage of the fever, combined almost always with delirium,
subsultus tendinum, involuntary evacuations and those various
spasms observed at the approach of death.
All observers have very generally agreed that these symptoms
denote, for the most part, imminent death. However, Double says
that he has seen many patients cured, after having been thus affected
for many days, and, therefore, confirms the assertion that their value
is entirely subordinate to the general state of the patient, and the
other symptoms present.
Some practitioners aver that they are not often observed, and were
1
88
A TREATISE ON TYPHOID FEVER.
seen only four times in more than 200 patients. Others say that they
have always observed them, in severe cases, and that, for the most
part, they end in death. In this diversity of opinion we have no
statistics by which we may finally decide. It may be therefore asserted
that, in the grave form, patients almost always die who present them.
When the carphologia makes its appearance the patients are almost
always prey to a manifest delirium, and, therefore, Chomel justly
observes that carphologia can not be regarded as a simple effect of
hallucination of the sight, as seems good to some to assert, and that
the intelligence of the patient is always injured.
8. Muscular Pains. In the beginning of Typhoid fever, the
patients complain only of the debility and lassitude of the limbs;
some sensations, sometimes become so painful, that every motion dis-
tresses and is avoided by the patient, who often complains of a pecu-
liar sensation which is always qualified with the singular name of
inquietude of the limbs, and, sometimes, there is real pain, having its
location in the muscular mass, or in the articulations only. These
symptoms are only observed in the beginning of the disease. It is
probable that the muscular contraction becomes painful in many parts
of the body which seems indicated by the lamentation, and expression
of suffering, which the physiognomy assumes when the patient is set
up in bed. This phenomenon has often excited the attention of the
practitioner when the lesions of sensibility and of mobility had
attained a considerable degree. Some patients complain of pain in
the cervical region, the dorsal or the lumbar, and it is thought that, in
similar cases, there exists some concomitant disease, an affection of
the medulla or its sheaths, hence that some have taken for Typhoid
fever, cases of cerebro-spinal meningitis, which disease in other times,
was surrounded with the greatest obscurity.
II. THE SKIN.
The skin is the seat of several symptoms of Typhoid fever; the
first among these is that which has a great symptomatic value and is
characterized as the rosy lenticular spots.
These papulous maculæ, lightly elevated, of a roseate hue, disappear-
ing under the pressure of the skin, and appearing again promptly, of
a roundish, oval or irregular form, whose diameter does not surpass
three or four millimetres, are characteristic of the disease, but do not
form an essential character of it, as do the intestinal lesions. When
the skin is white, they are easily discerned, but just the opposite
obtains in a brunette. In many cases the papule appears under the
SYMPTOMS OF THE DISEASE.
89
form of a red spot, of the size of a small lentile, protuberant mani-
festly enough to the eye and the touch, not disappearing under pres-
sure and resembles the papular eruption observed at the beginning of
small pox and is so confluent, and so marked, that, at a distance, it
might be taken for discreet varioloid. This confluent eruption is
quite different from that form, so fugacious, in which the papules only
appear to the number of eight or ten, upon the abdomen, the chest, in
the guise of little red points, which present themselves only to the
eyes of the most diligent observer; these spots do not form sensible
protuberances and easily disappear under the pressure of the finger.
The papules, large and protuberant, do not always disappear under
the pressure of the finger, and persist longer than the reddish points.
The skin remains also colored for a longer time under the first than
under the small rosy spots.
The most usual seat of this papulous eruption is the abdomen, the
lower and all the anterior part of the thorax; the posterior part of the
trunk, does not present it, except, when the eruption is confluent,
while the thoracic and abdominal limbs, the neck and the face are the
last places where it appears.
The number of the papules goes on decreasing the further they are
from the anterior part of the belly and from the thorax; sometimes,
in some cases, they have been seen more confluent upon the lumbar
region than upon that of the belly. The number of the papules also
is most variable; sometimes there are not more than ten or twelve;
in other cases they are so close together that they constitute a true
cutaneous eruption. Such a confluent eruption is chiefly observed
upon the abdomen and thorax and coincides, generally, with a greater
gravity and longer duration of the disease. This coincidence of the
confluence of the eruption with the gravity of the disease is more
evident, when, after having disappeared, it appears again in one or
more successive attacks, and, as the new and more numerous spots
make their appearance, the general symptoms of the disease seem to
acquire a new intensity and perhaps an increased gravity.
The period in which the papules manifest themselves is various.
It generally happens on the seventh or tenth day and often later, but
theu, the other symptoms of the disease, up to that point, but little
pronounced, are characterized by taking on a more serious form.
It is very seldom that they appear before the eighth day after the
invasion of the disease. It results from the observations of Chomel
that the spots most generally present themselves between the eighth
D6
90
A TREATISE ON TYPHOID FEVER.
and the fifteenth days. Louis says that we shall not be far from the
truth in admitting that the eruption takes place between the sixth
and ninth day of the disease in half the cases. It diminishes in
frequency, between the fifteenth and twentieth days, and still more
between the twentieth and thirtieth. Forget also asserts that, in the
great majority of cases, this eruption takes place in the second
week. Seldom does it manifest itself after the thirtieth day or during
convalescence.
Trousseau, however, in his Clinic, relates a case in which the len-
ticular spots had completely disappeared on the twenty-seventh day,
and, on the thirtieth day the convalescence seemed sufficiently con-
firmed to make it proper to allow the patient a portion of solid food,
when, on the thirty-fourth day, the abdominal pains appeared for the
third time, the borborygmi, the nausea, the vomiting, the diarrhoea,
etc. The next day, a new eruption of rose-colored spots appeared,
which did not disappear till the fortieth day of the disease, and the
convalescence was fully established on the forty-fifth day.
Some practitioners have noticed, moreover, that the papular erup-
tion was, perhaps, a little more tardy in light cases than in the severe.
The duration of the papular typhoid eruption, it is impossible to
determine. Louis gives, as the extremes in cases which die, and in
those which recover, as from three to fourteen days. Trousseau says,
"The total duration of the eruption is in the mean, eight days, vary-
ing, as terminal extremes, from three to eighteen, or even twenty
days.' We do not know, then, what may be the duration of the
papule in itself considered; it is thought, however, that it lasts from
four to five days. The resolution of this papule takes place without
any desquamation, only it seems, for two or three days, that the color
of the skin is a little deeper, and there has been likewise observed a
species of small ecchymoses in cases in which the papules were formed
of great nodules, arising from the surface of the skin.
"
The papular eruption has justly been considered as one of the
best signs of Typhoid fever, while, indeed, some wish to make of it
the pathognomonic symptom of the disease, but we should not deny
that there are cases in which the eruption never appears. Louis says
that it fails three times in thirty cases, and twice in twenty-four.
Chomel reports that in seventy patients it failed sixteen times.
Trousseau thus expresses himself on this point:
Though in certain localities, like Paris, we meet the rosy lenticular
spots almost constantly, yet, when looking for them as a manifest
SYMPTOMS OF THE DISEASE.
91
pathognomonic symptom, attentive observers in other countries have
not always found them; thus, in Touraine, they failed entirely in
different epidemics. Bouillaud also attributed much semeiotic value
to this eruption, of which he wrote, and declares that those who
were bled did not present it as often as others."
We must not confound the typhoid papule with petechiæ, which
are a sub-epidemic hæmorrhage, an entirely distinct matter, nor with
flea-bites, nor with malaria.
Upon the skin of patients with Typhoid fever, still another eruption
is observed, which does not belong to the disease as specially as the
preceding, but which is met with in this disease more frequently than
in any other. It is known by the name sudamina.
The sudamina consist in minute, transparent vesicles, from a quarter
of a line to half a line in diameter, of a round or oblong form, elevating
themselves above the skin, and containing a colorless serosity. In
general, they are very numerous, and chiefly appear upon the sides of
the neck, in the axillæ, and in the groins. All parts of the body are
sometimes covered with them, though they have never been observed
upon the face. They appear not long after the first half of the second
period. According to Louis, they have no connection with the greater
or less quantity of perspiration, while, according to Bouillaud, this
relation does exist in Typhoid fever, as well as in every acute disease.
This eruption often runs its course unobserved, seeing that it is not
perceptible except to the touch, even when examining obliquely the
surface of the skin where it is. Andral has noticed, in this liquid, an
acid reaction. Piedagnel also has declared this to be the nature of
the liquid contained in the vesicles of sudamina, which he compares to
sweat imprisoned under the skin. The liquid, which is colored when
the eruption is recent, becomes, after a few days, a little thickened;
it does not always fill the vesicles containing it, quite full, and then
the epidermis becomes rugose before they are ruptured.
We do not know the precise duration of any vesicle, but it is
asserted by Louis, to be from three to ten days. If the eruption is
confluent, the vesicles develop with great rapidity, so that the whole
body is covered with the eruption from one day to another, and their
diameter may be two lines or more. In this case the epidermis is
often removed in patches of three or four centimetres or more, by the
friction of the bed clothes of the patient.
This eruption, which appears later than the maculæ rosaceæ is,
however, of some diagnostic value, but much less than that of the
preceding eruption. The physician should always look for it dil-
1
92
A TREATISE ON TYPHOID FEVER.
igently, for it is really one of the symptoms of the fever, though
sometimes seen in other diseases, and constitutes a special morbid
determination, analogous to the lenticular maculæ, and to the eruption
upon the small intestines. Its nature is unknown, but it comes under
the influence of the general causes which produce the Typhoid fever.
Some practitioners have said that this eruption might be considered
as critical, but I am not of this opinion, since it exerts no influence,
either salutary or hurtful, upon the other symptoms. If diarrhoea
and debility increase during the time when the vesicles of sudamina
appear, this happens because the disease has assumed a greater
intensity, and everything follows the same course.
In some cases of Typhoid fever, besides the two eruptions just
described, there are also observed upon the skin petechio and vibices,
or suggillations. The petechiæ are little round ecchymoses, manifest-
ing themselves at the same time as the sudamina, but more rarely
than those of the maculæ rosacea. They are of a bright or brownish-
red or violet, and in some cases, of a darkish hue. Some would draw
a resemblance between these spots and the product of the flea-bite.
The spots caused by the bite of an insect present a central point,
darker than the adjacent skin, and disappear under the pressure of
the finger, which is not the case with the petechial eruption, which
rather becomes more apparent by the discoloration of the surrounding
skin under pressure. This eruption causes the patient neither itching
nor burning, and does not present the least elevation or roughness of
the skin. The petechiæ generally spare the face, and it is upon the
neck, upon the anterior surface of the breast, upon the belly, and the
extremities, that they are found in greater abundance. The petechia
appear at irregular times; in some cases they are manifest from the
first sign of invasion of the disease, but chiefly when it has quite
reached its greatest intensity; at other times, however, it is not
observed till an advanced period, from the seventh to the fourteenth
day, and even later.
The petechial eruption can never be considered as critical, as some
practitioners pretend, because its appearance brings still greater
gravity of the disease, rather than alleviation. Still, it has been
observed that the more their color approaches that of a bright red, the
less unfavorable will be the prognosis, and consequently, most unfa-
vorable when it presents a livid or blackish hue, indicating that there
is a positive alteration in the blood, which readily transudes through
the capillaries, and that the entire mass of the humors is tending to
SYMPTOMS OF THE DISEASE.
93
C
dissolution, and the sudden disappearance of the petechiæ is also a
bad sign, being very promptly followed by unfavorable changes.
Their multiplicity and their protracted stay announce danger immi-
nent in other diseases, as in scurvy, in pernicious intermittents, in
hæmorrhagic fevers, etc., etc., which are erroneously referred to
Typhoid fevers.
Drs. Raikem and Bianchi observed that, in more than 194 patients,
156 presented the petechiæ, either simple or complicated with purple
spots; women are more subject to them than men. A petechial
exanthem, however, has been observed without fever, and there are
benign fevers, accompanied by petechia, which would show that the
appearance of the symptom is not necessarily of a fatal presage. In
general, it may be said, that, the appearance of the petechiæ is some-
times a grave symptom at other times, nothing alarming being
connected with it, it seems a matter of indifference. In fine, we have
to consider, not the petechiæ, so much as the circumstances which
accompany them, and the intensity of the other symptoms.
The vibices are larger spots, and blacker than the petechiæ. The
smallest are about the size of a lentil, and the largest attain to the
diameter of an inch; they clearly show that there has been black
blood extravasated under the corpus mucosum.
The suggillations are larger than the vibices, not so black, of different
shades of color, irregular in figure, quite similar to ecchymoses, and
only differing from them as they seem to be produced by the blood
being scattered variously and stagnating in the rete mucosum.
The vibices and the suggillations come from the same cause, and
have the same semeiotic value as the petechiæ, and are enumerated
among the symptoms of Typhoid fever, by Littre and other observers
who have often noticed them.
The skin, in Typhoid fever patients, has a marked tendency to
gangrene, more or less extended, as it develops itself upon parts of the
body which sustain a certain pressure, or those always in contact with
the bed, and which likewise receive the contact of irritating matter,
as the fæces and urine passed in the bed; these parts are the sacrum,
the nates, the heels, the trochanters, when it is necessary to put the
patient upon his side, the elbows, also, and the occiput. The gangrene
does not present itself till the disease has lasted a long while, com-
mencing with a slight redness and a tumefaction, which soon increase
and spread; then the epidermis breaks and leaves the skin uncovered,
which is very white, dry and hard, or, indeed, presents a yellowish
94
A TREATISE ON TYPHOID FEVER.
tint, and, in some cases, a brown. The parts, thus changed in color,
are already gangrenous, and the eschar which results from them,
embraces all the thickness of the skin, and extends to the subjacent
cellular tissue. Sometimes there is nothing but a simple ulceration
of the skin, at first superficial, and then, extending, little by little;
sometimes simple crusts, dark or yellow, cover the ulceration of the
skin. Gangrene appears also in places where blisters have been
applied; the surface of the skin, denuded by the fly, takes on, at
a certain stage, a pellicle of light-grey color, which goes on increas-
ing in size, and which, on falling off, leaves an ulcer more or less
profound.
The parts upon which blisters, or, sinapisms, have been applied,
are almost always affected with gangrene, leaving no reason to suspect
the action of any other cause. The skin assumes a white, milky color,
or allows the blood to flow through it, which, coagulating, forms a
blackish crust, or is mixed with all the matter from the suppuration,
announced by a hospital gangrene. Upon the surface of the blisters
opened after a few days, and when their course is regular, there are
found, in some cases, little, round ulcerations, which penetrate the
skin. When the disease tends to a cure, the surface of the skin puts
on a better look, secretes a thick and whitish pus, and cicatrization
ensues. Almost always the state of these typhoid sores is a faithful
index of the general state, so that one can assert with confidence,
seeing the cicatrization of the sores progressing, that we may be sure
of a recovery, provided new accidents do not intervene, to change the
course of events.
It is also often seen in individuals seriously attacked, that the little
dark clot of blood which obliterates the triangular incision made by
the leech, softens, falls off, and leaves an aperture with perpendicular
margins; the bottom of this seems to be formed of a reddish cellular
tissue, and this is often loosened. When there are several of these
ulcerations, near together, the skin which separates them is sometimes
violet hued, livid, loosened, and becomes subject to mortification.
These sores are very painful, and keep the patient in a sleepless and
agitated state. There are not wanting cases in which the mortifica-
tion of the external parts follows the preceding lesion in a spontaneous
manner, and without any known cause. In fact, practitioners say
that they have seen it appear, suddenly, upon the internal surface of
the thighs, upon the dorsum of the foot, and in other parts, where it
could not be ascribed to any of the afore mentioned causes, but
SYMPTOMS OF THE DISEASE.
95
simply to the disposition in eschars, proper to Typhoid fever, and
which is not observed in any other disease. In the cases of spontane-
ous ulceration, the sores sometimes take on the form of phagedenic
ulcers, beginning with a kind of little pustule, which, opening, pours
out a fluid, more or less transparent, and presents to view a little
ulcer, which subsequently becomes larger.
Finally, whatever may be the mode in which these different ulcers
are formed, they sometimes acquire a size truly frightful, and con-
siderably prolong the convalescence, if they do not hasten death.
Ulcerations are observed, also, upon the internal organs which come
into view, as in the mouth and on the tongue, but I will not speak of
these, nor treat of the symptoms of these parts.
The skin sometimes takes on a greyish, leaden, earthy, or greenish
hue, in patients in a grave condition, and fallen into an adynamic
state. The morbid colors of the skin are not observed, but, in the
severest cases, and seem as if they should be referred to a general dis-
turbance of nutrition, in which the cutaneous surface also takes part,
where, also, many special morbid determinations take place.
Typhoid Cyanosis.—The only cause to which this phenomenon is
due, is the serious alteration of the nervous system to which a lesion
of the circulation soon joins itself. The skin of the dorsal surface of
the hand takes a cerulean or mottled red color, which depends upon'
stasis of the blood in the capillaries. The feet and the knees also
present this typhoid cyanosis, which appears even in the face, the
zygoma, and the end of the nose. It may persist many days; it
rarely comes in the beginning of the disease, provided this does not
set in with violence. It principally appears in the second or third
week. Diarrhoea, meteorism, subsultus tendinum, delirium, almost
always accompany this cerulean color of the skin, which is fresh and
cool, oftener than burning.
We must not forget another symptom which the skin presents, and
this is the exfoliation of the epidermis. It generally happens in con-
valescence, or when the general state of the patient is improving, that
the skin, which had been dry, earthy, and greyish, is despoiled of
its various integuments; and, in the graver forms of the disease, a
desquamation takes place, similar to that which is observed in the
exanthems, especially "pon the hands, under the form of a yellow
scale, as if transparent. They are seen also upon the face, the neck,
the thorax. In all these points, the exfoliation of the epidermis takes
place in small laminæ or in large scales. These are attributed to the
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A TREATISE ON TYPHOID FEVER.
frequent and abundant sweats which occur in the course of the
disease.
The sensibility of the skin is exalted very rarely, so that the patients
complain of it, but Andral says that he has seen some patients who
complain of a very severe pain in the skin of the abdominal parietes
whenever touched. At other times, this sensibility is diminished, or
even abolished. This might also arise from complications, and not be
a symptom of Typhoid fever.
Sometimes a peculiar odor is observed, proceeding from the bodies of
typhoid patients, and it is attributed to the quality of the sweat, but
it has not been demonstrated that it positively depends upon it. The
mousey smell, sometimes observed, depends upon letting the urine
flow in the bed, since the patients are overwhelmed with the greatest
prostration, and are a prey to delirium, so that they cannot be kept
with all the cleanliness desirable.
In some cases, and when the Typhoid fever is in an advanced stage,
after the second or third week, erysipelas sets in, which is, according
to Chomel, one of the most frequent, and, at the same time, most
dangerous complications of the disease. In forty-two cases, given by
him, erysipelas appeared four times upon the face, and was the cause
of the fatal termination. Louis met it more frequently in those who
died than in those who recovered. None of the patients, in whom the
affection was light, were attacked with erysipelas. It occupies almost
exclusively the face, commences, often, on the nose, and manifests
itself sometimes eight or nine days before death. Ordinarily, when it
appears, the pulse becomes more frequent, the heat of the skin
increases, there is delirium, cold rigors supervene, and, sometimes,
even vomiting; the tongue becomes drier, and the thirst more intense.
The erysipelas extends slowly from the nose towards the forehead and
the ears, and then occupies even the hairy scalp. It begins with
tumefaction of one of the alæ or the end of the nose; the tumefaction
and redness are not very marked. When the erysipelas begins on the
cheek, it presents a little reddish scab, which looks something like the
redness which comes on the face from lying on it. It progresses
sometimes with rapidity, and ends in gangrene.
In some cases, rather rare, however, subcutaneous abscesses are
observed in this disease; the arms, the præcordial region, the sulcus
of the nates and the thighs are their seat. These abscesses must not
be confounded with the purulent collections arising from absorption
of pus, observed in cases of pyæmia, but, as only a few differential
SYMPTOMS OF THE DISEASE.
97
symptoms present themselves, the distinction cannot be made, except
upon the cadaver.
*
III. SLEEP.
From the invasion of the disease there is often insomnia, and, from
the first period, wakefulness is continued, or almost so, through the
whole night, and if there is sleep, it is rarely natural; in some cases,
very slight, and interrupted by dreams, and agitation-the patient
says that he has not slept, though the attendants affirm to the contrary.
The sleep is often accompanied with painful dreams, groans, inter-
rupted talking, and delirium, and this is the state to which pathologists
give the name of coma-vigil. Sometimes the patients say that they
have had a disturbed sleep, wearisome, troubled, frequently disturbed
by unpleasant dreams, and they strive to resist sleep, which, other-
wise, they would desire, if it were only restorative and tranquil.
After this troublous sleep, they complain of a violent headache, and
often remain many nights without sleep.
Sometimes the sleep is so heavy that it is difficult to arouse the
patient, while, at others, he wakes, talks, answers to all questions put
to him, and then goes to sleep again. Pathologists give this first sleep
the name of coma, and to the second the name of coma somnolenta.
Cases are not lacking, though they are rare, in which there is a sleep
more prolonged than coma, and to this, pathologists give the name,
lethargy.
To these lesions of sleep, somnolence soon ensues, and the other
forms of stupor which will be spoken of subsequently.
IV. FEVERS.
This word is derived from the verb, ferreo--to become hot, and is
applied to a class of diseases characterized by a morbid heat of the
skin, frequency of pulse, and disturbance of various functions. Under
this name we describe, according to Jahr, the state of the pulse, of
the heat, etc., as is observed in Typhoid fever.
1. The Pulse.- The circulation of the blood, in all fevers, and,
especially in typhoid is characterized by increase of frequency in the
cardiac rhythm and, hence, in the pulse, that is to say, by the excite-
ment of the mechanism of circulation.
The pulse gives clear and distinct signs of the condition of the
fever and hence, to-day, physicians are generally accustomed to feel,
not only the arteries of the wrist, but, all others within reach, and, by
auscultation and percussion, to discern the motions of the heart.
The beats of the pulse are almost always accelerated. There are but
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A TREATISE ON TYPHOID FEVER.
few exceptions and there would be fewer, if we should take account
of the state of the circulation, from the beginning of the disease,
during its course and after the cure. It is impossible to fix general
principles relative to the acceleration of the pulse, as this is subject
to too many variations. I have under my eyes all the observations in
which are indicated, from day to day, the number of the pulsations
and am surprised at the extreme variations which the pulse presents,
from one day to another, without there being any appreciable change
in the morbid condition. We may conclude that one of the charac-
teristics of the pulse, in Typhoid fever, is that of presenting the
greatest variations of frequency from one day to another. The most
severe typhoid is not that in which we find the greatest acceleration
of the pulse, and this phenomenon of great acceleration can not be
held as a precursor of a fatal termination.
We must also observe that the rhythm of the pulse bears no relation
to the rhythm of the respiration, any more than it does to the degree
of the temperature; a great number of facts might be cited in proof of
this assertion, but, for brevity's sake, we withhold them.
Notwithstanding the restrictions established, it is none the less
true, that, in the great majority of cases, the frequency of the pulse
exists and constitutes a striking symptom of Typhoid fever; when
there are not more than 100 pulsations per minute, the prognosis is
favorable; from that to 132 it becomes grave. We must not forget
that the fever manifests itself before there is any appearance of any
visceral lesion, and, many times this persists when all the local symp-
toms have been dissipated.
Sarcone, in the epidemic of Naples, observed the slowness of the
pulse; but such cases are very rare. Louis observed a single case of
slowness of the pulse where the pulsations were less than eighty and
the patient recovered rapidly.
In the great majority of cases the pulse is regular and any irregu-
larity is but seldom observed; in eleven out of seventeen patients,
says Louis, in whom the pulse was unequal, irregular, intermittent,
small, feeble, trembling, indistinct, he found the heart softened, which
might lead us to believe that such alterations were not without
nfluence in producing these symptoms. In the midst of such various
functional lesions, to which all the organs are subjected, and more
particularly those of the circulation, there would seem nothing
trange in this inequality of the pulse, and, to explain the same, it is
not necessary to attribute them to a softening of the heart, which,
罩
​SYMPTOMS OF THE DISEASE.
99
moreover, was not observed in cases in which the pulse had presented
notable irregularities during the disease.
The pulse presents intermittences and inequalities, chiefly in the
ataxic-adynamic form, in patients fallen into a state of prostration
and delirium. That character of the pulse is likewise observed at the
moment in which the fever begins to cease and the patient enters
upon convalescence. In consulting the notes which were made, in
regard to the signs of convalescence, it is seen that several patients,
whose recovery was rapid and complete had a small, unequal, some-
times, intermittent pulse and that this symptom indicated conva-
lescence. This disturbance of the circulation, purely nervous,
is very
frequent in Typhoid fever and it has happened to have been observed
also in convalescence from other acute diseases.
Another character of the pulse, to which Bouillaud has called the
attention of pathologists, and which is frequently observed in Typhoid
fever, consists in a peculiar modification of the pulse, to which is
given the name of pulsus dicrotus, bis ferrens, double pulse. This
quality of pulse is not peculiar to Typhoid fever though it does not
occur in any other so often.
"With few exceptions," says Bouillaud," in all our patients affected
with entero-mesenteritis, in a violent form, we have observed and led
others to observe this character of the pulse, of which we speak, a
character which is sometimes found during convalescence. In no
other acute disease, have I happened to see this modification of the
pulse, at least, not to such a degree and with such constancy." This
symptom has a very great value, although it may not be observed very
often. A singular observation has been made with regard to the
double pulse and it is that, in certain epidemics, and, at certain
seasons, this quality of pulse appears in the most of the patients,
while, in other years, it appears only three or four times. And what
is said of the double pulse may be strictly applied as well to the other
symptoms.
In the first stage of the disease the pulse is usually strong, devel-
oped, and, although hard, in robust subjects who have the vascular
system full of blood, it becomes weak and impressible, just in the
same degree as the prostration of the forces and the stupor progress,
in a word, in the adynamic period. Sometimes it is soft and undulat-
ing and these characters are frequently seen in patients who have been
bled often. Sometimes, notwithstanding the adynamic state, the pulse
maintains itself hard, wiry, small; but, more commonly, it is weak
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A TREATISE ON TYPHOID FEVER.
filiform, very small and fleeting. Such a quality of pulse is of bad
omen, because it betokens a profound adynamy and a prompt and
unfavorable end.
By auscultation we hear, in the arteries, the bruit de diable when the
patients have fallen into a chloro-anemic state, which so constantly
produces these sounds, and which Bouillaud met in patients treated
by him by bleeding. Beau noticed the existence of this souffle in the
beginning of Typhoid fever, before any treatment could have weak-
ened the patient, and attributed it to plethora. His opinion is not
accepted by all, but, the fact of which he speaks, is no less true.
Many times there has been observed in patients a very strong friction
sound, intermittent, located in the carotid artery. No one has ever
happened to meet with the soft venous souffle or almost continuous,
characteristic of chloro-anemia, unless the Typhoid fever were com-
plicated with that disease. Thus, to reduce to its just value, what
has been written on this subject, we may say that we may hear a
friction sound in an artery, either at the beginning of the Typhoid
fever, or subsequently, but never the bruit de souffle properly called,
except in case of a complication.
2. Febrile Temperature.-By febrile temperature we understand that
derangement of animal calorification which forms one of the elements
of Typhoid fever. It consists, not only in an abnormal quantitative
change in the production of heat, but, even in the modification of the
tactile character of the heat.
The sense of cold and the sense of heat, of fever patients, are like-
wise objective and real phenomena, that is to say, the cold is deter-
mined by a physical lowering and the heat by a like exaltation, of the
animal temperature.
The means of learning the pathological oscillations of the tempera-
ture are the touch and the thermometer. The latter has an advantage
in measuring and detecting the least difference, but, in its turn, the
touch, has the advantage over the thermometer in perceiving the
character of the heat, whether it is moist or dry, moderate or biting,
etc.,which characters are peculiar to certain kinds of fever and certain
stages in their course. The exploring hand of the pathologist, that
it may perceive changes of temperature, should be in a normal state,
since undue heat and cold benumb the thermo-tactile sensibility.
The hand is applied with its whole palmar surface, in succession, to
the great regions of the trunk, and to the segments of the limbs.
The bulb of the mercurial thermometer is then applied, also in suc-
SYMPTOMS OF THE DISEASE.
101
cession, to the cutaneous hollows, as the axillæ, the popliteal and
inguinal regions, also to the accessible mucous cavities and to the
extremities of the patient. But, by means of the mercurial metas-
tatic thermometers, and, of the needles of the thermo-électric pile,
we may institute a long series of researches to learn the distribution
of the heat of the blood and of, the various tissues of fever patients.
The falling of the temperature, in the cold stage of fevers is, in
general, sensible even to the touch; but the thermometer measures
and confirms it. The cutaneous temperature falls from 96.80° to 93.20°
and, in the paroxysmal cold of intermittents, to 93.20°. But, in the
axillary, and other cutaneous hollows, it does not fall in the same
degree; the temperature maintains itself there more elevated than
the normal degree which indicates a change in the distribution of the
caloric. In the development of the cold, on the other hand, the
cutaneous temperature is elevated 3° or 4° or more, and, in the first
stage of typhoid-rheumatism it has been noticed, in young patients, to
rise from 96.80° to 105.80°.
These measures of oscillation of temperature give the same results,
when they are taken in the extremities of the fever patient, where
they are sooner perceived by him, by reason of the profusion of the
tactile sense, comparatively greater than in other regions, and where
they are more lasting. The same condition of profusely sensitive
points, in the extremities, explains another fact, that is, that, even
when the heat of the fever may be developed in the cutaneous per-
iphery, although the extremities remain quite cold, their sensation
preponderates on account of the relative profusion and exquisiteness
of their nerves, and the fever patient will continue to feel cold. Even
the temperature of the muscular system is elevated, and, from recent
investigations, it is certain that the heat of all the blood is also
elevated. The elevation of the organic temperature is an essential
phenomenon of fever. It is understood, however, that the febrile
temperature has its diurnal oscillations, corresponding to the remis-
sions and exacerbations of the fever.
Typhoid fever is frequently accompanied with shivering, occurring
on the first or second day, and frequently re-appearing in the first four
days, and even for a longer time, in those who have not yet taken
their bed, and who continue to eat and to work. The cold in this.
fever is ordinarily slight, and is dissipated when the patient goes to
bed, or approaches a fire. Some are taken, also, with trembling.
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A TREATISE ON TYPHOID FEVER.
Usually, a slight internal shivering is perceived, in the loins and
shoulders, which ceases very promptly, to be followed by cold, which
is sufficiently sensible, but seldom very intense, soon to be succeeded
by heat. But whenever the patient moves in the bed, or gets up, or
tries to stretch out his arms, he complains of feeling the horripilations
return, and even increase.
At first, the heat does not much exceed the normal state, but, in the
course of the disease, the temperature of the skin is modified; the
patients give notice of the changes in temperature, and they manifest
themselves to the exploring physician as well as to the thermometer;
but, to judge of the temperature, it is necessary to institute ther-
mometric observations upon the patient. Bouillaud has seen the tem-
perature vary from 91.40° or 93.20° to 104° or 105.80° F., and says that it
is from 104° to 105.80° in severe cases, from 100.40° to 102.20° in cases
of medium severity, and from 96.80° to 98.66° in light cases. Andral
has obtained the following results of temperature: Maximum, 107.24°
only once in ninety-one cases; minimum, 100.40° thirteen times; in
twenty-six cases, 102.20°; in forty-three cases, 104°; in eight cases,
105.80°; mean, 103.15°. Among twenty-three children, from nine to
twelve years old, Roger found the mean temperature to be 103.58° and,
taking account of severe cases, only 104.73°.
The febrile heat, in this fever, presents characters of great import-
ance. At the beginning of the disease, when the symptoms develop
themselves slowly, the temperature is seen to rise, though slowly. In ·
the three or five first days, the temperature rises from eight-tenths of
a degree to a degree more than it was the night before, so that the
heat the first evening, in one patient, was 98.66°, and, the fourth even-
ing, marked 104°. At other times, the cutaneous temperature is
rapidly increased, and often presents a great intensity when the other
phenomena are, as yet, but little pronounced. In general, this measures
well enough the intensity of the disease, so that the temperature is
from 104° to 105.80° in the severer forms, and is always more elevated
in proportion as the disease gains intensity; the more elevated tem-
perature was commonly seen in the ataxic-adynamic form. The
increase of temperature is an excellent sign of the disease, because,
many times, it appears very promptly, and because but few other dis-
eases give rise to such an elevated temperature. Upon this fact, some
practitioners have established the following canon for the diagnosis of
Typhoid fever: If, on the fourth day of the fever, the temperature has not
risen to 103.10°, then it is not typhoid. These figures, as is natural to
SYMPTOMS OF THE DISEASE.
103
suppose, will ascend during the second period, till, in very severe
cases, they reach 107.60°.
The increase of the temperature is not always proportionate to the
frequency of the pulse. Patients have been seen whose cutaneous
temperature was 104°, and the arterial pulsations only 96 or 100.
Roger thought that he could establish the fact that, in the Typhoid
fever of children, a great elevation of temperature frequently con-
trasted with the slight acceleration of the pulse; this same proportion
has also been observed in adults, but not as frequently as has been
stated by Roger.
The hand applied upon the abdomen, upon the sides of the thorax,
or in the axillæ, readily observes the increase of temperature, the
degree of which, one can more readily estimate when he has been
accustomed to taking the temperature with the thermometer, and
thus to compare the sensations themselves with the degrees on the
thermometer. The skin is hot, burning, and produces a painful sen-
sation; and when these characteristics are met, we say that the heat is
acrid or biting. This violent heat is chiefly observed during the first
two or three weeks; it is often accompanied with moisture, and even
with abundant sweat, chiefly in the morning and during the night.
The febrile heat is not the same in all hours of the day; it often
happens that it increases in the latter part of the day, towards evening.
This difference is about that of a degree, and some observers have
noticed this difference, day after day, so that, towards evening, they
have observed that the degree of heat was 102.20°, while in the morn-
ing, it was 100.40°, in the evening again 104.00°, and the next morning,
102.92º, and so on. In other cases, the skin became warmer between 1
and 3 r. M.; more seldom, towards the middle of the night. Some-
times there are two increments of temperature, every day, or every
two days, which represent real attacks of quotidian, tertian or double
tertian fever. Such periodical exacerbations would be observed more
frequently if physicians would observe their patients in the latter
part of the day. Practitioners consider the decrease of heat as the
surest sign of confirmed convalescence.
•
The cutaneous temperature decreases, in many patients, toward
night, and even when they have passed the thirtieth or fortieth day,
and when the patients, reduced by diarrhoea, fall into marasmus.
The same phenomenon occurs at the moment in which a profound
and fatal adynamy succeeds the other symptoms. The symptom in
question is also observed in patients who have been affected with
3
·
104
A TREATISE ON TYPHOID FEVER.
vomiting and considerable diarrhoea, or who perish with intestinal
hæmorrhages or gangrene.
The changes of the cutaneous temperature are not very rare in those
cases in which the skin presents, in the same hour, the most rapid
change, from an almost icy cold to the greatest heat. These singular
changes are more frequently observed in the ataxic-adynamic form,
and in which there is a very evident pulmonary engorgement.
In general, it may be said that the course of the temperature in
Typhoid fever presents a slow and gradual elevation from the moment
of the invasion; that then the temperature is stationary, for a time,
with slight remissions, every morning, and, finally, there is a slow and
gradual defervescence. When this defervescence does not take place
at the right time, and when the temperature rises at the moment
when the defervescence ought to commence, it indicates that there is
a complication, for which we must search with diligence, if it is not
made evident by the symptoms. The thermometer would be useful,
and every physician should avail himself of it in this insidious disease.
If the heat is a diagnostic symptom for Typhoid fever, it also fur-
nishes many positive data relative to the prognosis. In fact, Prof.
Wunderlich says, that, in the second week, with the help of the ther-
mometer, we may judge very well of the future course of the disease.
Here are his observations :
1. If the evening temperature maintains itself between 103.10° and
104°, and that of the morning is half a degree or a degree lower, and
this happens regularly, every day, we may conclude that the disease
will be mild, and that the patient will enter upon his convalescence in
the third or fourth week, especially if the temperature begins to abate
slightly on the eleventh, twelfth or fourteenth day.
2. As soon as, in the second week, the morning temperature is
maintained at 102.20° or 103.10°, and the temperature of the evening
reaches or passes 104.90° without observing, towards the middle of this
week, an incipient diminution of heat, we may be sure that the con-
valescence will not begin, at the least, before the fourth week.
3. All irregularities in temperature which happen in the second
week, should receive attention.
4. Even when the highest figures do not go beyond 104°, it is always
a bad sign, when the remission, in the last half of the second week,
does not take place, and when a rise is observed towards the end of
this week.
5. The case is most serious when, in the morning, the thermometer
is at 104° or thereabouts, and in the evening at 105.80°and more, or
when, towards the end of the second week, the elevation of the tem-
perature is constantly increasing. It may be said, in a general way,
1
SYMPTOMS OF THE DISEASE.
105
that 105.80° is seldom seen, and never, but in fatal cases. You see
what is the prognostic value of this cypher. The temperature of
106.70° and 107.60° is a fatal indication, which may also be feared
when the morning temperature rises to or beyond 104° for several days
successively.
Allow me to bring together, in a prognostic point of view, this great
alteration of the temperature, and the extreme frequency of the pulse.
Dothinenteritis is not an affection in which the pulse can be very
frequent, since 100 or 110 pulsations is its normal rhythm; well, when
in this fever, in an adult, the pulse rises to 120 or more, the prognosis
is as serious as when the temperature rises to 105.80° or above.
6. From the beginning of the third week we may distinguish with
the greatest precision, the slight cases from the serious. They are the
former, if we observe the great morning remissions; so that the tem-
perature of the morning is one degree and a half, and even two
degrees lower than that of the evening; in the course of this week, the
temperature rises above the normal, while that of the evening, in like
manner, readily falls, but does not reach the normal point till towards
the middle of the fourth week. In serious cases, on the contrary, the
temperature maintains the same height, and, sometimes, at the end of
the third week, or at the beginning of the fourth, the grand remissions
begin.
7. The stage of defervescence is never rapid, as in exanthematic
typhus. It takes place in different ways. In most cases, the tempera-
ture begins to descend considerably in the morning, as we have said,
while the evening exacerbations remain still the same for several
days. Thus, I repeat, in the morning we may have normal tempera-
ture, and in the evening 102.20°, and even 104°. Sometimes, for eight
or eleven days, the defervescence takes place regularly, and in a par- ·
allel manner, morning and evening.
8. It may be affirmed that the entrance upon convalescence dates
from the day in which the temperature has returned to the normal
point, in the evening, that is to say, to 98°.
9. Generally, the temperature rises at the moment of death, or a
few hours before.
In fifteen fatal cases, Drs. Thomas and A. Lade have found the
extreme temperature: Five times, 104.45° to 105.20°. Two times,
106.20° to 106.25°. Seven times, 107.60° to 108.95°. So that, seven
times, the temperature rose to 107.60° or above, and this is the hyper-
pyretic temperature of Wunderlich, which is necessarily fatal.
"In almost all these cases there was a predominance of nervous
symptoms, that is, furious delirium, excessive agitation, then sinking
of the strength, paralysis and death.
However, in opposition to these cases, I should tell you that there
are others in which the temperature is normal, or less, at the same
time the pulse is small and very frequent, the skin is covered with a
cold sweat, the extremities are livid; in a word, the patient dies in
collapse, sometimes after hæmorrhage.
D6
106
A TREATISE ON TYPHOID FEVER.
"Finally, in such cases, death ensues without the temperature being
much elevated or much depressed; patients die then, from sinking of
the forces, after an abundant and obstinate diarrhoea, with meteorism,
and in the midst of nervous symptoms not very distinct.”
Sweats.— The cutaneous transpiration is, sometimes, abundant in the
first days of the fever; very often it accompanies the appearance of
the first febrile accidents, and has, in such cases a marked acid smell;
but it ceases toward the middle of the first period, and that dry, bit-
ing heat succeeds it, which is considered characteristic of the disease.
All practitioners observe dryness of the skin, as a very frequent
symptom of Typhoid fever, especially under the influence of certain
medical constitutions, and in some forms of the disease. This dryness
is greatest in the second period, and the skin seems even more rugose
to the touch than is normal. In the third period, then, when the issue
is to be favorable, the skin is no longer dry; sometimes slight sweats
supervene, at others, the skin takes on a certain degree of softness,
without having any perceptible transpiration. Cases are not wanting
in which the sweats are a symptom which accompanies the disease,
and it has been observed that patients with copious sweats are in a
more serious condition than those in which the sweat is moderate.
The sweats sometimes are seen only in the morning, and during
the course of the night, and sometimes, during the whole day. In the
first case they often announce the end of a quotidian and nocturnal
febrile exacerbation; in the second, the sweats are symptomatic, and
as some hold, indicate a resolution of the disease; but Louis says that
he has never observed this good sign in the sweats to lead him to con-
sider them as critical.
Generally the sweats weaken the patients and do not shorten the
duration of the fever; they have no salutary influence upon the other
evacuations, as, for example, upon the diarrhoea, which seems more
obstinate in patients who have sweated much. Attention has been
called to the relation which might exist between the sweats and the
bronchial rales; and it has been seen that the cutaneous secretion
avails nothing in diminishing the congestion of the bronchial mucous
membrane, nor does it even aggravate it.
V. MORALE.
The morale of patients is often modified, chiefly in fever, and
above all, in Typhoid fever. In the first days of the disease, a certain
moral inquietude is present, a discouragement, an aversion to conver-
sation, to which, with the progress of the disease, a greater change of
SYMPTOMS OF THE DISEASE.
107
-
the nature of the patient is added, passing from undue solicitude to
a certain apathy, to slowness in the exercise of the intellectual func-
tions, to a rage, inquietude, and anguish, which do not permit him to
remain in any one place, especially in the evening, in bed, or in the
morning on waking, and often accompanied with tremor, sweats, cold-
ness, oppression and fainting.
Sometimes, tranquil individuals, and affable, become irritable and
ill-humored, with a repugnance for any labor, and with moral dejec-
tion and inquietude regarding their children, their affairs, and the
future, with a lack of confidence in themselves, At other times we
see a confident, courageous character, free from care, becoming timid,
diffident, suspicious, apprehensive, with excessive sensibility for every
impression, and a disposition to be easily frightened. In some, there
is excessive sensibility, with scruples of conscience, with sad ideas, as
if they had offended every one; in others, great apathy, indifference,
indecision, and changeable humor; in fire, the morale always presents
a change in the course of Typhoid fever, either in one way or another,
which cannot be precisely stated.
As the disease progresses farther, we have intolerance of light, and
the excessive impressibility of all the organs, or a great apathy and
indifference, stupidity and obtuseness; in this state we have the
coma-vigil and the delirium, which no longer fail to show themselves
in this disease.
All practitioners have noticed, in fact, that the delirium is a constant
symptom of Typhoid fever, and that, ordinarily, it succeeds the
stupor and somnolence, and takes different forms which it is impor-
tant to describe.
At one time the agitation is extreme, the patient wishes to rise and go
out; at other times he thinks that he sees objects not before his eyes,
and hence screams and cries out, and it is necessary to restrain him
with a strait jacket; at another time the delirium is tranquil; the
patient only complains, pronounces unintelligible words, keeps up a
constant muttering; some speak in a bass voice, others are out of
temper with the doctor, strike him with the hand, and try to avoid
him when he wishes to feel the pulse or the state of the abdomen.
Patients have been seen who invariably occupy themselves with the
same idea, and repeat the same things, with great perseverance.
Most generally the delirium turns upon various subjects, and we see
the patients pass, with the greatest rapidity, from one subject to
another. The most common of all forms of delirium is that which
108
A TREATISE ON TYPHOID FEVER.
appears at night. The patient speaks in a loud voice, without know-
ing it; only the persons who watch him can give account, to the
physician, of what has happened, and it is seldom that this delirium
takes place during the day. Another character of the delirium is this,
that it always increases the length of the night, that is, during the
period of febrile and nervous exacerbation, and we can often inter-
rupt this by speaking to the patient, and by fixing his attention by
constant questions; but left to himself, he soon returns to the series
of changed ideas which he first had. To this species of delirium, the
name of typhomania has been given, and it is carried to the highest
pitch when the patient has preserved a considerable share of his
strength. It is also necessary to observe that this delirium is proper
to Typhoid fever, because the delirium from affections of the brain,
and its membranes, does not cease, on arresting the attention by con-
tinued interrogations.
Sometimes the delirium appears very early, on the fourth or fifth
day, in patients who are severely affected, and who die on the tenth
or twelfth day; in some cases, indeed, this is seen from the beginning,
the first of all the symptoms. Louis says, that in those who die from
the fifteenth to the twentieth day, the delirium generally manifests
itself on the tenth day, and on the fifteenth in those who die after
that. According to Chomel the delirium appears from the fifth to the
thirtieth day.
It is not necessary to say that the delirium, as well as the stupor, has
no relation, in this disease, to the violence and the phases of the intes-
tinal lesion, and, neither, the state of the stomach, nor that of the
brain, gives any explanation of the development of the cerebral phe-
nomena.
Chronic Delirium.- Notwithstanding the frequency and severity of
the cerebral lesions, it is rare that intelligence remains injured after
recovery. "In more than 300 cases,” says Louis, “I have happened to
see only one case in which the intelligence presented any degree of
alteration during convalescence."
Other writers assert that these lesions of intelligence are often
noticed, but that they cease entirely when the cure of the disease is
complete. In two cases the minds of the patients were weakened, so
that they complained, upon the most trifling occasion; in a youth of
fifteen years, the inclinations of childhood returned, and persisted for
two months, and in two other cases the memory remained so enfeebled
that the patients did not regain, but in a very confused manner,
the
SYMPTOMS OF THE DISEASE.
109
cognitions necessary to the exercise of their professions, but these
lesions finally disappeared.
VI. HEAD.
Among the symptoms of the head, we notice headache, vertigo,
-stupor, etc.
1. Headache.- Headache is technically called cephalalgia, from the
Greek Kepaλn, head, and aλyos, pain. It is almost always constant in
Typhoid fever, and is observed from the beginning, appearing in very
few cases on the fourth, and, sometimes, not till the twelfth day.
headache for example, and, like that, it should not be referred to a
ity through all the first week, and almost always yields at the end of
this time, and, sometimes, much before, by reason of the first remedies
given. In subjects who have no treatment, it generally continues a
longer time; in some others, it is a predominant symptom through the
Appearing with the invasion of the disease, it persists with great intens-
whole course of the disease.
The pain occupies the frontal region, chiefly, and the supra-orbital;
thence it extends over the whole head, or it fixes its seat originally in
the occiput. It very seldom fails, but in certain cases, when patients
are uselessly asked where they have headache, they cannot indicate its
precise location.
Usually the pain is gravative; sometimes it is tensive or lancinat-
ing, or contusive; it is seldom very intense; sometimes patients com-
plain very much and thus direct the attention of the physician to this
symptom, by which he may be led to think of some cerebral complica-
tions, where none exists.
This symptom is very frequent in Typhoid fever, and should be
considered as one of the most constant; and it is of the more impor-
tance, as it generally signalizes the invasion of the disease. The
most ordinary duration is from eight to ten days; the terminal
extremes are from four to twenty days; sometimes it increases, some-
times remains nearly at the same degree, and this is generally the
case; but the headache does not cease till the moment when the
patient is taken with somnolence and delirium.
2. Vertigo.-The vertigo is more marked as the disease is more
severe. This name is given to the sensation experienced by the
patient when he stands on his feet or sits up in bed, and looks at
objects about him. He sees them oscillate, tremble, turn around him,
and it seems to him as if his head moved and turned around; this
symptom is of the same nature as the other nervous disturbances, of
110
A TREATISE ON TYPHOID FEVER.
1
cerebral congestion, imagined by some authors. It manifests itself
contemporaneously with the headache, and is its constant companion.
The vertigo, however, lasts longer than the headache, and often con-
tinues one or two weeks without interruption; patients are affected
with it only when they move, or, sit up in bed, and it is often neces-
sary to put them in that position to know if the symptom exists. The
blindness, vertigo, and turning of the head, and the vacillation of sur-
rounding objects, apparent to the patient, are observed in no other
disease with the intensity and frequency which they present in Typhoid
fever.
3. Stupor, Somnolence, Coma.-A stupor, more or less pronounced,
manifests itself in patients affected with this disease, and traces of
this symptom are often seen in the lightest cases, according to the
opinion of Prof. Jacquot. It is made up of a number of symptoms,
and not of one alone. Saying that it is characterized by an expression
of dulness and indifference which the face presents, gives, no doubt,
one of its principal phenomena, but it does not set it forth completely.
In fact, the stupor is a morbid state shown by the expression of the
face, and resulting from the dullness of the senses, from the intellec-
tual inertia, and from the weakness of the muscular system.
In its lightest form, this stupor appears as a kind of indifference
into which the patient falls. Settled in bed, he drowses, but keeps all
that passes about him to himself, without showing that he under-
stands anything. The patient ceases to interest himself in his affairs,
in his relations, in his friends; he remains silent concerning them and
does not reply except when urged; at other times the answers which
he gives, are very appropriate and sufficiently prompt, but that which
he requires, more than anything else, is, that he may be left in the
most perfect repose as to his intelligence and his memory.
Another characteristic, which likewise announces this degree of
stupor, is the immobility of the lineaments of the face, and, to speak
more exactly, the lack of any muscular movement capable of giving
expression to the physiognomy; this state, nevertheless, ceases, and
the physiognomy becomes animated, when the patient is called upon
to tell about his sufferings; a state of repose of intelligence, of fucial
mobility and of phonation, inaptitude of the senses to enter, actively and
spontaneously, into relation with the external world, such is, in conclusion,
the first state of stupor which generally signalizes the invasion of
Typhoid fever and in the first week.
In the second degree, we have, not only, a defect of spontaneity of
SYMPTOMS OF THE DISEASE.
111
the intelligence, and, of the senses, but there is required a pretty
active and energetic stimulation to induce them to perform their
functions. The patient has a wandering and stupid expression when
he wakens; he needs a certain time to put himself in relation with
persons and things about him. Sometimes, when questioned, he
strives to understand; his answers are slow, uncertain, short, some-
times correct, at other times, erroneous; he has lost his memory, and,
in spite of the efforts which he makes, to recall things, he can only
give the most incomplete notions about the beginning of his disease.
His eyelids are raised with difficulty, the eyes look glassy, dry and
lustreless. His senses perform their functions tolerably, as far as his
intelligence permits, he thrusts out his tongue, and, sometimes, leaves
it forgotten between his lips and teeth and indicates the region of the
head as the seat of the suffering. Hardly has one ceased to interro-
gate him, when he falls into a species of sleep which is called somno-
lence. If the person, immersed in this stupor, is a woman, you may
examine her abdomen and touch her without any sign of shame or any
opposition to all needful examinations. Some patients fall into dis-
couragement, and say that they are sure to die; others, on the con-
trary, say that they feel well while their life is seriously threatened.
Finally, in the third degree, intelligence is abolished without there
being any delirium, and the same may be said of the special sensi-
bility. The eyelids are closed, and, if the patient opens them half
way, he can only do it with difficulty, and, for the merest moment. If
you strive to raise them it is resisted with force; the ball of the eye is
carried up under the upper eyelid or situated in its natural position;
the pupils are immovable and insensible to the light; the mouth is
open, the lips hang down, and are often agitated with a constant
tremor, or, the patient seems to mutter some incoherent words; the
respiration is noisy, and, sometimes, rattling, on account of the secre-
tions which linger in the posterior fauces. Nothing is capable of
raising the patient from that state in which he is plunged and which
is designated by the name of typhoid coma. Shaking the patient
violently or making him sit up so as to auscult the chest, he emits
groans and lamentations or heaves a sigh, which cease when he is per-
mitted to return to the horizontal posture.
It is manifest that the different morbid states known as somnolence,
coma and carus are only degrees of stupor, more or less, pronounced.
Let us add, that, if the patient has his eyes open and dreams, although
awake, that is called coma vigil or typhomania, and it is called comatose
t
112
A TREATISE ON TYPHOID FEVER.
1
delirium, when the patient has his eyes closed, and dreams, while
sleeping. The patients then begin to agitate their lips without articu-
lating anything distinctly; others speak with a bass voice or a high
and cracked voice, which is more rare, except in case of certain com-
plications.
Jacquot, who has given a good description of this kind of stupor,
admits three degrees of it, a little different from those which have
been described. He justly observes that, to give this symptom all the
value, it really has, in the diagnosis of Typhoid fever, we need to
know the slightest gradations. According to this author, it is mani-
fest in the entire course of the disease. This proposition is perfectly
true, if we consider the stupor in the manner in which it has been
previously considered, and, no cases of typhoid are ever observed,
however light, which are not accompanied with stupor.
The stupor is a symptom which manifests itself from beginning to
end and consists in an air of sadness, of heaviness and of indifference
not habitual to the patient. It increases constantly, persists, with but
few exceptions, though in different degrees, till the fatal termination.
Stupor existed in all the patients observed by Louis who died of
Typhoid fever.
Sometimes it ceases twelve or fifteen days before death. In cases
less severe, and, terminating favorably, the stupor, though most con-
stant, manifests itself much later (the fourteenth day as a middle
term), does not last so long (eight days on an average) and less
frequently arrives at that degree which is called somnolence or lethargy.
Under head symptoms we also observe the falling off of the hair,
which is very frequent in Typhoid fever, and, chiefly, in conva-
lescence. This falling of the hair is not permanent; always, and,
without exception, it returns in proportion as the strength of the
patient is restored and it is quite as thick as before the sickness.
VII. THE EYES.
The eyeballs and the parts which protect them present, in the course
of the disease, noteworthy changes.
The expression of the eyes in the disorders which accompany
malignant fever is various; it may be affectionate, imploring, threat-
ening, terrified, wandering, etc. The ocular conjunctiva presents a
redness, chiefly occupying the inner angle of the eye. Large red ves-
sels, or, a most delicate injection, appears upon the sclerotica, towards
the angles of the eye, but, chiefly, towards the internal angle, where
we see the caruncula lachrymalia, red and injected. This redness
SYMPTOMS OF THE DISEASE.
113
depends upon the congestion of the mucous membrane and does not
indicate inflammation. The ocular redness generally appears, in severe
cases, either at the beginning of the disease, or, in the latter part,
which is most frequent. Louis observed it in more than half of the
cases which were followed by death.
The bleared state of the eyes consists in the secretion of a dense and
puriform mucus which accumulates toward the inner angle of the eye
or diffuses itself over the free margin of the eyelids; it most gener-
ally is gathered within the eyelashes or extends over the ball of the
eye, constituting a whitish purulent coat, obscuring the vision. The
ocular blearedness is more common in the grave and adynamic forms
of Typhoid fever than in any other.
The pulverulent state of the eyelashes is also observed, arising from an
extreme dryness of the same upon which is deposited the dust floating
about in the atmosphere.
The eyes are often dry, squalid or glassy, they direct themselves
indifferently towards the different surrounding objects and not
towards the physician who seeks to attract the attention of the
patient.
The pupils are sometimes considerably dilated, although exposed to
a bright light, as we observe in comatose patients; sometimes, they
are contracted, and this indicates, as some think, an inflammation of
the meninges; we generally see them in the normal state, so that they
have no uniform appearance and nothing can be affirmed in this
regard. It is certain, however, that the sight loses its strength; it
seems that the patients, when perfectly conscious, sometimes expe-
rience difficulty in recognizing their friends, and, if a book is presented
them, they can not distinguish the letters.
The eyelids, when spasms prevail, often remain convulsively closed
and they can only be opened by a great effort. Often, instead of the
spasmodic closure of the eyelids, strabismus is observed, and we see
the ball of the eye turned upward and hidden behind the upper lid.
A symptom which is also sometimes observed, in severe cases, is the
incomplete closure of the eyes, during sleep, so that the lower segment
of the cornea remains exposed to contact with the air. If this condi-
tion lasts many days, the conjunctiva becomes injected, the eyes
become bleared, and we often have a catarrhal ophthalmia. In some
cases, even complete softening of the cornea, has been observed, and
the eye is lost, if remedies are not seasonably applied.
This softening of the transparent cornea, which many have observed,
114
A TREATISE ON TYPHOID FEVER.
not only in Typhoid fever, but also in all diseases accompanied by
cerebral disturbances is thus explained by Prof. Trousseau.
"In the course of putrid fevers," he says, "it almost always hap-
pens that the ball of the eye is carried upwards and that the transparent
cornea remains entirely concealed. In this case the lack of motion.
in the eyelids, has no other inconvenience than to occasion an inflam-
mation of the ocular mucous membrane, and, if this inflammation is
dependent upon the general condition, just as are the inflammations
of the bronchi, the pharynx, etc., we can not admit that it is aggra-
vated by the lack of motion of the eyelids, as we see in those who
have a paralysis of the facial nerve.
"Patients affected with paralysis of the seventh pair of nerves, not
being able to close the eye, nor to wink, all have an irritation more or
less considerable of the ocular mucous membrane, and, this irritation
extends, in certain individuals, to inflammation, and, finally to soften-
ing of the transparent cornea.
"Such patients know how to remedy this inconvenience by moving
the eyelid with the finger, to supply the place of the lacking motion;
but, during sleep, if they do not take special precautions, the eyeball
is exposed to contact with the air, and, the next morning, they awake
with irritative congestion, with pain and lippitudo.
"In severe fevers, whatever may be their nature otherwise, the eyes
remain generally closed, and, if the stupor lasts a long while, if it is
pushed to an extreme they are, night and day, in a condition analo-
gous to that in which patients are found when afflicted with paralysis
of the seventh pair.
"Add to this, that the sensibility is obtuse in the course of putrid
fever, and, that the irritation produced by contact with the air is not
perceived, just as if the need to wink no longer existed. The same
thing happens to the eyes, that happens to the nostrils that become
filled with dust; they are filled with foreign bodies, that float in the
air, because the patient does not perceive the irritation which these
foreign bodies usually produce and, consequently, does nothing to
relieve himself of them.
66
Reflecting upon the theory of the palpebral winking it is readily
seen that the accidents, of which we speak, must be pretty frequent.
Three pair of nerves concur in this phenomenon. In the first place,
the fifth pair (the sensitive) which transmits to the brain painful
impressions, produced by continued contact with the air, and, by the
desiccation which makes it necessary to wink. In the second place,
the seventh pair (motors) which transmit to the sphincter of the eye-
lids, the order to contract. Finally, the third pair (also motors) which
sends a twig to the elevator palpebræ superioris and which, conse-
quently, presides over its elevation. But there is still another nervous
twig, that is, the lachrymal nerve, proceeding from the ophthalmic
branch of the fifth pair; and which presides over the secretion of
tears which serve, still more than the ocular mucus, to lubricate the
conjunctiva, which is the chief purpose of winking.
SYMPTOMS OF THE DISEASE.
115
[
"It is readily seen how a phenomenon, as complicated as winking,
which requires the action of so great a number of nerves, may be dis-
turbed, or, even suspended, in an affection, which, like dothinenter-
itis shatters, to such a great degree, the entire nervous system.
"It is necessary to take account, in severe fevers, of the other
particular conditions, perfectly independent of these circumstances
physically, of which I have already spoken.
"By reason of causes, known to us but imperfectly, but, which
derive their very nature from septic diseases, the mucous membranes
become the seat of congestions, semi-active, semi-passive which
readily go on to inflammation and even to sphacelus. Thus the
ophthalmiæ, the coryzas, the anginæ, the laryngites, the phlegmasiæ
of the genitalia, especially in children, are the usual accompaniments
of pyrexia in the septic form so that we can more easily understand
how the transparent cornea, when it becomes inflamed, for lack of
winking, easily goes on to softening, a species of gangrene of the
membrane."
"I treated," says the same Dr. Trousseau, "in company with Dr.
Granet, a youth who was affected with a nervous disease, not very
clearly made out, which formed a circle of concatenation between
cerebral fever, putrid fever and the ordinary typhoid. A slight con-
gestion of the conjunctiva supervened, as much under the influence
of the fever itself, as from the lack of winking. One of the corneæ
softened and the patient lost the eye. This sad accident made me
reflect and I thought that, if the greater part of this affair should be
set down to the account of the fever, the continued exposure of the
eye to the air, from the failure to wink, was an important, and, per-
haps, the chief cause, and from that time, I prepared to do what, in
fact, I did do with great success, in a patient in No. 8 of the Salle S.
Bernardo. In this woman, as I have told you, the sight seemed to me,
as well as to my assistants, in the clinic, to be inevitably lost. I had
no more hope than they, but tried the method of treatment which I
had laid down.
"I closed the eyes of the patient completely; over the eyelids I laid
two pledgets of carded cotton and fixed them there with a moderately
tight bandage. This little apparatus was applied during the morning
visit. During the day, the pains were less and, in course of the
evening, they disappeared. The next day, to our great satisfaction,
when we examined the eyes, we found the cornea with its normal
color, and, except a marked injection of the conjunctiva, everything
had resumed its usual course. The sight was still a little disturbed,
but there was no longer any photophobia. The treatment was con-
tinued for three days, and, then, the apparatus was removed. In the
meantime the general nervous accidents had yielded a little, the
stupor had disappeared almost entirely, and the eyes, since that
time, have been closed during sleep.
"I wish to refer you now," and it is the same Trousseau that
116
A TREATISE ON TYPHOID FEVER.
speaks," to another fact observed by my friend and colleague, Ambrose
Tardieu.
"An individual took scarlet fever which, from the first, was com-
plicated with septic accidents. The eyelids remained closed and the
inferior segment of the transparent cornea softened, just like that of
our other patient. He had already very acute pains, photophobia and
a considerable disturbance of vision. All at once, erysipelas appeared
upon the face, which rapidly invaded the eyelids and closed them
completely for four days. When the erysipelas yielded, and the eyes
opened again, Tardieu saw with pleasure that the eyes, which he had
thought lost, were perfectly cured.
Although in this case, gentlemen, the disease was not the same as
the other which we treated, yet the accidents were identical and the
means used to combat it, which nature in this case undertook to apply,
were merely the closure of the lids, a simple measure and easy of
application, which I beg you not to forget."
VIII. EARS.
The ears too become the seat of various symptoms during Typhoid
fever. The patients hear various noises which they compare to the
buzzing of insects, to the murmuring of water, and to sharp sounds.
The buzzing is more common than the hissing, and is a symptom,
sometimes, very distressing to the patient and increases the stupor in
which he is plunged. It is sometimes double, that is to say, it is in
both ears; sometimes, on the other hand, it is more pronounced, on
one side, than on the other. It manifests itself, sometimes, in con-
nection with the first symptom, or, it appears in the second week when
the nervous symptoms assume greater intensity. In general, it appears
nearer the beginning, than the end of the disease.
Hardness of Hearing.- This is a symptom quite often met in the
second period and, which, in some cases, may be confounded with
stupor. In a small number of cases, we may, it is true, consider the
hardness of hearing as dependent upon the same stupor, but in others,
it is quite distinct. Sometimes the hearing is hard, from the moment
of the invasion of the disease; the patients hear with difficulty, and it
is necessary to speak to them with a loud voice. The deafness is not
always very great, except, in an advanced stage of the disease, when
the stupor and delirium reach a considerable height. The hardness of
hearing is sometimes preceded by a humming in the ears, and some
patients experience both symptoms at the same time. They attribute
their deafness to sounds with which the ears are continually vexed.
The deafness is a more rare symptom than the humming. This
usually manifests itself at a more advanced period of the disease, and
SYMPTOMS OF THE DISEASE.
117
is often somewhat tardy, in the course of the third or fourth week.
The pains of the ears are sometimes the effect of an inflammation
of the auditory canal, or, of the internal ear; these pains are not
observed except in patients who have been sick for more than twenty-
five days and is rarely seen at the beginning of the disease.
Otorrhoea does not delay, when the ear is the seat of inflammation;
but, in other cases, this does not exist and then, the pain is not per-
sistent. The inflammation of the external auditory canal and the
otorrhoea, resulting therefrom, are not a rare complication. Louis, in
forty-five patients, severely attacked, noticed pains in the ears seven
times, and, four times, a running from the external auditory canal.
This author has not seen purulent otorrhoea, except in an'advanced'
stage of the disease, that is, after the twenty-second day from the
invasion. This occurred in all cases which presented themselves.
Twice this did not happen till after the fortieth day and the patients
died. Otitis and otorrhoea are not met except in severe, but not
always fatal cases. In these last times Meniere has observed that the
suppuration of the ear was accompanied, frequently, with perforation
of the tympanum. It appears also in other diseases.
"This lesion,"
says Louis, "would be merely a consequence of the predisposition to
ulceration. Would it occur more frequently in these patients than in
those attacked with otitis, in the course of other acute diseases."
The physician then ought to watch the state of the auditory canal
carefully, thus to prevent the lesions which may produce loss of sleep.
ease.
IX. THE NOSE.
In course of Typhoid fever, especially, in the first period, epistaxis
is frequently noticed, and is a symptom of great value as a diag-
nostic means, especially when it appears in the first days of the dis-
Because, notwithstanding the great number of symptoms,
proper to typhoid disease, which manifest themselves from the first
days of the disease, and which cannot, even from the very begin-
ning, leave any doubt, in most cases, as to the nature of the disease,
yet, with all this, there are some cases in which the failure of the most
important of these symptoms might hinder the physician in making
a positive diagnosis; if, in these doubtful cases, epistaxis inter-
venes one or more times, this new symptom would suffice, at once,
to reveal the true nature of the disease. The epistaxis which super-
venes, in the progress of the typhoid affection, is a phenomenon all
the more important according as it is observed in patients who have
never before suffered any loss of blood by the nose, and which, con-
118
A TREATISE ON TYPHOID FEVER.
sidering the age in which this affection is wont to occur, is a rare
normal condition. Neither can we compare the rarity of the epistaxis
which occurs, as we may say, accidentally in those persons who enjoy
good health, or who are laboring under other acute diseases, with the
frequency with which it manifests itself in Typhoid fever. Epistaxis
is not always observed in light cases, it is apt to fail. Prof. Barth
says that he has observed; it in half the cases noticed by him. Jacquot
has seen it forty-six times in 108 cases. Louis twenty-seven times in
thirty-four. In fine, we may say, that epistaxis is one of the more
favorable symptoms of the disease, and is observed less frequently in
slight cases than in severe. The time is variable; at one time, it ap-
pears at the beginning of the disease, together with the other prodro-
mic symptoms; at others in the first or second week, or even later.
Sometimes it occurs, once or twice, in the first days, and then returns
no more; more usually it persists, three or four days, in different
degrees, once or more in the same day, without our being able to
establish any relation between the gravity of the fever and the fre-
quency of the hæmorrhage.
The patient, affected with nosebleed, loses just a few drops of
blood, which scarcely attract his attention and which occurs a few
days in succession. Sometimes the quantity of blood is so small that
the patient has not noticed it, thinking it was red-colored mucus, or
the secretions which descend from the nasal fossæ, tinged with blood.
In some cases the epistaxis is very slight; the patient loses barely
sixty or eighty grammes of blood, while, at other times, it assumes
the proportions of a violent and frightful hæmorrhage. In children it
is very often difficult to verify the existence of the epistaxis, on
account of the position which they occupy, and, because they swal-
low the blood, as fast as it descends the posterior fauces. Some-
times the hæmorrhage is so considerable as to require a tampon in
the nasal fossæ.
In the adult, the blood coagulates at the orifice of the nostril, where
it forms blackish crusts, which suddenly produce suspicion of epis-
taxis. Sometimes the nose, the upper lip and the cheek are soiled
with the desiccated blood. Delirious patients, or adynamic, thrust
their fingers into the nose, automatically, by which they stop and
even lacerate the orifice, on account of which the blood forms crusts
there on the brownish spots. When this fluid descends the posterior
fauces and mingles there with the secretions, these present a brown-
ish appearance; they appear under the form of a blackish crust, or of
SYMPTOMS OF THE DISEASE.
119
shining or brownish liquid, covering the viscous, dense, or irregular
secretions which the patients expectorate.
The pulverulent state of the nostrils is announced by the whitish color
which the skin, at the orifice of each nostril, assumes, which color is
owing to the pulverulent particles which adhere to the skin. This
phenomenon seems to have its origin in the fact that respiration takes
place through the mouth, and, hence, the air does not any longer carry
with it the pulverulent particles which are drawn to the orifices of the
nasal fossæ. It was thought that this symptom announced a great
danger; but now, very little importance is given to it. However, it
should be said that it is more common to those gravely affected and
plunged in an ataxic, adynamic state, in which case the ingress of
air takes place entirely through the mouth.
In some cases the cartilages of the nose may be affected with typhoid
necrosis, and Dr. Henry Roger, in the Bulletin of the Medical Soci-
ety of the Hospitals of Paris, relates a case of it as follows:
"A young man, convalescent from a very severe Typhoid fever,
called the attention of his physicians to a phenomenon quite unusual;
he had a perforation of the nasal septum through which he could
pass two fingers. In fact they observed the existence of an ulcer-
ation with edges perfectly sound, bleeding in some points, covered
with scabs in others, circumscribing a complete loss of substance in
the septum equal to that of a dime.
“The cicatrization of the ulcer, of the soft parts, took place shortly,
but the perforation of the septum remained. In form, irregularly oval,
it was situated at three millimetres above the orifice of the nares. The
only functional disturbance which it produced was a nasal utterance,
which, at first very manifest, gradually and sensibly diminished."
This necrosis of the cartilages of the nose is much more rare than
that of any other part, and some writers on this fever make no men-
tion of it. Cruvelhier has not given a single example of it, while
others have noticed it as very rare.
Such lesions present themselves, finally, without making it necessary
to invoke a special location of the disease analogous to that found in
the intestines. In fact, in dothinteritis, there always exists, to a
degree more or less marked, that catarrhal state of the respiratory pass-
ages to which I have called attention; and, on the other hand, it is
well known how great is the tendency, in this fever, to ulceration in
every place where an inflammation, or simple irritation, of the
mucous membrane takes place. Now these membranes, in septic
diseases, become the seat of semi-active and semi-passive congestions,
readily going on to inflammation, and even sphacelus, a fact which
120
A TREATISE ON TYPHOID FEVER.
accounts for the opthalmiæ of which we have spoken, and, of the
laryngitis, in short, which is the habitual companion of these fevers in
septic constitutions, with a tendency to ulceration, a tendency which
produces it in parts where we have not been wont to look for it. Thus
Dr. Charcot has found it in the gall bladder.
A species of ulcerous diathesis manifests itself, then, in this dis-
ease, but, independently of this diathesis, of this species of dyscrasia
of the blood, in dothinenteritis, which constitutes one of the charac-
ters of putridity, the production of ulcerations is still one of the
effects of inaction, as has been demonstrated in the beautiful experi-
ments of Chossat.
Thus the ulceration of the nose and other parts, to be described in
their proper place, will never be as frequent as in the cases in which
the dothinenteritis has taken on the putrid adynamic form, and in
which it has had a longer duration, or in cases, in fine, in which
the individuals have been kept on too rigid diet.
X. THE FACE.
All physicians give great importance to the physiognomy of the
patient. In fact diseases impress upon the face a multitude of divers
expressions. If, in the healthy state of man, all the passions may
be depicted there, in the diseased state, all the internal processes of
disease may there express their quality. Hence, it is no wonder if
we inquire, what is the face of Typhoid fever? The great clinical
physicians are accustomed to observe the physiognomy of their
patients often, for the sake only of reading the diseases suffered,
which constitutes the so-called practical eye. Hence, the celebrated
Baglivi left, as a maxim, "Never leave a patient without looking at
his face."
The face assumes a different aspect in this disease according to the
form with which it presents itself, and the period in which it is found..
Sometimes, before the invasion, a change, more or less marked, may
be observed in the expression of the physiognomy, which becomes
sad or dejected, and shows a diminished aptitude for mental occu-
pations.
When the fever sets in with nervous phenomena, we find, from the
beginning, dejection, sadness, apathy, depicted upon the counten-
ance, and the complexion is changed and becomes greenish. If the
invasion is marked by great disorder of the circulation, the face is
animated and red when the patient lies in bed, but when he is half
reclining, or if he is raised up in bed, he is pale, and his look is that
SYMPTOMS OF THE DISEASE.
121
of one exhausted. If the attack comes with nosebleed, profuse and
repeated, the face is pallid, discolored and dejected.
In the first week, the phenomena of the invasion being increased,
and the stupor being more marked, the face has an expression of
dulness, shows loss of mobility, and is without expression, except
that of indifference, and apathy from which the patient can not be
aroused; the complexion is pale and greenish, the eyes are injected
and bleared, and the eyelids half closed.
In the second period, the symptoms still increase, the patient lies
like an inert mass, convulsive motions are seen in the face, which is
contracted variously, according to the action of the different muscles;
thus we have strabismus, closing of the eyelids, trismus, cracked
lips. Sometimes, when watching the patient, at this period, he
appears drunk, as the turgidity of the face, the redness of the eyes,
and the suffusion of the face, give him a dark color, as if painted.
In the third period, if the fever increases and is about to end in
death, the face becomes cadaveric; the nose becomes pointed from
the pinching together of the nostrils; the eyes sunken, moving but
little, and languid; the conjunctiva covered with an opaque veil;
the eyelids relaxed, pale, black, and as if motionless; the temples
sunken; the ears cold and drawn upward, and their edges turned
back, the lips hang down, are tremulous, white and cold; the fore-
head hard, dry and shrunken; the complexion pale or dark, even livid
and leaden; all the skin is earthy, dry, or covered with a cold sweat.
These features, described as they were, with the pencil of nature, by
the immortal Hippocrates, have been called the facies Hippocratica.
It must be observed, however, that these features, if not associated
with other fatal phenomena, do not always indicate approaching
death. Many times this appearance is produced by great loss.of
humors, and often, by profuse discharges from the bowels, and, in
this case, if there is no grave organic lesion, the forces may rally
and the patient recover. Amongst all these characteristics of the
Hippocratic face, the pinching of the nose is connected with the
greatest danger.
When the disease is to have a favorable termination the face of
the patient becomes, from moment to moment, less changed, and
more confident; the various contractions disappear gradually, and
the physiognomy is that of one just arousing from sleep or intoxi-
cation; the eye and the look, before languid, and dull, become
:
F
D7
122
A TREATISE ON TYPHOID FEVER.
more vivacious and freer; external objects begin to make an
impression, and the patients take interest in all about them.
XI. MOUTH.
The inspection of the cavity of the mouth brings to view many
points which are changed in Typhoid fever. And, in first examining
the lips, we must note the color which is natural at the beginning
of the disease, as is also their humidity; but when the fever assumes
a certain degree of intensity, often, indeed, quite early, they become
dry, as if pulverulent, then they swell and their epithelium cracks
and then appear those fissures, often deep, which allow the blood to
flow, and make the motions of the lips difficult and painful. The
drying of the mucus and blood, upon the lips, produces the fuliginous
lips, which, however, are seen in other diseases besides Typhoid
fever. The corners of the mouth are also the seats of fissures, of
fuliginosities, and little ulcerations, which are observed very often in
the course of the disease and in convalescence. We must notice also,
that the mouth is habitually open, particularly in sleep, a circum-
stance very frequently met when the nostrils are obstructed, and when
respiration is accomplished with. difficulty; we must also notice the
complicated motion of the lips, which is often observed in this dis-
ease, in which they are thrust forward, imitating quite well the
physiognomy of one smoking, although the lips in the wrinkled
face are closed, and, if the patient is near death, they hang down,
and are flaccid.
Teeth.-The examination of the teeth brings to light positive facts
about the constitution of the patient, and the state of the disease.
Of the first, this is not the place to speak, but we must see what char-
acteristics they present in Typhoid fever.
The teeth present nothing remarkable in the light forms of the
disease, but in severe cases, and during the first stage, the drying
of a light film of mucus, upon their surface, gives them a peculiar
shiny appearance, and, in the second stage, they are covered with a
mucous coating, at first grey, then brown, then black and shining,
covering them entirely. Sometimes this coating is bloody, brownish,
making thick crusts, which form upon the anterior surface of the
upper incisors especially, a line corresponding with the interval
between the two lips.
These conditions are derived not so much from the disease, as
from the manner in which the patient breathes, while all that we
SYMPTOMS OF THE DISEASE.
123
•
have said about the tongue is applicable to the teeth. Sometimes the
teeth are spotted with blood issuing from cracks in the lips or gums.
In some cases we see the enamel change, become friable and fall off
in little scales. We also observe, in this disease, the grating and
chattering of the teeth. Both these symptoms are wont to precede
delirium, of which they are the precursor, when they are not a sign
of the presence of worms in the intestines. The chattering of the
teeth may even appear in the beginning of this disease, when it
begins with a violent chill, as it sometimes does. In examining the
teeth, we must not neglect
The Gums. In this disease the gums often present the same
mucous coating, and, mostly, of a whitish pellicle, light and easy
to remove, and these deposits are not always confined to the gums,
but sometimes extend even to the internal surface of the lips and
cheeks.
The membrane which lines the interior of the mouth is but seldom
explored; in cases in which this examination was not omitted, the
membrane of the mouth was found in a normal condition, or dry and
red, or covered with mucus, blood, diphtheritic deposit, and some-
times ulcerated. A very constant symptom, and almost peculiar to
this disease, is the excoriation of the interior of the mouth, and the
aphthæ upon the gums. But of all parts of the mouth, that which
deserves the most attention, is
The Tongue.-The symptoms presented by the tongue are of great
importance to the physician, and are, in a measure, to the digestive
tube what the pulse is to the circulation. Some physicians have said
that the tongue is the faithful mirror of the state of the gastro-enteric
mucous membrane, and, hence, should be watched with all the atten-
tion possible, noticing with exactness all the morbid symptoms which
it presents. To proceed methodically in this inquiry, we must, first,
study its
Color.-Not to be deceived in the color of the tongue, we must
observe it in its natural position, and when it lies in the circumscribed
space in the inferior dental arch. This, in fact, is the only method
of avoiding a certain degree of redness which is wont to present
itself in consequence of the contraction of its muscles, and on requir-
ing the patient to put the tongue out of the mouth, we notice that the
point is redder than when it is lying in its natural position. Pathol-
ogists are much occupied with the color of the tongue, and as regards
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A TREATISE ON TYPHOID FEVER.
all the modifications occurring therein, they do not agree, nor are
they all worthy of the importance attached to them.
The tongue preserves its natural color in slight cases, and those
moderately severe, even from the beginning of the disease; but
sometimes the moisture and the color of the tongue are preserved, in
a normal state, even in the severe forms. In some cases, from the
very beginning of the disease, the tongue is red towards the point
and edges, but in the greater number of cases, the red color does not
appear till towards the end of the first period. Usually, it is white,
shiny, yellowish, and associated with a sensation of marked bitter-
ness; in thirty-one patients, in whom the disease was light, it
the
continued normal, except assuming a yellowish tint. Often, also,
tongue is found to present a diffused redness over all the mucous mem-
brane; sometimes this redness depends simply upon the protuberance
of the papillæ, situated at the apex and upon the superior surface of
the tongue. The redness coincides with the dryness, and often, too,
with the lack of the mucous covering. The natural color of the
tongue is often not altered, except in the posterior part where the
coatings which cover it are more likely to occur, and manifest them-
selves promptly. Hence, properly to judge of this symptom, we must
request the patient to thrust the tongue far out of the mouth. It very
rarely happens that the middle part is red, and that two bands,
white, yellowish, or black, exist at the sides without extending quite
to the edges.
The brownish color, mixed or not, with the sanguinolent matter
exuding from the mucous membrane, or which comes from the nose
or the gums, is very common, chiefly in the severe ataxic or adynamic
form. This color, often appears simultaneously with the dentar or
labial fuliginosities. The white color of the tongue, or the more or
less yellowish color, is observed in those forms of fever called mucous
or bilious.
Humidity.- When the mouth of the patient becomes glazed at the
same time that its moisture diminishes, the scanty and very thick saliva
moistens it imperfectly; hence, when the patient speaks, we may、
sometimes distinguish the clatter which the tongue makes in striking
against the parts with which it was in contact. This symptom of dry-
ness of the mouth is very frequent, and is more usually joined with the
redness and with the dull tint of the mucous membrane, than with
white or yellowish colors. We often see a membrane presenting these
two last colors preserving its physiological humidity. The dryness,
SYMPTOMS OF THE DISEASE.
125
in some cases, is limited to the apex, but more commonly it is general ;
this may exist in different degrees. When it is extreme, and when
the mucous coat is not covered with a fur, the tongue shows a polished
surface, levigated, as if covered with a reddish lucid pellicle, or with a
varnish with transverse lines or fissures, more or less profound, at all
points. Sometimes the tongue seems as if it had been dipped in blood
-it is so red. Before presenting this extreme dryness, the tongue is
clammy, that is to say, the viscosity of the furs, and chiefly of the
mucous coat, makes the finger stick for a moment upon the superior
surface of the tongue. This condition, denoted by authors by the
name of the callous tongue, is the first degree of dryness, which gener-
ally becomes complete before the end of the first period. In some
cases, however, the tongue preserves its humidity through the whole
course of the disease.
The dryness of the tongue, in many cases, is accidental, and does
not depend upon a deficiency in the secretion of saliva, or upon an
excess of absorption, but it is the result of the evaporation of the
saliva, owing to the passage of air over the superior surface of the
tongue, and this because the patient breathes through his mouth, the
nostrils being occluded, or from some other cause which obliges the
patient to keep the mouth open.
The furs or coatings which are formed upon the tongue are often the
cause of the morbid color of the same. The redness frequently de
pends upon the want of these, and upon the dryness of the mucous
membrane. The most common of all is the white or yellowish, some-
times quite thick, occupying the centre and base of the tongue, while
at the apex, and upon the borders, are seen reddish points which con-
trast with the morbid color. The redness is sometimes bright and
uniform, and due to the mucous membrane and not to the papillary
system. The greyish, reddish, yellowish, brownish or blackish furs
are quite common. In some rare cases, the white color of the tongue
is to be referred to the secretion of the white pseudo-membrane, or to
a creamy deposit, also diphtheritic.
Properly, to judge of the semeiotic and prognostic value of the
various furs of the tongue, we must know their causes. Now, the
examination of the liquid matters which tinge the mucous papillæ
shows these matters to be composed, in varying proportions, of saliva,
of the coloring matter of the bile and of the blood, together with the
various medicinal substances accidentally mixed with the drink. The
whitish or yellowish furs indicate the presence of mucus only. Some
126
A TREATISE ON TYPHOID FEVER.
have said that the yellow color announces the presence of bile. As to
the brownish furs, they are evidently formed from the dried mucus
as well as blood. Some practitioners say that the origin of the glaze
on the tongue is the saliva which dries, and the mucus has but little
share in it. Let one collect the saliva of a man in perfect health, and
dry it at the temperature of 89°, he will obtain every possible appear-
ance of the glaze, of the white and pultaceous glaze of the so-called
mucous fever, the yellow of the bilous fever, or the almost black of
the so-called putrid fevers; that these various appearanees should
present themselves, it suffices that they should dry, more or less.
completely, or should be exposed, for a longer or shorter time, to
the air. Hence, in a number of cases, without any gastro-intestinal
symptom, the tongue may be covered with a thick glaze of every
color. It is often observed that, when the mouth remains open, for
some time, the tongue presents a grayish covering. This, little by
little, takes on a blackish hue, if the mouth remains wide open, for
many consecutive days, and the drying up becomes complete; the
same happens as regards those strata which cover the teeth and the
lips.
The tongue, covered with different kinds of coatings, is more
frequent in Typhoid fever, than in any other disease. If the brownish
mucous, or, less frequent, sanguinolent coatings are dense, and dry,
there results, therefrom, upon the upper surface of the tongue, a
blackish crust, with a species of brown scales or red and cracked,
sometimes covered with a yellow viscous mucus and which gives the
organ an appearance horrible to behold. Often these brownish furs
are divided by crevices which supply blood and stain the tongue,
which is often dry, small, diminished in volume and as if indurated;
sometimes the tongue, which presents this appearance is said to be
parched. Wine decoctions, the powder of Peruvian bark and other sub-
stances, beside, may give the tongue a blackish color, purely acci-
dental, but these tints differ, very generally, from those of the morbid
glaze, and, with a little attention, and practice, they are readily dis-
tinguished. Most frequently these foreign colors exist in a very
uniform manner upon these moist glazed patches, and the colored
surface occupies, especially, the posterior and superior part of the
base of the tongue.
On touching some test paper to the tongue, covered with these white,
or yellow coatings, one always finds an acidity more or less pro-
nounced, which depends upon the very quality of the lingual mucus
SYMPTOMS OF THE DISEASE.
127
which is acid in the normal state. When a certain quantity of saliva
flows into the mouth, this acidity becomes weaker and neutralized,
and, even, in some rare cases, supplanted by the alkaline reaction
proper to the saliva; in this way we explain the differences, noted by
observers who have studied the mucus of the mouth.
This mucus has been examined very often, and it has been observed,
that, when the lingual mucus was copious enough to wet the test
paper, this became red, at least, if the saliva did not happen to
neutralize the lingual mucus. Donne found the mucus of the mouth
most frequently acid and thought that this acidity should be attrib-
uted to a gastric irritation; but, at present, even he has abandoned
this opinion. Bouillaud has observed the greatest difference in this
regard; in forty-three cases, in which the mucus of the mouth was
examined, it was acid in twenty-three cases, and not acid in twenty.
We do not know how to explain these results. We must avoid giving
any importance to the signs furnished by the examination of the
fluids of the mouth.
The form of the tongue is natural in most cases; often it is large
and thrust out upon the lower lip; sometimes it is round, cylindrical,
like a parrot's or strongly contracted and pointed, in form of a spear-
head; sometimes, finally, it is withdrawn to the bottom of the mouth.
Louis has seen it, much enlarged and tumid, in some cases.
Motion. The motions of the tongue, natural and easy, in the
greater part of cases, are changed, at an advanced period of the dis-
ease, and, in severe cases. It is vacillating, trembling, thrust out of the
mouth without hesitation; sometimes it is impossible to thrust it
beyond the teeth; sometimes it is kept within the mouth, with diffi-
culty, and rests upon the teeth and lips; in some cases it can not be
thrust out of this cavity, either because the patient is not conscious of
his condition, or, because of the thick coatings, the extreme dryness,
the cracks, the ulcerations which impede the free motion of the
tongue. This lesion of motion manifests itself in the ataxic or
adynamic form of the disease and explains, also, the impossibility in
which patients find themselves to articulate intelligible words, even if
they are not affected with delirium.
The texture of the mucous membrane of the tongue is very seldom
altered, if we except the fissures which exist in the epithelium. In
fifty-seven cases, says Louis, affected with Typhoid fever, terminating
in cure, only two presented ulcerations of the tongue, and still more
rarely is the tissue of the tongue softened.
128
A TREATISE ON TYPHOID FEVER.
If we look for the signification of the various symptoms, inferred
from the state of the tongue, we shall first find that the most import-
ant are its redness, and dryness and the white, yellowish or blackish
coatings. Many post mortem examinations showed Louis that these
three morbid states of the tongue do not indicate, in any manner, that
there exists any alteration of the mucous membrane of the stomach,
"the state of the tongue being identical, the mucous membrane of the
stomach was either in a natural condition, or, almost natural, or, if it
departed much from the normal state, it was found more or less pro-
foundly altered." Andral also arrived at similar results.
"There does not exist," says he, "any necessary relation between
the state of the small intestines and that of the tongue, any more than
between the state of the tongue and that of the stomach." And this
is now a fact recognized by all pathologists, who have generally
abandoned the opinion given by Broussais regarding the cause of the
redness of the tongue, But few, at present, consider this state of the
tongue as a sign of a gastro-intestinal inflammation. As the many
morbid conditions, which are the causes of the colors and coatings of
the tongue, are noticed elsewhere, we will not return to the subject
now; suffice it merely to say that all these conditions are presented in
almost all those affected with Typhoid fever. In truth, a febrile
movement very intense and continuous, a frequent and impeded
respiration, a violent, incessant thirst, seldom satisfied, the viscous
and thick coatings, a sanguinolent transudation, delirium - these are
the causes which act in a physical and chemical manner upon the
state of the lingual mucous membrane.
It should be said that the thick, yellow or white, and, somewhat
later, dark coatings, without being proper to Typhoid fever, are seen
in this disease much more frequently than in any other.
But it is necessary to know the sensations in the mouth experienced
by the patient. Now he speaks of a sensation of dryness or of heat
throughout the mouth, now he perceives a nauseous or acid taste,
now an extreme bitterness, a taste of bile, as some patients say.
Other patients have the pasty mouth, have an earthy taste and find no
drink palatable. We shall see further on, that, from some of these
symptoms, various therapeutic indications are derived.
XII. THE THROAT.
On examination of the throat and the pillars of the veil of the
palate, symptoms appear, similar to those furnished by exploring the
cavity of the mouth. Thus the pillars of the veil of the palate, and
SYMPTOMS OF THE DISEASE.
12
the uvula present, at one time, a state of simple redness, at another, of
tumefaction, and these symptoms are not rare. So too, sometimes,
one tonsil appears red, tumefied or covered with a diphtheritic pellicle
extending even to the arch of the palate; sometimes, in fine, the
tonsils, the vault of the palate and the pharynx are ulcerated. In
thirty-two patients, observed by Louis, twenty presented one or more
of these alterations; the most frequent phenomena were the redness
and tumefaction; twice only did ulcerations of the pillars of the
velum of the palate present themselves.
In some cases, the ulcerations extended to the œsophagus and partly
destroyed the epiglottis even. In Typhoid fever, there has been
observed, as all writers on the subject bear witness, a great tendency
to ulceration, and, in fact, ulcers are met in several organs and chiefly
in the intestines, which form an essential characteristic of the dis-
ease. In slight cases, the pharynx remains in its normal state, or, the
changes presented are very trifling. These lesions are observed in
grave cases and, after a certain duration of the disease.
In these it happens that the patients often complain of pain in the
throat, and, sometimes, they swallow with difficulty; in this case, the
fluids, which the patients wish to take, are some times rejected from
the mouth or nose. This happens, however, at an advanced period of
the disease, when they are plunged into an ataxic-adynamic state; in
fact, it is plain to see, that, in such periods, the actions of the organs
of deglutition must be injured so as to produce this dysphagia, which,
moreover, in some circumstances, quite rare, is to be referred to the
redness, the tumefaction, the ulceration of the pillars of the palate,
the pharynx, the epiglottis and the œsophagus. In cases in which the
impossibility to swallow depends upon a change in the epiglottis,
there is always enlargement, with induration and infiltration of the
part and reflux of fluids through the nose; however small may be the
quantity of liquid introduced into the mouth, it is, at the very instant,
rejected with a danger of suffocation. Some admit, however, as
cause of this dysphagia, paralysis or spasm of the muscles of degluti-
tion; but such conditions are rare; and, in this case, if the head of
the patient is properly sustained while he is trying to drink, the liquid
will frequently flow through the mouth without producing suffocation
and the epiglottis will present no alterations except as already noted.
XIII. APPETITE.
The diminution and, even the total loss of appetite is a symptom
which most generally accompanies the diseases of the organs of diges-
130
A TREATISE ON TYPHOID FEVER.
tion. The practical canon that an injured organ can not regularly
execute its functions is, however, too true, since the loss of appetite
is so constant a symptom and appears very early, even in different
degrees of Typhoid fever. In general, the patients begin to lose their
appetite several days, and, sometimes two or three weeks before they
are obliged to abandon their occupations or to betake themselves to
bed; gradually the desire to take food ceases to be felt, and, when the
disease is fully established, there is anorexia and even repugnance for
food. In rarer cases, the appetite is maintained till the moment the
fever begins. It may be established, as a general rule, that anorexia
always continues through the period of the invasion and increase of
the disease. The time at which it ceases is most various; usually, the
diminution of the febrile state and of the abdominal symptoms pre-
cedes the return of the appetite, and announces convalescence, but
this does not always happen. The appetite returns, chiefly, in those
patients in whom the tongue preserves its moisture and its natural
color. As long as the coatings remain on the tongue, and the tongue
itself is dry and clammy, the appetite does not return; nevertheless,
some patients, in whom these symptoms appear, assert that they feel
a desire to eat. Finally, anorexia is a sympathetic phenomenon and
nothing more. It is necessary to distinguish carefully between a real
appetite and what may be called a forced appetite, to indicate that the
patient makes known his desire to eat merely because he imagines,
that his feebleness, the continuation of the disease or any other
chimerical reason imperatively demands that he should take nourish-
ment. In such cases, it would be sometimes dangerous to obey these
false instincts of the patient.
The thirst, as regards local diagnosis, has but very little value, but
it is not the same as a sympathetic symptom. Its increase is one of
the most certain signs of an irritation and its intensity stands always
in a ratio to the degree of this irritation. When the irritation persists,
and, the thirst fails, it indicates a serious nervous disturbance, and
delirium or collapse interfere with the desire to drink.
Thirst, then, is a frequent symptom in Typhoid fever, but, it pre-
sents different degrees in different persons. Little intense, at first, it
increases as the febrile movement increases, and, when the tongue
becomes dry and covered with fur; sometimes there are patients who
drink very little, although they have a dry and brownish tongue. In
such cases it is necessary to consider the state of the intelligence; in
fact, the patient in delirium, or, in an adynamic state, often refuses
SYMPTOMS OF THE DISEASE.
131
:
the vessel containing the drink or rejects the drink when it has
reached the bottom of his mouth. The greater part of the patients
who present the condition of tongue, just noticed, drink with great
avidity, even when it is given to them every moment.
The intensity of the thirst is no indication of the gastric lesion
because such lesions did not appear in patients in whom the thirst was
violent and incessant. In general, it is more moderate in those who
have the white or yellowish coating upon the tongue, with bitter or
pasty mouth.
Most commonly the patients desire cold drinks, acidulated, not
sweetened, and, in this case it is necessary to second this, their instinc-
tive, sensation; some prefer bitter drinks or aromatic; most patients
require their drink to be changed every day, saying that the drink they
took, the day before, was bad and not suitable to quench their thirst.
The intensity of the febrile motion and of the heat of the skin,
the sweats, the failure of the coats upon the tongue, and the fre-
quency of respiration, are the symptoms which most commonly
coincide with the intensity of the thirst; perhaps they are its cause.
XIV. THE STOMACH.
Although the stomach is not the organ primarily injured in this
disease, yet it presents many phenomena of alteration in its func-
tion. In fact, the greater part of patients violently attacked, have
nausea, with or without pain in the epigastrium. In twenty-one
patients who died, Louis observed nausea in twelve. It was of short
duration, and, in the greater number of cases, was noticed at a period
more or less remote from the appearance of the first symptoms. Some
authors say that they have rarely seen this symptom, and mostly
at the beginning of the disease, and for a few days. Nausea may
return repeatedly, together with vomiting. As regards this symp-
tom, as well as regards the others, no relation can be admitted
between the manifestation of the same, and the existence of a mor-
bid state in the membrane of the stomach.
Vomiting constitutes a symptom, not very rare, in Typhoid fever.
Louis says that in forty-three cases, which recovered, and in which
he studied attentively the state of the digestive function, nineteen
had nausea, and twenty vomited. In twenty cases which died, and
in which inquiries regarding this symptom were not neglected, five
only had spontaneous vomiting; in seven vomiting was produced; in
èight there was none at all. Thus, in summing up, in sixty-three
132
A TREATISE ON TYPHOID FEVER.
cases, vomiting was observed twenty-five times. This symptom is a
little more frequent than the nausea.
The period in which these symptoms appear is very variable; they
most commonly manifest themselves at the beginning, and cease
early; they are sometimes occasioned by the drinks which the patient
takes, or from the use of emetics; in other cases they come, for the
first time, in course of the second or third week, or, even a little
later. In such a case, the vomiting is more persistent, and more
violent than that which appears at the beginning of the disease; the
concomitant symptoms are nausea and epigastric pain.
The matters vomited most commonly consist of green bile, greenish
or yellowish, sometimes a viscous fluid, slightly bitter and mucous.
In most cases, the matters vomited are more frequently found acid
than alkaline, on account of the quantity of gastric juices prevailing
in the bilious matter. The vomiting alone cannot be considered as a
symptom of lesion of the stomach. Louis says that such lesion is to
be feared, when, with the vomiting, there are epigastric pains. The
cause of this vomiting, in a great number of cases, seems to be a
simple nervous disturbance, and, in these cases, the patients vomit
obstinately, once or twice a day, for a week, or more, the drinks and
various medicines which they take. Often these same persons digest
broth and soup very well, and, giving them this nourishment, though
it may seem a little premature, ends in establishing their health. The
frequency of nausea and bilious vomiting is not the same in all cases
of Typhoid fever; sometimes these symptoms are so prevalent that
they may be referred to a particular form, under the name of the bil-
ious form of Typhoid fever. Some consider it as an effect of gastric
saburres, or as a bilious state, and draw from it deductions important
for the treatment.
Lesions of Epigastric Sensibility.-These lesions consist in pains in
the epigastric region, spontaneous, or excited by pressure. The first
are rather painful sensations than real pains; patients complain of
weight, constriction, distress in the epigastrium, at the end of the
sternum, and in one hypochondrium or the other. Sometimes these
lesions of sensibility increase under pressure, which, in other cases,
gives rise to a most acute pain, which may precede and accompany
the vomiting. The seat of the epigastric pain is the stomach, and
perhaps, also, the colon distended with gas. There are cases which
lead us to suppose that the cause of the epigastric pain may sometimes
be a simple gastralgia, produced by gas formed in the cavity
SYMPTOMS OF THE DISEASE.
133
of the stomach.
The epigastric pains are not the symptom of
a visceral inflammation except, in some rare cases, in which vomiting
exists at the same time.
XV. ABDOMEN.
From the first days of the disease the conformation of the abdomen
differs from that in the normal state, and, without increasing its
volume sensibly, it gives, on percussion, too clear a sound, owing
to the presence of gas in the intestines; somewhat later it takes a
form more convex, and is not much changed from its normal shape
till after the first or second week. The abdomen is tumid and sonor-
ous, in all its extent, but the highest degree of this sonorousness, is.
usually towards the hypogastrium and the iliac fossæ, where, by
means of percussion, meteorism may be detected before it can be
seen.
The meteorism has its chief seat in the large intestines, in which
the gas is exclusively found, after death. The developement of the
gas may be discovered by pressing the abdomen with the hand, which,
in such cases, presents a very firm and uniform resistance. When
this exploration is made, the patients often contract the abdominal
parietes, on account of the pain which the pressure excites, or by an
instinctive motion, which renders abdominal palpation difficult. We
may easily define, by percussion, the various points occupied by the
distended intestines. By this means, in the cases of which we speak,
we obtain a very clear sound, over all the abdominal region. Percus-
sion is also the only means by which we may learn that the large
intestines crowd the diaphragm, to a considerable height, on the left
side, for example, as high as the third or fourth rib in front. Meteor-
ism arrived at this height, or even less, impedes or accelerates the
respiration, already rendered difficult by the fluid matter accumulated
in the bronchi, or occupying the pulmonary tissues. It favors, besides,
intestinal perforation, and is more constant as the conditions of the
patient are more serious. Barth says that in twenty patients, who
died, three only failed to present this symptom, while it failed fifteen
times in those who recovered. Yet it constitutes one of the most
constant symptoms of Typhoid fever; hence, we must use every dili-
gence in inquiring about this matter, when we wish to establish the
diagnosis of this disease. Louis, having instituted a comparison
between this symptom, which presented itself in patients dead with
Typhoid fever, and the symptom itself, as seen in subjects who died
with other diseases, found that it was observed thirty-four times out
134
A TREATISE ON TYPHOID FEVER.
of forty-six, in patients of the first category, and but six times in
eighty in those of the second. Finally, this symptom developes itself
and disappears in a period which it is very difficult to determine; and
it lasts longer in the abdominal form than in any other.
In general,
it is grave, and goes on increasing till death.
We cannot attribute tympanites to an alteration of the large intes-
tines, because the alterations of these intestines are rare, and besides,
they do not occur till a long time after those in the small intestines.
Nor have we any greater reason to refer it, as some do, to the putridity
of the fæcal matter, to paralysis, to atony of the muscular walls
of the large intestines. This last lesion, admitting that it exists,
would be an effect and not a cause. What we are permitted to
conjecture is this, that a gaseous, and in fact, peculiar, secretion
takes place in the large intestines, by sympathetic action.
Extensive and strong palpation of the abdomen often produces a
gurgling sound. It is a species of "glu-glu," of prolonged rolling, to
which the name of borborygmus has been given, which expresses very
well the sound to which the name is given. This proceeds from the
displacement of the gases, mingled with the liquid matters contained
in the intestines, and is a symptom which most authors consider as
almost constant in this disease. This phenomenon is produced by
pressing with the hand upon various points in the abdominal region,
and particularly in the right iliac fossa, where it is most frequently
found.
This gurgling and borborygmus is nothing but a form of meteorism,
as Forget has well said, and to observe it, we have to place the patient
in such a position as that the muscles of the abdominal parieties shall
become relaxed: even where the patient seeks to resist the pressure,
either because it is painful, or for any other reason, it will not prevent
our observing the symptom, if the conditions capable of producing it
exist. It is often necessary to make use of both hands, which are
applied upon one and the other iliac fossa alternately, so as to displace
the fluids and gas of the intestines. Admitting that the exclusive
seat of the meteorism is in the large intestines, which seems to be
perfectly demonstrated, the gurgling also should be located in the
same region. In any case, it is more partial than general. In the first
case, it is limited, as a rule, in frequency, to the right iliac fossa, cor-
responding with the cæcum, and the ileo-cocal valve, and in the left
iliac fossa.
Sometimes it is general and, then, it is observed in any part of the
SYMPTOMS OF THE DISEASE.
135
abdomen on which pressure is made. Many times it is very marked
and, even at a distance, one may hear the noises arising from the dis-
placement of the gas and the fluids. The gurgling, in some cases, is
in great bubbles and in others in smaller ones which give the sensa-
tion of a sort of emphysematous crepitation. Sometimes it is observed
in the first period but, most frequently, in the second or third.
The borborygmi are complained of by the patients and, when they
follow the direction of the colon, they are generally succeeded by
alvine evacuations. In patients who suffer diarrhoea, it seems as if the
borborygmi displaced liquids, and, in such a case, they are often pre-
ceded by abundant evacuations of alvine fluids; consequently, in
this disease, in which diarrhoea is sometimes the cause of the loss of
the serum of the blood, and of death, they are unfavorable indica-
tions, and are chiefly found in bloodless patients, with a very weak
pulse.
Patients troubled with meteorism, pass a great quantity of gas,
having a very fetid and offensive odor. Such emissions do not avail
to diminish the meteorism. The partisans of the evacuant method do
not fail, in support of their views, to make the most of this pressing
indication, which seems to warrant the inference, that there are liquid
matters and gas in the intestines, which, according to them, tend to
irritate the mucous membrane and become re-absorbed.
In the number of abdominal symptoms, to proceed according to
Jahr's method, as has been said in the beginning of this chapter, those
also should appear which are the result of the alterations in the func-
tions of the liver and spleen, for these organs, as well as the stomach
and intestines are situated in the cavity of the abdomen.
Liver.- Icterus appears accidentally, only, and as a complication ;
the same may be said of the sensitiveness of the liver and the changes
of volume derived from the congestion, or from the phlogosis of the
tissue of this organ and, for that reason, have not been described
exactly. It must be noticed, however, that the bilious form of this
disease is rarely observed and such cases are seen only in certain
localities, during summer or autumn, that is, in the moist and hot
seasons, under the influence of peculiar epidemic constitutions, in a
word, in every circumstance in which bilious fever may be observed.
Spleen.-Splenic hypertrophy often takes place in Typhoid fever and,
towards the end of the first week, it is distinctly pronounced. This
lesion should always be sought for by means of palpation and
especially percussion, which readily shows if the organ is enlarged in
136
A TREATISE ON TYPHOID FEVER.
ts dimension upwards, towards the diaphragm or descends below the
bs, where also it may be felt in the form of a round tumor, hard and
uperficially smooth. The meteorism of the large intestines some-
times makes it rather difficult to circumscribe the limits of the hyper-
trophied spleen, whether by palpation or percussion.
The tumefied spleen ordinarily presents a position rather horizontal,
t scarcely goes beyond the arch of the ribs, and, by the meteorized
ntestines is pushed, upwards and backwards, against the vertebral
column. Therefore the splenic tumor of Typhoid fever is sometimes,
in exceptional cases, accessible to diagnosis in the supine position, and
in those cases, too, the softness of its edges does not permit one to
distinguish readily its inferior margin. If, on the contrary, the
patient is made to recline on the right side and put his hand upon his
head, the physician will perceive, by percussion upon the left lower
ribs, an obtuse sound, for a space of about six inches in length and
four broad; this corresponds with the eighth, ninth and tenth ribs,
and reaches posteriorly, to the spinal column and, in front, to the
costal arch or projects beyond it. An increase or diminution of the
volume of the spleen, by one or more centimetres, can not be verified
with certainty, notwithstanding the assertion of several masters of
physical diagnosis. Although the dimension of the obtuse sound may,
without doubt, be diminished or increased by any little manœuvre, we
must remember that this does not always depend upon a decrease or
increase of the spleen, but also upon an alteration in its site.
The hypertrophy of the spleen is so frequent in this fever, that
Louis has seen it fail, in but four cases among those who died of this
disease, and, in three-fourths of the cases, too, the patients died
between the twentieth and thirtieth days of the disease. "In all
these cases," says Chomel," the spleen presented a larger volume than
in the normal state and percussion enabled one readily to delineate it.
Often this viscus was four or five times larger than usual and this first
on the twentieth day, though, after that, its volume constantly
decreased."
Many patients complain of pressing pain in the region occupied by
the spleen, or, above that organ, which presented a protuberance
beneath the abdominal parietes. This splenic sensibility should not
be confounded with the pain which arises from pressing the large
intestines, distended with gas, or even the small intestines (abdominal
pain); the sensibility, of which we are now speaking, manifests itself
on percussing the splenic region.
SYMPTOMS OF THE DISEASE.
137
From all this it appears that the hypertrophy and sensibility of the
spleen come most frequently, and are most intense, in the grave
forms and, chiefly, in cases in which there are one or more febrile
exacerbations every twenty-four hours.
XVI. DEJECTIONS.
The alvine dejections constitute a symptom very important to be
studied in Typhoid fever. In more than three-fourths of patients
affected with this disease, diarrhoea is observed as a constant symptom.
In fact it was present thirty-four times in forty-two cases of which
Chomel speaks. In 101 cases, observed by Barth, the diarrhoea failed
only in five. The more grave the malady, the more frequent and pro-
longed is the diarrhoea. It begins in very different periods of the
disease. 1. It precedes all the other symptoms and lasts from eight
days to three weeks and this case is the most frequent of all. 2. It
presents itself, conjointly with all the other symptoms, in the first
week. 3. In course of the disease, and often on the twentieth or
thirtieth day. 4. In convalescence.
This division represents, most exactly, the various periods in which
the diarrhoea begins, though, indeed, it may fail entirely; the intens-
ity, too, of this symptom is most variable; sometimes the patient has
eight or ten evacuations a day; often four or five, or, even a single
one, which is very rare. The number of the evacuations does not
always bear relation with the duration of the diarrhoea; sometimes
this remains at the same degree without increasing; at others, it
becomes every day more severe.
Studying the relations which the diarrhoea may have with the state of the
intestines, we find: 1. That the lesion of Peyer's patches is often the
only cause of the initial diarrhoea, as well as of that which supervenes
in the course of the fever and in convalescence, as there is, in fact, a
lesion of the mucous membrane lying between Peyer's patches and
that of the large intestines. 2. In other cases, the mucous membrane
is colored red, softened or ulcerated, to all of which lesions the
development of the diarrhoea should be referred. 3. Sometimes the
large and small intestines are affected simultaneously. 4. At others
the alimentary canal is found in a perfect condition, though, in the
course of the disease, the diarrhoea had been intense and pertinacious.
The diarrhoea, which manifests itself in convalescence, either abso-
lute or incomplete, is the result of the ulceration of Peyer's patches or
of the isolated follicles.
D8
138
A TREATISE ON TYPHOID FEVER.
Constipation, is a very rare phenomenon,* sometimes observed at
the beginning of the disease, but not continuing very long, especially
when the fever has a certain intensity. But, in some cases, constipa-
tion is seen continuing till death or recovery.
Involuntary Evacuations.-Towards the end of the first week, or
even a little later, when the ataxic and adynamic symptoms appear,
the patients are no longer conscious, and, then, they have involuntary
evacuations. The comatose state, too, determines the same effects.
Involuntary evacuations are a very serions symptom, although patients
who have them, often recover.
The matters evacuated are hard, liquid, gaseous and even contain
worms. The hard evacuations are seen only at first, they finally
become liquid. The color is ochre-yellow, or dark, ashy grey or green.
Sometimes the stools are pappy and black or greenish, in which little
white corpuscles are observed; sometimes a yellowish mucosity is
mixed with the same white clots. The odor of the passages is
extremely fetid and, sometimes, it seems even as if they were putre-
fied.
In some cases, the evacuations are sanguinolent; where the blood is
mixed, in small proportion, with the sero-mucous matter of the intes-
tines, the evacuations present a bright reddish and uniform color or
they are disseminated in zones, or, small blackish clots are seen float-
ing in the liquid. At other times, the blood exhaled, is in consider-
able quantity and composes, almost entirely, the substance of the
evacuations, which, in such case, present an intense color and appear
quite similar to the blood from a vein; sometimes they have a reddish
color quite bright or violet. The bloody evacuations, always announce
a serious condition and should inspire the physician with great con-
cern. It is a very important matter, that, in the course of Typhoid
.fever, these bloody stools should not be passed without being noticed,
since they teach the physician the danger which the patient runs, and,
demonstrate, almost to a certainty, that the disease is truly a Typhoid
fever, though the diagnosis, up to this time, may have been doubtful.
Sometimes, in the course of Typhoid fever, real hæmorrhages set in
which are not a proper symptom of the fever, but, are merely acci-
dental. In fact, hæmorrhage may take place in the stomach or intes-
* NOTE.- If I might judge from my own observations it is not a "very rare phe-
nomenon" in this country, under Homœopathic treatment, and I fully agree with
those who are content to leave the bowels quite inactive, as long as it pleases them
to be so.-TRANS.
SYMPTOMS OF THE DIsfase.
139
ન
tines; that which comes from the primæ viæ, is the rarest and can not
be considered as a complication of Typhoid fever; it depends, some-
times, upon a lesion, quite anterior to this fever, as, in a case reported
by Chomel, in which the liver was affected with cirrhosis; and,
sometimes, it arises from some other visceral disease.
Enterorrhagia is a frequent complication of Typhoid fever; it is
produced by an alteration of the mucous membrane of Peyer's
patches, or, by the simple exhalation of blood from the unaltered
tunic. This double cause of hæmorrhage is made evident by post
mortem examination and the study of the symptoms. In fact, we
often find, in the intestines, some inflamed patches and the hæmor-
rhage takes place from the first days of the disease. In this case, it is
a product of exhalation and constitutes a phenomenon of the same
order, and, the same nature, as epistaxis, ecchymosis and visceral
sanguineous congestion. That such is really the origin of these
hæmorrhages is demonstrated, beyond a doubt, by the fact, that, while
the sanguineous humor flows from the free surface of the mucous
membrane, it is infiltrated also into this membrane or the cellular
tissue.
Andral says that intestinal hæmorrhages generally take place in a
somewhat advanced epoch, but, that they may also manifest them-
selves from the beginning. What has already been said shows the
difference in this respect. The enterorrhagia is observed, during the
first week in some patients who die with all the symptoms of fulmi-
nating typhoid; in other cases, the disease had passed beyond the
second week.
The symptom which usually reveals the existence of this complica-
tion is to be inferred from the nature of the alvine evacuations, which,
sometimes, consist of coagulated or fluid blood, blackish or reddish,
sometimes brown and pappy or simply rose-color, sometimes, finally,
of yellow matter, mixed with blackish clots. It may also happen that
the blood is not discharged, but is retained in the intestines. Some
patients discharge, in one day, two, four and even five pounds; then
this fluid disappears entirely from the dejections. This sanguineous
drain is very often accompanied by colic, by abdominal tenderness,
and tumefaction, by dulness of sound under percussion and by all the
general signs of hæmorrhage, such as coldness of the extremities,
swooning, fainting, cold sweats and pallor of the face. When the
enterorrhagia manifests itself at an advanced stage of Typhoid fever,
the bloody discharges pass involuntarily, and the patient must be
140
A TREATISE ON TYPHOID FEVER.
watched very carefully, or, rather the physician himself should exam-
ine the soiled linen, that he may discover the discharge. Some patients
discharge from the anus a reddish liquid, the nature of which can
leave no doubt.
The intestinal hæmorrhage constitutes a serious symptom, though,
it does not, always, announce an unfavorable issue. Louis, Andral
and all other authors who have observed this hæmorrhage, have seen
a certain number of patients cured. Quite recently, too, patients
were cured in whom this symptom was observed.
The blood coming from a nose bleed may be swallowed and expelled
with the dejections. It is not always easy to discover the real origin
of the loss of blood; still it is a rare case that this symptom is mis-
taken for the result of nose bleed.
Sometimes, in the passages, we meet with the tricocephalus, lum-
brici and with crystals.
Sensibility of the Abdomen.- The abdominal pain has its seat in the
whole belly, or, only in certain points; the points where it is most
frequent are the epigastrium, the right ileo-cœcal region, and the left
iliac fossa. Of the epigastric pain we have spoken already; all we
need to examine now is the pain occupying the other parts of the
abdomen.
The pain, diffused or local, is rarely spontaneous; but not a few
patients complain of feeling, through the whole belly, an obtuse, deep
seated pain without particular character; some have colics, like that
produced by a slight diarrhoea. In general, the spontaneous pain is
increased on making pressure upon the abdomen. To arouse the pain
we must press, successively, and, with more or less force, upon all
parts of the abdominal parietes. By this means, we find, almost
always, a decided pain, at least, an abnormal sensibility, in the right
iliac fossa, in the epigastrium, more rarely in the left iliac fossa or
towards the umbilicus. On making this pressure, which excites the
pain, we discover, at the same time, also the gurgling.
The abdominal pains are a very frequent symptom, usually mani-
fested at the beginning of the disease. They are observed in all the
course of the first or second week, and it is rarely that they appear
later. When delirium supervenes, or, the sensibility becomes very
obtuse, the patients no longer complain of pain, which, however, may
remit and return again successively.
Sometimes these pains are very acute and quite like those produced
by peritonitis, in intestinal perforation, which is observed in certain
SYMPTOMS OF THE DISEASE.
141
cases and the patient dies in a short time. A very severe pain is an
unusual phenomenon, in the common form of Typhoid fever, and one
which ought to lead the physician to suspect the existence of a pro-
found lesion of the membranes of the intestines. With intestinal pain
we must not confound that observed by Andral, in some cases, and
arising from morbid sensibility of the skin or from hæmorrhage inter-
vening in the muscular fascia of the abdominal parietes.
The pain has no relation to the diarrhoea, since, we see it arise and
disappear, where this is not present. These two symptoms are always
preceded by one common cause, that is, alteration of the intestines.
The abdominal pains are no stronger, in case of intestinal hæmor-
rhage, than they may be under other circumstances. The intensity of
these pains, according to Louis, is proportionate to the violence of the
disease. Besides, we see patients seriously affected who do not com-
plain of any pain, even when the abdomen is strongly compressed,
though we should give due weight to the stupor and state of insensi-
bility into which the patient is found. Neither does the pain have any
relation to the intensity or the extension of the intestinal lesion, since
intense pains are met with where there is slight alteration and, great
alterations, with slight pain. Besides, this symptom appears early and
before there could be any ulceration. Andral says that he has seen
the pains to fail, First, in cases in which the mucous membrane was
red. Second, in those in which numerous patches were met or only
pustules of a circular form. Third, finally, in cases in which there
were ulcerations of the large or small intestines. Sometimes the
ulceration is so profound that the peritoneum is the only membrane
which remains, and, meanwhile, there had been no pains. We hence
conclude, that, if the abdominal pains constitute a frequent symptom
of Typhoid fever, they can not serve to indicate the state of the intes-
tines, and, consequently, the therapeutic criteria which some wish to
derive from this symptom, have not all the importance attributed to
them, by some physicians, and especially by the school of Broussais.
In some cases, intestinal perforation occurs, which may easily be
confounded with peritonitis, which always follows it. There is ordi-
narily but one perforation, though sometimes there are two or three.
The seat of this is the small intestines, and rarely, the large. Typhoid
fever, accompanied by this grave complication, presents, sometimes,
a mild form, and rarely the symptoms indicate a certain gravity. The
insidious, and latent course, of the pathological process, seated in the
intestines, is explained by the processes of ulceration, which extend
142
A TREATISE ON TYPHOID FEVER.
to muscular and serous tunics, and, by the formation of an eschar.
The gaseous distension of the small intestines has been considered as
a cause which might, by itself alone, if not produce, at least favor,
the development of the perforation. Chomel insists much upon this
cause, and seeks to establish the assertion, that, upon its intervention,
depends the greater frequency of intestinal perforations in Typhoid
fever patients.
The perforation does not take place till after the twelfth day, that
is to say, from the time when Peyer's patches are ulcerated or soft-
ened; it may take place after the thirtieth day, when the bottom of
the ulcer, in process of cicatrization, is only formed of the most deli-
icate muscular coat, or the peritoneum. The perforation is announced
by a pain, generally violent and instantaneous, which has its seat in
the abdomen, by the extreme sensibility of all that region, the cold
accompanied with malaise, general prostration, alteration of the lin-
eaments of the face, nausea, bilious vomiting, and by the frequency,
the hardness, and sometimes the inequality, of the pulse. Very soon
the abdominal pains become so intense that the least motion made by
the patient, or the slightest pressure, annoy him; his features express
suffering and anxiety, except, on the other hand, the patient should
be in delirium, or in such an adynamic state as to suspend the man-
ifestation of the abdominal sensibility. The suppression of the
dejections or of the urine, is less constant than in simple periton-
itis. When the symptoms are thus marked, the diagnosis no longer
remains uncertain; these symptoms increase till death, which gener-
ally happens in a day or two. The same cannot be said in the slow
and insidious form of perforation; some patients only complain of a
very slight abdominal pain; but the nausea, the vomiting, the exacer-
bation of the fever, the meteorism, and the expression of suffering,
which the face assumes when any pressure is made upon the belly,
should lead us to suspect an inflammation of the peritoneum.
some cases, the peritonitis is partial or circumscribed by adherences,
which are rapidly developed, and which impede the effusion of
liquids. In others, the symptoms are so light, that the physician does
not notice them, and is surprised to find, at the post mortem, a lesion
which he had not suspected during the life of the patient. This ci-
eumscribed lesion is produced at the moment in which the perforation
has taken place, by the passage, into the cavity of the peritoneum, of
the liquid matters, and of the gases contained in the intestines. Louis
saw a patient resist this grave complication for seven days. Some
In
SYMPTOMS OF THE DISEASE.
143
*
patients complain of pains in the inferior extremity of the rectum,
which, sometimes, consist in painful pressings of very short duration,
and accompanied with diarrhea; sometimes with a sense of heat or
weight.
XII.
URINE.
The symptoms presented by the genito-urinary apparatus do not
fail in importance, in the disease of which we have been treating.
Studying it with attention, we see in the first days of the disease, or,
when the affection is light, the patient passes urine with facility; nor
is there any other phenomenon present as regards the urinary
secretion.
But very soon, if the disease is aggravated, and gives rise to ataxic-
adynamic symptoms, it happens that the bladder retains the urine, or
it is expelled without the concurrence of the will of the patient. In
the first case, we have retention, and in the next, incontinence of
urine. Hence, it is necessary, at every visit, that the physician
should explore the bladder attentively, and not permit it to remain
distended by the urine. He should not content himself with the
attention, often incomplete, given it by the nurses, but, with palpation
and percussion, he should ascertain that the bladder does not occupy
the hypogastrium, or push itself up to the umbilicus, even, as is
observed in very many cases. The incontinence of urine, which
almost always accompanies involuntary alvine evacuations, and
which, as well as this, depends upon the prostration into which the
patients have fallen, is an unpleasant symptom, which does not occur
except in grave cases, and at an advanced stage of the disease.
The urine in the first week, is concentrated, corresponding with the
intensity of the fever, and shows an increase in specific gravity. Its
absolute quantity is not diminished; the patients compensate, with
drink, the loss of serum produced by the increased evaporation, and
by the diarrhoea.
As regards its alteration in Typhoid fever, contradictory opinions
prevail, based, for the most part, upon imperfect observations or theo-
The more
retic ideas, to which the hypothetical pathology gives rise.
exact researches of physicians of our times, will give to this part of
semeiotics a precision which leaves nothing to desire.
Vogel was the first who demonstrated that the production of urea,
which, in proportion to the quantity of food introduced, is considerably
augmented, corresponds with the increased temperature of the body,
which it can derive solely from the greater material interchange of
144
A TREATISE ON TYPHOID FEVER.
the tissues of the organism. Subsequently, if the fever ceases, the
increased production of urea also ceases, and, correspondingly with
the temperature of the body, often descends below the normal state.
The alkaline chlorides are diminished in the urine of Typhoid fever
patients. The explanation of this fact is not so easy as that of the
increase of the proportion of urea. It depends, in part, upon the
diminished introduction of table salt, as the patients abstain from
food; and, in part, from an increase of the excretion of these same
chlorides, with diarrhoeic dejections, and perhaps, also, from the fact
that the blood, becoming poor in albumen, retains a greater quantity
of salt. In any case, neither the increase of urea, nor the diminution
of the alkaline chlorides, in the urine, are alterations characteristic of
Typhoid fever, since they are found also in other diseases, occurring
with violent fever and exudation.
Andral, in the years 1837 and 1838, studied the urine in forty-one
individuals affected with Typhoid fever. In thirty-four cases, which
had a favorable issue, the urine was normal eleven times; twenty-
three times it was colored reddish, and presented a spontaneous tur-
bidity, from amorphous uric acid, mixed or not, with this same
crystallized acid. The urine then had a jumentose appearance, or
deposited a sediment. Nitric acid produced a precipitate in it. At
other times, the urine, at first limpid, became jumentose after a few
days, or gave a precipitate on the addition of Nitric acid. The urine
was always acid in thirty-four cases, through the whole course of the
disease, and maintained the same state through convalescence, except
in two cases, in which it became alkaline, although perfectly trans-
parent; neither acid nor heat rendered it turbid, and it subsequently
resumed its acid quality. In seven cases terminating fatally, the urine
maintained its acid character. Once, only, was albumen passed in
the urine, but this was very transient.
A capital fact resulting from the researches of Andral, is that in
more than 150 individuals, the urine was always acid, except in the
following cases: 1. When pus was mingled with the urine. 2. When
there had been retention of this fluid. 3. When it had been examined
several hours after emission. 4. When the patients had made use of
a great quantity of alkaline drinks, and of chlorides. Such causes, it
is manifest, are all accidental and foreign to Typhoid fever. The
urine is seldom alkaline in this disease, not even in its last stages, and
its most severe forms. Out of fifty cases, twice, and for three days
SYMPTOMS OF THE DISEASE.
145
only, alkalinity of the urine was observed. To know the alterations
of the urine exactly it is necessary to use the greatest precautions;
to see, for example, that the vessels destined to receive it are as clean
as possible, and that the urine is discharged by the patient directly
into the vessel.
We also find the urine a little denser than in its normal state, a little
too copious, highly colored, and, with uric acid sediment, in a word, as
it is in febrile affections. During the convalesence of thirty-four
patients, the urine was pale and transparent; but occasionally it
remained turbid and sedimentous some time after the cessation of the
fever. The albumen was only found in eight out of thirty-eight cases,
two of which terminated fatally. Twice, blood was found, mixed
with the albumen, and in eight cases out of thirty-seven it was mixed
with mucus.
The urine is much inclined to change as soon as it leaves the blad-
der, and more easily and more promptly, as the Typhoid fever is more
severe. In thirteen patients Bouillaud found, that in one case, the
urine exhaled the odor of veal broth when it decomposed; at other
times, the urine was ammoniacal, but such cases are exceptional; the
urine has no odor sui generis, and when one is met, it must be attribu-
ted to an occasional cause -- foreign to the disease.
It results, from the preceding researches, that the urine, in individ-
uals affected with Typhoid fever, presents nothing special to the
disease; it is acid and not alkali, as has been said by some,
and
perhaps more disposed, than the urine of patients in other diseases, to
become turbid and jumentose; as to the passage, in the urine, of albu-
men, of pus, or of blood, these cases are rare. The mucus is secreted
in greater abundance by reason of the frequent retention of urine in
the bladder. In similar circumstances, too, pus may be secreted by
the bladder, and thus supply albumen.
The sediments which are spontaneously formed in the urine, or with
the addition of a drop of Nitric acid, are constituted of uric acid, are
amorphous or crystallized, united to animal matter and to a small
quantity of coloring principle. The sediments are grey or reddish,
sometimes mixed with mucus. The ready precipitation of salts is
seen in the saline incrustations upon the sides of the vessels des-
tined to receive the urine*
* NOTE.— On this subject see Appendix.-TRANS.
146
A TREATISE ON TYPHOID FEVER.
XVIII. PARTES VIRILIA.
The genital organs and their functions, in man, at least, do not pre-
sent any symptoms peculiar to Typhoid fever.
*
*
*
*
*
XIX. MENSTRUATION.
*
*
Menstruation is usually deranged, anticipating or retarded, or failing
entirely, in Typhoid fever patients; but, on the other hand, some-
times, it occurs at its ordinary period, notwithstanding the invasion
of the fever. We have happened to see, in a certain number of cases,
this function pursuing its normal course, though the Typhoid fever
was intense, and had already reached an advanced stage. It is often
observed, however, that women affected with this disease, have
hæmorrhage of the sexual organs, which does not always coincide with
the return of the menses, which, though thought by the laity to be a
phenomenon of favorable augury, is generally most sinister, even
when the loss of blood is but very trifling.
ance.
Pregnancy is a natural function, and, like all others, is influenced
by this disease. Abortion is often the result of the general disturb-
Forget speaks of two cases in which abortion took place
during the first days of the disease, and which terminated in death;
in a third case, the patient, in the third month, recovered. Other
practitioners do not fail to observe that pregnant patients, in whom
abortion occurs, die more readily from the intensity of this fever.
XX.
LARYNX.
The larynx and the other organs of respiration should be attentively
studied, because, in this disease, there is no function of the animal
economy which does not suffer. And it may be said with certainty,
that there are but few severe cases of Typhoid fever in which we do
not meet frequent lesions of these organs in different degrees.
The larynx is the organ of the voice, and hence, when it is altered,
the voice cannot be natural. But it often happens, as in this disease,
that the voice is altered and the larynx found to be in its normal
state. The voice is often feeble when the other functions are equally
so. In order that the sound produced by the larynx, should be accom-
plished, it is necessary that a certain volume of air should pass
through that organ; if that does not take place, and the expiratory
powers are enfeebled. the voice cannot but be weak. In disease of the
encephalon, or in any lesion of the nerves which are distributed to
the larynx, aphonia, or loss of voice, is usually manifested. An
extreme enfeeblement of the thoracic muscles also gives rise, some-
times, to a kind of aphonia.
SYMPTOMS OF THE DISEASE.
147
The voice, in the beginning of this disease, retains its natural
sound, but when it alters, it becomes weak, melancholic or sighing,
interrupted, and it is often difficult to understand what the patients
say. Their voice is uttered with some difficulty, and it is necessary
to excite them to speak distinctly, that they may be understood.
When they are plunged in stupor, or their forces are prostrated, and
they speak slowly, this is to be referred much more to the state of
the intelligence than to that of the larynx. It is always necessary to
consider the presence of viscous and tenacious mucosity in the cavity
of this organ, which is often raised with difficulty, and remains
adherent to the epiglottis, and the posterior part of the mouth, as
well as the difficulty that patients experience in moving the tongue to
articulate a word.
But cases are not wanting in which the voice is hoarse, from the
irritation of the vocal cords, or from inflammation of the edges of the.
glottis, or from a true laryngitis. Sometimes the voice is hoarse, deep,
evidently guttural from amygdalitis and pharyngitis, and, especially,
if there is at the same time, increase of volume, a fact not unusual in
this disease, as has been already observed. Aphony from ulceration
and oedema of the glottis, has also been observed in the course of
Typhoid fever or during convalescence.
Another symptom of this disease is the cough, the sounds of which
are produced in the larynx or trachea; perhaps, even, it never exists
without these canals being primarily or symptomatically, irritated,
and without there being a spasmodic contraction of the glottis.
We will merely notice here that the cough may present a multi-
tude of characters. It is idiopathic or symptomatic, according as the
air passages are primarily or secondarily the seat of the organic cause
which produces it; it is sometimes dry, sometimes moist; it con-
sists in a small number of inspiratory and expiratory movements, or
it returns spasmodically. It is hoarse in certain affections, guttural,
pectoral, according to the point in which it seems chiefly to sound.
The laryngeal cough is capable of two degrees; in the first, which has
a special character, it holds, in a measure, a middle ground between
the movement by which the mucus is expelled from the air passages
and the deep and bronchial cough. It is evident that the locomotor
organs of the larynx contribute alone to produce it, and the patient
feels very distinctly that its source is not deep. The walls of the
chest and the diaphragm scarcely participate in this movement, and
only act to expel the volume of air which should take with it the
M
148
A TREATISE ON TYPHOID FEVER.
laryngeal expectoration and produce the sound with which this cough
is accompanied. While the bronchial cough is often involuntary, this
which is derived from the larynx, is often under the control of the
will. It is a very slight expiratory movement and accompanied by a
hoarse sound which the patient utters and which is often heard in
state of health, when the saliva flows towards the guttural orifice of
the larynx and inclines to enter. In many cases, and, especially in
laryngeal ulcerations, this cough occurs often in a given time. It
announces almost always, a pain in the larynx, more or less severe,
but it may be the consequence of many causes; some times from the
tendency of the saliva to flow into the larynx, when the act of swal-
lowing is imperfectly executed; sometimes because the glottis or the
adjacent parts are irritated, inflamed or ulcerated; sometimes this
little cough has its rise under the influence of moral causes, and hap-
pens, for example, when some candidate appears before an assembly
unexpectedly large, when he is frightened and especially when he has
to think what he should say. The fear of phthisis laryngea has made
many medical students cough.
The cough, an almost constant symptom of Typhoid fever, and,
especially, of its severe form, very seldom appears in the first days of
the disease; like the sonorous rale it does not appear till the sixth or
seventh day. Louis observed the cough, usually, from the third to the
twelfth day, in patients who died, and, from the sixth to the fifteenth,
in those who recovered; so that, from what was observed by this dis-
tinguished physician, we may conclude, that, in severe Typhoid fever,
the cough begins early, and is quite prolonged; it may often be
referred to some pulmonary lesion, and, in this case, does not cease
but with the cessation of the patient. In most cases, sonorous rales
are heard, from the first manifestation of the cough, and, hence, it is
not necessary to wait for the appearance of this symptom to induce
one to explore the chest. Every day we should practice auscultation,
even before the cough appears, in patients with this fever; pursuing
this course, it often happens that we meet with sonorous rales before
any cough has existed, and while the respiration is normal.
The cough, in general, is infrequent, when there is only bronchial
catarrh, but, it becomes frequent, and even troublesome, as soon as
the pulmonary congestion takes place. This difference of the cough
has often served to indicate the pathological transformation of which
we are speaking, rendered still more evident by the results of auscult-
ation. The cough is incomplete, abortive, when the patients are
SYMPTOMS OF THE DISEASE.
149
i
delirious or in a state of prostration. It is more frequent in the morn-
ing, and, during the febrile exacerbation, than in any other hour of
the day.
The excretions are usually not very abundant, and we should
observe, that, in a very great number of cases, expectoration fails
entirely by reason of many circumstances which writers upon this
subject have not always distinguished. In the first place, as a general
rule, typhoid bronchial congestion is accompanied by a very slight
secretion only; and, indeed, there is no secretion at the beginning, as
the sonorous rales indicate, which are produced by the tumefaction of
the mucous membrane, or, by the presence of the least quantity of
fluid. Afterwards, when the secretion is abundant, expectoration is
rendered difficult, or, even impossible, by the weakness of the thoracic
muscles, as well as of all others, as well as by the delirium or irregu-
lar or illy-directed action of the muscular forces which produce
expectoration. In many cases the excretions remain upon the lips, or
in the mouth, unknown to the patient. All the pharynx is likewise
covered with the matter of these secretions, as they are not expelled,
and the excretions, discharged by expectoration, remain in the back
part of the mouth; in fine, the dryness of the membrane which covers
this cavity and the fuliginosity of the tongue, and of the lips, are
other obstacles which prevent their expulsion.
The excretions are whitish, mucous, or puriform, dense, not mingled
with air; at other times they are transparent, viscous, tenacious,
thready, presenting a peculiar form, dependent upon the difficulty with
which they are expelled from the mouth, or, upon a particular alteration
of the fluids furnished by the follicles or the salivary glands. One of
the best characteristics of these typhoid excretions is their sanious,
brownish aspect, which arises from the presence of blood or of mucus
combined in different proportions. This blood comes from the nostrils,
at the beginning of the disease, and, afterwards from sanguineous
exhalation of the mucous membrane of the mouth. Sometimes these
sputa are bruised and more or less round, at other times they are quite
large and fleshy-like; their odor is excessively fetid. In convalescence,.
the quantity of these excretions increases and their nature is changed;
they become mucous, whiter and more filled with air; sometimes they
are even tinted with a blackish matter or are mixed with blood, etc.
XXI. CHEST.
The chest presents many symptoms, which, before they are apparent
to the assistants, the physician can detect by means of observation,
150
A TREATISE ON TYPHOID FEVER.
without which they will not be discovered, for, indeed, they have not
yet arrived at a stage where they can readily manifest themselves to
the senses, without minute investigation. In fact, the acceleration of
the vital functions is a symptom of all febrile diseases and, in all, may
be noticed a certain degree of dyspnoea, which is in proportion to the
acceleration of the circulation of the blood. This dyspnoea is not
observed by the patient nor his watchers; but the physician, examining
him by means of auscultation, perceives symptoms indicating lesions
about to take place. These symptoms are the rales, which in Typhoid
fever, are heard in two modes, which are distinguished, as the dry
rale and the moist, and, sometimes, there is the mixture of the two.
The dry rales consist of sibilant and sonorous rales, which are joined
to, and follow, each other, or are heard separately. The moist rales
are mucous with large or small bubbles, or subcrepitant.
The dry rales, sibilant or sonorous which, for sake, of brevity, are
called the typhoid sonorous rales, may be heard throughout the whole
chest, anteriorly as well as posteriorly. The dissemination of these
rales constitutes a distinctive character of them; but, sometimes,
when they begin to manifest themselves, they can not be discerned,
but, in a few points, especially, posteriorly and towards the base of
one lung, or, the other, where they are first manifested; from these
points, then, they propagate themselves, to the other air passages.
This propagation of the rales, or, rather, of the bronchial congestion,
which is their cause, is compared to the intestinal lesion of the ileo-
cœcal valve towards the superior part of the ileum. Finally, then,
these sonorous rales are heard, even in front, and, over the whole of
the chest. It is peculiar, to them, too, that they vary from one day to
another, and, often indeed, even while the physician is listening; they
rarely have the same intensity at all points; thus, for example, they
are more pronounced in the posterior parts of the chest than ante-
riorly.
The.sibilant rale is rather more common than the sonorous; joined
together they produce those mournful, gravely sibilant sounds, pain-
ful to the ear. They are so noisy, so universal that they cannot be
confounded with those of simple pulmonary catarrh. They appear at
the beginning of the disease but, more commonly, towards the end of
the first week; in the second or third week they increase in intensity
when the disease is very severe. And, in these two last periods,
another rale is heard, connected with the foregoing, which has its seat,
almost exclusively, in the inferior and posterior fifth of the two lungs;
SYMPTOMS OF THE DISEASE.
151
more frequently on the right than on the left side, and this is a mucous
rale.
When the bubbles of the mucous rales are mingled with sonorous or
sibilant rales, and occupy the parts indicated, they are so characteris-
tic of Typhoid fever that one might almost assume the diagnosis of
the disease from this sole fact of their existence, and the rale resulting
therefrom, might be called the typhoid rale. This symptom indicates
the congestion of the bronchi which is called typhoid bronchial con-
gestion. If the Typhoid fever is aggravated, and, if the congestion
extends from the bronchi to the pulmonary tissue, the rales often
diminish, or, cease entirely, or the bubbles of the rales become finer and
they are supplanted by a sub-crepitant rale occupying the same
points. In such conditions, there can be no doubt that there is con-
gestion of the lungs.
The sibilant and sonorous rales are, as Louis justly considers, such
characteristic signs, that, in doubtful cases, they suffice to fix the
diagnosis of the disease. The typhoid rale so rarely fails in this dis-
ease that it may be regarded as an important sign of the disease, like
the gurgling, the meteorism and the cutaneous eruption.
The duration of the sonorous rales is variable; thus they are less
frequent and persistent in the benign, than, in the grave form. They
increase when the adynamia makes progress, and, at the same time,
they are combined with mucous rales. Delirium supervenes, too, at
the same time, as well as oppression of the respiration and prostration
of the strength. The lungs, like all the other viscera, are exposed to
the influence of this fatal tendency to congestion which is not one of
the least essential characteristics of the disease, and which seems to
owe its origin to the septic alteration of the blood.
At the points where the sonorous rale was heard, some days after,
we often observe a rough respiration, dry and unpleasant to the ear,
which is not heard with the soft and vesicular murmur of the normal
respiration. Sometimes, the respiration is weakened in many points,
and the respiratory murmur is heard with difficulty notwithstanding
the strong inspirations which are made. These symptoms only exist
at first, are supplanted by a dry respiration, then by sonorous sub-
crepitant rales, and finally, by a bronchial souffle which differs much
from that which is observed in pneumonitis; it is but little distinct,
obscured by rales and is heard at a greater distance, by the ear, than
that peculiar to pneumonitis.
When we cause the patient to speak, the voice is resonant; but this
152
A TREATISE ON TYPHOID FEVER.
bronchophony is not so clear as that which belongs to pneumonitis
and the voice does not enter the ear. Often, when we force the patient
to speak, we perceive, after each word or each phrase, a sound as of a
distant expiration, short, but distinct, and analogous to that which is
observed in pleuritic effusions.
Percussion, practiced upon different parts of the thorax, does not
furnish any important symptom. The resonance is normal in all parts,
even posteriorly, and below, towards the most dependent part of the
lung, unless, at least, there exists an engorgement or a pneumonitis,
which, in such cases, constitutes a complication.
As long as we hear nothing in the air passages but sonorous and
moist rales, which announce congestion of the bronchial mucous
membrane alone, we find no appreciable dullness. On the contrary,
the sonoreity is found diminished in the inferior and posterior third of
the thorax, sometimes at the right, sometimes at the left, sometimes
at both sides, when there exists a pulmonary congestion of the second
degree or a pulmonary apoplexy of some extent. The resistance to
the finger is increased; besides, the diminution of the sound, and the
digital resistance are not as pronounced as in simple pneumonitis.
Many times the thoracic vibration is found notably increased, corres-
ponding with the seat of pulmonary congestion. At other times, the
hand, applied upon the thorax, anteriorly, notices a very strong vibra-
tion, during the respiratory movements. This vibration is determined
by the grave sonorous rales which have their seat in the bronchi; it is.
distinct from the preceding, which is not felt at the moment in which
the patient speaks and has, in fact, a different semeiotic value.
Respiration.— At first, it is not exactly accelerated, but, when the
sonorous rales become more numerous, and, chiefly, when they are
replaced by the subcrepitant rales, it is seldom that the respiration is.
not accelerated. However we need not think that the dyspnoea is
always in proportion to the bronchial rales. It happens very often,
that, on account of the dyspnoea, physicians are not always led to
suspect the extension and the nature of the pulmonary lesion, demon-
strated by auscultation. The respiration of which we speak, some-
times, maintains itself normal till the end. Another cause existing in
the chest, and, capable of producing the dyspnoea, may be an ancient.
disease, consisting of pulmonary tubercles or an intercurrent disease,
as a pneumonitis or a pleurisy. Besides, the gaseous distension of the
intestines may be another cause of dyspnea.
The gravity of the nervous disturbances seems to be the cause of
SYMPTOMS OF THE DISEASE.
153
the acceleration of respiration. Such a phenomenon is observed in
patients seriously affected. For example, it has been observed by
certain writers, that, more than half the patients who died, had from
thirty-six to forty respirations a minute; in subjects who died. the
maximum of the respirations was forty-eight, the minimum eighteen
and the mean thirty-six: The cause of death was found now in the
lungs and now in the brain. This subject needs much investigation.
but physicians have given it little attention and but little light has
been thrown upon it. Bouillaud and others have observed that the
frequency of the respiratory movements is not proportioned to the
frequency of the pulse; the temperature does not seem to have much
influence upon the rhythm of the respiration.
Some patients complain of suffocation, and respire with the greatest
difficulty. The dyspnoea which occurs at the period of the invasion is
a nervous phenomenon; but, when it appears subsequently, there is
reason to fear the existence of some pulmonary lesion and it is neces-
sary to explore the respiratory organs attentively. Some patients
complain of a very painful constriction in all the anterior part of the
thorax or above the sternum or towards the xyphoid appendix.
The odor of the expired air of the patients is flat, acid or alliaceous.
in the first stage and of an extreme fetidity and almost stercoraceous
in the second. Bouillaud says that he has observed this fetidity in the
second stage, characterized, according to him, by stupor and by the
septic alteration of the fluids. This fetidity is also observed in other
periods of the disease and the causes from which it seems to arise are
the presence in the mouth of mucous coatings, of the blood, of the
excretions, in a word, of the matters which experience contact with
the air and a very rapid fermentation. The respiration taking place
only through the mouth, favors this alteration of the quality of the
air expired; besides this, the general alteration of the humors concurs
therein to a great extent.
XXII. TRUNK AND LIMBS.
In some cases the patients complain of pains in the back, and it is
necessary for the physician to determine the quality and nature of
these pains, so as to compare them with similar ones, which drugs
are wont to produce. At other times, they complain of pain in the
kidneys, or in the nape of the neck, now permanent, now transient,
now very intense, now tolerable. Some patients say that they feel a
painful tension in the cervical muscles, and in the back, which makes
D9
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A TREATISE ON TYPHOID FEVER.
1
it impossible for them to maintain, for a long time, the same position,
and they are constrained to turn, now to one side, now to the other.
Sometimes a slight shivering is felt in the loins, which disappears very
shortly, only to return again. Sometimes complaints are heard, from
patients, of pains in the articulations, somewhat fixed and intense,
sometimes transient, and at others, like an electric shock. Very
often they complain of very violent pains in the extremities, increas-
ing at night, like those felt in a broken leg. At some periods they
are slightly relieved, but, at intervals, they increase so as to excite
spasms in the loins. There are frequently subsultus tendinum, a tor-
por of the arms and a tremor of the hands; the legs, in some cases,
seem paralyzed, but it is necessary to use much care not to confound
the extreme adynamy and the extraordinary lassitude, which does
not allow the patient to stand on his feet, nor make any motion, with
true paralysis, which happened in a woman who allowed her arm
to be pinched without giving any sign of pain, though the next day
she said she felt the pain, but had not the power to withdraw the
arm. The true paralysis of the limbs is not a symptom of Typhoid
fever, and when it exists, it constitutes a real complication. It is
not unusual to see convulsions and other contractions, especially in
the ataxic form. Sometimes the limbs are cold, and the patients
complain of a slight sense of cold. Sometimes they are œdematous;
this oedema, however, appears at the end of the disease, and some-
times it prolongs the convalescence very much. For the most part,
it is of so little importance, that it does not engage the attention of
the physician, and it gradually disappears, as the patient acquires
strength and returns to his former habits. In some cases it is hardly
noticeable, and is even accompanied with a slight pain, and some
elevation of the temperature of the skin; this œdema appears ordi-
narily about the malleoli, whence it extends to the legs, above which
it seldom goes.
4.
XXIII. STATE OF THE BLOOD.
The blood, in Typhoid fever, when it circulates, or when it is
drawn from the veins, is not putrified; for death would be the imme-
diate consequence of such a lesion. It can only be altered by the
action of miasms and putrid substances. Almost always, when this
alteration appears, the flow of blood, when a vein is opened, is
slow, feeble, and diminishing in energy the longer it flows, and in
extreme cases, the fluid escapes drop by drop. In this regard, there
SYMPTOMS OF THE DISEASE.
155
are many differences, pertaining to the organic alterations, and par-
ticularly to that presented by the heart and lungs.
The blood drawn from the veins, in Typhoid fever, presents tints.
varying, in proportion, as the hæmatosis is diminished by the slowness
of the circulation, which, consequently gives rise to a color but little
charged with blood. In certain complications, when the circulation is
active, and the respiration accelerated, the vermilion color of this fluid
is preserved and increased.
It is very difficult to describe the state of the blood in Typhoid
fever, because this improper expression, Typhoid fever, having been
given to different affections, and the amount of change in the blood
not having been considered by itself, the consequence has been that we
have not been able to assign any proper character to this fluid. Now,
in cases given as real Typhoid fever, as regards the change of blood
which results from it, both by the absorption of putrid matters, and
from the most active septic miasms, the following is what the best
observations of ancient and modern physicians have verified:
Coagulation takes place slowly; the clot retains the serum in its
tissue, hence, the result is, that it seems scanty; and generally it is
very scanty, at the beginning, when the patient has not yet lost much
blood, or when he has not been affected with hæmorrhage, or exhaust-
ing discharges. In contrary cases, the relative quantity of the clot is
small, and this takes place, especially, when they have been made to
drink largely, and when they have replaced, with water, the loss of
nutritive matters to which the patient has been exposed.
Constantly, or almost constantly, the cruor is soft, diffluent, and is
torn with the greatest ease; it does not contract, and often remains
in contact with the walls of the vessel, at least if it is not much
shaken. According to Prof. Bouillaud, it resembles, when the disease
is not very marked, currant jelly badly cooked, and when the fever is
prolonged, it may be compared to very soft gum.
If a slight pressure is made upon the clot, with the finger, it readily
penetrates deeply; if one seeks to raise a portion of it, it breaks and
separates much more promptly from the rest of the mass, than in
other cases. The blood, according to Bouillaud, is more fluid than
that in the normal state, as if the fibrin might have undergone a kind
of dissolution. This alteration is susceptible of many degrees, from
that in which the coagulum is simply soft and without consistence, to
the point in which the blood has lost all its consistency, and forms only
a blackish and fluid mass in which no trace of coagulum can be found.
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A TREATISE ON TYPHOID FEVER.
But this, out-
In fact, this
At ot h imes, the clot is covered with a buffy coat.
side of cases complicated with emesis, is quite rare.
thick, greenish yellow, firm, plastic production, analogous to acciden-
tal pleuritic membrane, is not like that observed in vomiting, but it
is a thin substance, easily torn, sometimes having a gelatinous appear-
Somewhat later, when
ance, which covers the clot a few lines thick.
the blood has remained sometime in the vessel, round globules are
found at the bottom, or coloring matter is deposited upon its sides;
these globules sometimes make this serum reddish, and stain the
finger plunged in them. L'Heritier, in 1832, verified the fact that the
cruor of the blood, and its serum, was a little less than in acute
inflammation of the lungs, of the pleura, or of the articulations.
Blood drawn by leeches, or cups, presents appearances analogous to
those just indicated. In certain affections, accompanied by a state of
putridity, the blood presents other characters, as, for example, the
loss, more or less complete, of its serum.
The state of the blood, of which we speak, is considered as a con-
stant fact, by Bouillaud and Andral, in treating of advanced or
confirmed Typhoid fever.
It is to be desired that chemistry and the microscope should give
positive characteristics of the alterations of the blood in Typhoid
fever. Hitherto, analysis has not permitted us to verify them. Bon-
net di Leone is the only one who has found sulphuretted hydrogen in
the blood and urine of a patient affected with absorption of putrid
virus. The experiments of this distinguished surgeon have been
repeated by Darcet and Conte, who did not obtain similar results.
Andral has admitted, from the first, that the proper character of grave
fevers (Typhoid) was a diminution in the proportion of the fibrine.
This opinion also agrees with the experiments of Magendie, upon
animals, in which he observed symptoms of violent fever, after he
had defibrinated their blood; but Andral admits that fibrine may be
found there in normal quantities; that the diminution of which we
speak, does not constitute the characteristic of the alteration of the
blood in Typhoid fever, that there exists a cause or a specific poison
which diminishes the fibrine, and that this diminution of the nutri-
tion of the blood increases in consequence of the hæmorrhage.
Becquerel and Rodier declare, in contradiction to the opinion of
Andral, that, at the beginning of the trouble the amount of fibrine is
about normal, and that from facts analyzed by them, the general
mean of fibrine was 2.8. In a similar case, although no coincident
SYMPTOMS OF THE DISEASE.
157
inflammations were observed, the proportions of fibrine amounted to
4.9. They found, in some Typhoid fevers, which presented a great
diminution in the plastic element of the blood, accidents not very
severe. After blood-letting, the proportions of fibrine diminished.
It clearly results, from all this, that the diminution of the plasticity
of the blood is not an absolute characteristic of Typhoid fever.
As regards the increase in the number of globules, admitted at first,
by Andral, as belonging to Typhoid fever, this author has abandoned
this view, and attributes this increase to a co-existent state of hyper-
æmia, and to the strong constitutions of those who are usually
attacked with Typhoid fever.
It was thought at first, that we should find that, the alteration of
the globules, uneven, deformed, rough, broken, granular in their
circumference, was a proper characteristic of Typhoid fever. Donne
had, in fact, seen changes of this kind manifested in the blood of
cadavers, taking place immediately after death, and even during life.
Various micrographers have also admitted, in Typhoid fever, a similar
state of the globules. Andral, on the contrary, says distinctly that
there does not exist in these little bodies any property having any
relation with the morbid alterations of the blood.
Very numerous researches have been made upon the state of the
blood globules in Typhoid fever, and that in many cases, where the
accidents had attained a high degree. In one case, that of a youth
who was attacked with an immense gangrenous eschar, and morti-
fication of the genitalia; in two other cases, in which the skin pre-
sented gangrenous eschars, and in which the circulation was much
weakened, punctures were made with a pin; the blood which issued
from the punctures was gathered upon two bits of glass, and it was
found that the globules were not distinctly round, but, on the con-
trary, were uneven, broken, lacerated in their sides. The blood of
healthy persons collected in the same way, has been taken as a
standard of comparison. In these latter, just the same identical state
of the globules is not always found, but only sometimes. On the
contrary, it is found, that in persons attacked with Typhoid fever,
much advanced, it has not been possible to discern any characteristics
not common to normal globules. It results, from all this, that the
uneven, broken state of the little bodies of which we are speaking,
although it may be the result of some fortuitous alteration, subse-
quent to the drawing of the blood, is nevertheless often observed in
confirmed Typhoid fever.
+
1
158
A TREATISE ON TYPHOID FEVER.
Dujardin and Didiot have recently applied the experiments of Prof.
Dumas, upon the oxidization of the blood globules, to the blood of
Typhoid fever, and they have found that, in severe cases, the infiltra-
tion of colored serum occurs rapidly, and that it cannot be hindered,
whatever may be the activity of æration. This fact is pregnant with
practical consequences. It is desirable to renew such researches, but
we should not fail, by way of increasing their value, to notice atten-
tively the manner in which respiration is made, and how the air
reaches the lungs, in Typhoid fever patients, the state of whose blood
we are seeking to study:
It unhappily results from the foregoing, that science does not yet
possess any chemical or microscopical characteristics of blood in
Typhoid fever; that the results of inspection are even more positive
than all other circumstances. These results, taken in connection
with the causes, the symptoms, the course and the treatment of affec-
tions called typhoid, would suffice, above all, to characterize this
Typhoid fever, and so lead us to consider it as a state of special
organic change.
CHAPTER IV.
THE COURSE OF TYPHOID FEVER.
The course of Typhoid fever, which has its origin, as has been
already said, from causes constituting an endemic, epidemic, acute
contagious virus is necessary, and fixed. This disease runs through
and describes certain indispensable periods prescribed by nature and
by the mode of action of the unknown virus, which is common to all
the other diseases of the same nature, and it would be ridiculous obsti-
nately to combat symptoms which must naturally disappear of them-
selves, and it is useless to administer drugs which can do nothing but
hinder the cure rather than favor it; all we can do, with their employ-
ment, is to keep the disease as mild as possible and prevent its taking
the severe form, as it might do if left to itself.
Every physician knows that this disease does not follow a regular
course; exacerbations and frequent and unexpected improvements,
are observed which happens even in cases in which the disease is left
to itself, and, hence, it is difficult to describe its course just as it
appears to the most accredited physician. I will seek to trace it as
exactly as possible, whence the reader may acquire an idea, if not
exact, at least, sufficiently clear to enable him to distinguish it in any
circumstance.
All writers on practical medicines, describe in this disease, a precur-
sory period, a beginning, and three periods, characterized by different
phenomena; they may be more or less separated by diverse circum-
stances, and somewhat different in form, and from these, they derived
the variety of Typhoid fever.
The divisions which various writers have made, all seem to me
hypothetic, hence I lay down only those which are most commonly
seen in practice, and they are
1. The common form, including three varieties, the common properly
so-called; the common prolonged and the putrid.
2. The benign form,
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A TREATISE ON TYPHOID FEVER.
3. The malignant form which presents three varieties- the fulmina-
ting, the slow nervous and the hæmorrhagic.
It cannot be said that these varieties are always observed just pre-
cisely as they are described here, since, in nature, there can be nothing
which has something else precisely like it, but on this point enough
has already been said, and it is not necessary to repeat; hence Hahne-
mann affirmed that all diseases were individual and specific, and all
are diversified as the physiognomy of man, which has always something
peculiar to each case and one cannot be confounded with another.
I.
COMMON FORM.
The common form, properly so-called, is characterized by the regular
evolution of the disease, by a moderate intensity of symptoms, by a
duration of from twenty to forty days, and it may serve as a type for
the description of the disease.
3. Premonitory Symptoms.-These are almost always constant, and
consist in various derangements of the functions of relation, which
derangements, moreover, are not entirely peculiar to this affection,
since they are observed, also, before the commencement of other
severe diseases and especially of eruptive diseases.
Sometimes, before the invasion of the disease, a change more
or less notable is observed, in the expression of the physiognomy,
which becomes sad and dejected, while there is a lack of readiness for
mental occupations. For the space of some weeks, or only for a few
days, we see a sensible diminution of the strength with emaciation;
the patient becomes weary much more easily than before, all his
senses have lost their acuteness and usual vigor, the patient is
uneasy and seems to be threatened with a violent disease; he experi-
ences a general uneasiness, pains in the limbs, and, at the same time
a notable decrease of the appetite; the mouth becomes pasty, in some
cases there is diarrhoea which ceases in a few days, to return after the
invasion, the urine is more dense and has a very fetid odor, and,
sometimes, there is nausea and even vomiting.
Sometimes the attack of the disease is sudden, following unexpect-
edly upon the appearance of the most flourishing health and without
any precursory symptom giving any indication thereof.
Invasion. The phenomena of invasion appear with intensity, in cases
in which the precursory symptoms are like those in which the invasion
is sudden. In the greater number, the disease begins with a violent
headache, which occupies the forehead mainly, and usually the first
THE COURSE OF TYPHOID FEVER.
161
attack comes on in the morning on rising; sometimes, but rarely, it
is preceded by diarrhoea. Then the physiognomy changes promptly;
not unfrequently, we observe, even in the first days, that stupor,
already well marked, which, by some authors, has been described as
belonging, rather to an advanced period of adynamic fever. The
muscular contractility suffers a considerable enfeeblement, and, in
the first days, there are frequently chills, more or less severe, followed
by very violent fevers. Sometimes, these chills are repeated, at longer
or shorter intervals, and, in certain cases, are entirely wanting. The
fever which follows the chills requires the patient to remain in bed;
sometimes, if he is very brave, he wishes to continue to attend to his
usual calling, but, after a few hours, or a few days, at the most, he is
overcome by the force of the disease, and constrained to remain at
repose in bed, which he does not leave again, but with difficulty, and
when he walks, he staggers like a drunken man.
The diarrhoea is also one of the most important symptoms of inva-
sion. In the majority of cases this appears on the first or second
day, and, sometimes, at a period more remote from the beginning of
the disease.
The abdominal pains come almost at the same time with the diar-
rhoea, and, may, in some cases, complete the diagnosis of the disease.
Such are the initial phenomena of Typhoid fever; others still might
be added which are also observed at the beginning; but, as they, for
the most part, are not observed till a period more advanced, they thus
make part of three successive periods, which, however, are character-
ized by different phenomena, and the duration of which is circum-
scribed in such a manner that we may use the word septenary, as a
synonym for the period; not that each period may always be limited
to the number of seven days, but, because, in the more simple cases,
and more fortunate, in those in which we may conclude that the dis-
ease had a very regular progress, the phenomena belonging to each
period present themselves very nearly in this space of time.
First Period or Period of Increase. It is very difficult to determine
the point at which this period begins; sometimes the appearance
of new symptoms, and the increase of those already existing, may
serve to characterize it. The fever, commenced at the beginning,
pursues its course and increases, every day presenting a remission in
the morning and an increase in the evening. The pulse is full, soft,
and beats from 100 to 120 times in a minute.
The temperature of the body increases the first days of the disease
162
A TREATISE ON TYPHOID FEVER.
almost without interruption, except the slight remissions in the morn-
ing hour, and reaches, on the third, fourth or fifth day, 104° or 105.80°.
In the second half of the first week a considerable diminution takes
place, in light cases, though the temperature of the evening does
not readily fall below 104°. In severe cases, this decrease of tem-
perature is not observed. The loss of appetite is complete; the thirst
great; the taste of the mouth mucous and bitter; some patients
in this state, thinking the stomach diseased, take emetics. The con-
stipation is habitual during the first days, and the diarrhoea comes on
afterwards, although, in certain epidemics, the constipation persists
during the greater part of the disease.
The diarrhoea, when it exists, is greenish and abundant, and very
fetid; there are from four to eight stools in the twenty-four hours.
The abdomen is swollen a little, a little painful, and presents in the right
iliac fossa, a gurgling which constitutes a sign of much importance.
The tongue, white or yellowish, presents upon its sides and point a V
shaped redness; the gums red and a little swollen, are covered with a
pultaceous coating. The headache is very violent; the face red and sen-
sual looking; frequent nosebleed, but seldom copious. In the first days,
there is not, as yet, any delirium, nor coma, but a touch of the stupor and
prostration, which characterizes the disease. The stupor manifests
itself by indifference and a little slowness in answers; then comes
prostration with dorsal decubitus, while the motions which the
patient performs are slow and few. In the last days of this
period patients are often delirious at night. While awake, they are
almost always masters of themselves, but they take little interest
in what goes on about them, and, to questions, their replies are slow
and ill-natured. To this is joined the thoracic affection announced by
the cough, by the sibilant rales, more or less extensive, which are gen-
erated by the catarrh of the smaller bronchi and are heard on applying
the ear to the chest. The appearance of these rales should lead one
to conclude that he had to do with Typhoid fever, if there had
been before any doubt on this point. The cough is rare and out of all
proportion with the intensity of the rales; the patient raises with
difficulty a little transparent viscous excretion, adhering to the spit
cup and often tinged with blood, coming from the nostrils. The first
period terminates with the eruption of lenticular spots of a pale red
color, sometimes slightly prominent, the typhoid roseola, varying in
number upon the chest and abdomen, on the ninth day of the disease;
a little sooner in severe cases; this eruption is accompanied by a
THE COURSE OF TYPHOID FEVER.
163
slight remission, but it is not to be compared with that of eruptive
fevers. This period corresponds to the first week.
Second Period, or Period of Acme.-The febrile movement has
reached a great intensity. The pulse continues to be soft and quite
full, often dicrotic and beats 110, 120, 130 times a minute; the heat, dry
and biting, is 104°. The prostration and stupor are very marked. The
patients are motionless, lying on their backs like an inert mass, which
obeys the laws of gravity, and always slide toward the foot of the bed;
they are indifferent to their state and insensible to what passes about
them. The face has a sensual and stupid look, but, towards evening
becomes animated, the eyes become brilliant, the patient talks freely
and is often delirious; this delirium continues all night, and, in the
earlier days, it gives way towards morning, but, before long, becomes
continuous. Where there is no complication, this delirium is never
violent. The patient seems to sleep, and in the meantime talks and
holds disconnected discourses. This state is called typhomania, so
frequent is it in typhus. The delirium now prevails over the coma,
and the patient is agitated and seeks to leave his bed; at another
time the coma is more marked and the patient remains motionless,
immersed in a somnolence interrupted, from time to time, by a few
words, muttered between his teeth. The diarrhoea is more abundant,
yellow,greenish, fetid. The evacuations become involuntary, whether
from the paralysis, more or less complete, of the sphincters of the anus,
or because the patients have lost consciousness of their actions.
The urine, which the patient neglects to emit, regurgitates, and,
very soon, the bladder, paralyzed, becomes enormously distended and
it is necessary to use the catheter. On observing the urine, we find it
colored, reddish, a little watery, inclined to deposit sediments and
is acid and without particular odor; it has all the characteristics of
febrile urine.
The abdomen is very much distended; it is not painful, or at least,
the patients do not speak of it; the gurgling is very marked; the
tongue becomes, all the time, more and more dry, and is pointed,
blackish and trembling; the lips and teeth are covered with a brown
coat; the nostrils are pulverulent.
The thoracic affection develops itself simultaneously with the cere-
bral and abdominal. Dyspnoea especially characterizes this period,
because the cough is often much diminished, the patients no longer
receive the stimulus which excites them to cough; but auscultation
reveals sibilant, sub-crepitant and mucous rales, more or less abundant,
164
A TREATISE ON TYPHOID FEVER.
and sometimes we have the bruit de souffle, a certain indication of a
very intense bronchitis.
The increase of the thoracic symptoms is one of the more striking
characteristics of the second period; up to a certain point, it may
serve to measure the intensity of the disease. The physician, seeing
the respiration accelerated and becoming more suffocating, uses
auscultation, and finds that the sonorous and crepitant rales are
increased, and make themselve apparent in all the bronchial divis-
ions, and are connected with humid rales, with large and unequal
bubbles, which occupy the dependent and posterior part of both lungs.
These symptoms, as has already been said, in the symptomatology,
indicate the congestion of the mucous membrane of the bronchi, and
of the parenchyma of the lungs, such as is sometimes observed in
patients presenting a moderate degree of adynamia. Hence, thoracic
auscultation should not be neglected, if we wish to observe the
gradual progress of the disease.
The emaciation is, as yet, scarcely sensible; the skin which covers
the sacrum and the great trochanters becomes very red, is inflamed,
and already presents small eschars. These eschars often begin with
an eruption of papules, analogous to those of variola. We should
notice also the appearance of sudaminæ, a vesicular eruption of the
size of a millet-seed, quite transparent, prevailing chiefly upon the sides
of the neck, and the front of the chest; this is observed on more than
two-thirds of the patients. It is at the end of this period that the
grave accidents of intestinal hæmorrhage begin to present themselves,
with perforation and peritonitis, from extension of the inflammation.
This period is a little longer than the first, and ends, usually, at the
seventeenth day.
Third Period. When the patient has passed the danger of the
second period, on the fourteenth, seventeenth, or twentieth day, the
fever abates; the pulse diminishes ten or twenty pulsations, and
the heat falls one or two degrees. At the same time the tongue
becomes moist, puts off its coatings, and the appetite returns; the
evacuations become voluntary, and the meteorism disappears; the
delirium ceases, the prostration and stupor diminish, the patient
responds more readily to the demands made upon him, his physiog-
nomy expresses the attention with which he observes things going
on around him, he begins to take his drink himself, and to ask for
what is necessary to supply his wants. The pectoral symptoms also
improve, the sonorous rales diminish and become more moist, the
THE COURSE OF TYPHOID FEVER.
165
patient expectorates with more facility, and the excretions are less
viscous; the sub-crepitant rales, which announce pulmonary conges-
tion, diminish, then cease entirely, and one hears only here and there,
sonorous rales, the last sign of the bronchial congestion. In the mean-
time, the patient loses flesh, becomes pale, and a slight deafness
is often observed. The eschars habitually increase until, this
period, when they commence to be detached. On the fourteenth,
seventeenth, twentieth, or twenty-fourth days, critical evacuations
are almost always observed; epistaxis, intestinal hemorrhages,
sweats, sediments in the urine, and, at the same time, the fever
ceases completely, the appetite is distinct, sleep is natural, and con-
valescence commences, unless the consecutive pulmonary, cerebral, or
abdominal affections prolong the disease another week.
Convalescence.—The Typhoid fever patient, as has been seen, does
not pass immediately, and in a few moments, from the state of
danger just indicated, to perfect and established health, but grad-
ually. In some cases where the grave symptoms have disappeared,
and there is no more danger, the patients pass a month or two more
in a painful convalescence. The emaciation, the loss of strength, the
desquamation of the epidermis, and the falling off of the hair, the
loss of memory and intelligence, a certain deafness, are constant
phenomena in the convalescence of Typhoid fever. The forgetful-
ness more or less complete, of knowledge previously acquired is
a frequent symptom. The appetite is developed, and sometimes,
becomes so voracious, that, if the demands of the patient should be
gratified, the most serious effects would follow, without fail. When
no new accidents occur the disease proceeds, little by little, towards a
cure; the strength returns gradually to its normal state, and the
cure will be complete in six weeks or two months. Nutrition
acquires activity; the young grow much, and often take on a ful-
ness and a solidity of constitution greater than that before the
disease; the hair is always renewed.
Convalescence is full of accidents and dangers. The chief are: the
consecutive enteritis, perforations, peritonitis, rarely intestinal hæm-
orrhages, obstinate vomiting, various inflammations, pneumonia,
pleurisy, circumscribed encephalitis, oedema of the glottis, with or
without necrosis of the cartilages, numerous abscesses, necrosis of
the long bones, gangrene of the limbs, paraplegia, insanity and gen-
eral paralysis of the insane.
Fatal Termination.- Death habitually takes place during the period
166
A TREATISE ON TYPHOID Fever.
of acme, but may also happen in the period of decrease and during
convalescence.
In the period of acme, death occurs from increase of fever, its
destructive symptoms culminating, and utter prostration ensuing
without the appearance of any extraneous aggravations, either from
the cerebral affection, which is now prominent, or from the thoracic
disease.
In the first case, the febrile movement increases, the heat rises still
higher, the pulse becomes more frequent, small, feeble, the respira-
tion is accelerated, the eye is dull, the cornea turbid, the conjunctiva
red, the nostrils pulverulent, the prostration excessive. At this
moment, chattering of the teeth appears, headache, putrid and invol-
untary evacuations; the pulse becomes all the time more frequent,
uneven and very feeble; then the skin becomes damp, and the patients
pass away in a fainting state.
The physician should know that this very serious state may be pro-
longed till the critical days,* and that such patients may escape death
which seems inevitable. The Typhoid fever is a disease in which the
prognosis should be exceedingly reserved.
In the second case, when death ensues from predominance of cere-
bral symptoms, and the Typhoid fever is called by most physicians
cerebral typhus, the delirium is violent, continuous, with excessive
agitation; the patients seek to escape from the bed, to fall upon their
attendants, and they have to be put into the strait jacket. At the
same time, subsultus tendinum appears, contractions of the muscles
of the neck and trunk, and the patient dies in the midst of a sort of
epileptiform attack; most frequently, after the attacks of wild and
boisterous delirium, patients lose their strength, then suddenly fall
into coma and die. Often, in the last days, partial paralysis of the
facial muscles is observed, and, more rarely, convulsions.
In the third case, when the patients succumb to the broncho-
pneumonia, and the disease becomes the so-called pneumo-typhus, the
dyspnoea increases from day to day, sibilant and sonorous rales are
heard, in just these cases, all over the chest, and, at the base, moist
rales are heard, with large bubbles, and often with small ones, too,
constituting the subcrepitant rale. The face assumes an asphyctic
hue, respiration becomes frequent, difficult and stertorous, adynamic
*NOTE.- Grauvogl has thrown much light on these critical days. See Text
Book of Homœopathy, 847.-TRANS.
THE COURSE OF TYPHOID FEVER.
167
and ataxic and the patients die in a state of slow asphyxia, or, more
rapidly of syncope.
When death comes during the period of declension or convalescence,
and the patients seem to be certainly progressing towards recovery,
intestinal hæmorrhages unexpectedly set in, perforation, peritonitis,
pneumonia, circumscribed encephalitis; still later, in decided conva-
lescence, diarrhoea, obstinate vomiting, oedema of the glottis, gan-
grene, necrosis, abscesses, finally, hæmorrhages, and, at last, intestinal
perforations, and all these complications may, in a longer or shorter
time, produce death.
Intestinal Hæmorrhages.
These are produced by a simple transuda-
tion from the surface of the mucous membrane or by corrosion of the
small vessels under the scab of the eschar, and partly by a rupture of
the over-distended capillary vessels, of those spongy surfaces of the
mucous membrane which are found above the patches, or, by the per-
foration of an important vessel. The first are not generally very
common, but are repeated; the blood is black and has suddenly a
beginning of digestion. This is melana. Such an accident is not
very grave, it is symptomatic in the period of acme and critical in the
stage of declension.
Hæmorrhage, by ulceration of an important vessel, is a serious mat-
ter. The hæmorrhage is abundant, the blood flows in great clots and
is of a dark red. It may even be so abundant that the patients die in
a few hours. This accident especially occurs at the end of the period
of acme and, in the period of decline; it may happen even during
convalescence.
Sometimes, a considerable loss of blood takes place, but the patient
does not die immediately from exsanguification; the hæmorrhage
ceases, the fever pursues its course, but the patient has not sufficient
strength to endure the intensity of the disease and he dies, a longer or
shorter time after the hæmorrhage, from the general exhaustion, ren-
dered more complete by the fever and by diarrhea.
Perforation.-Perforation is not a rare phenomenon, in Typhoid
fever; many physicians have seen it often in different cases. Its most
frequent seat is the lower portion of the small intestines; it is rarely
seen in the large. There is usually but one perforation, but, some-
times, there are two or three. It is produced by the progress of the
ulceration in Peyer's patches, after the twelfth or thirtieth day,
when the bottom of the ulcer, in process of cicatrization, is formed
only of the most delicate muscular coat or of the peritoneun and
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A TREATISE ON TYPHOID FEVER.
announces itself by an instantaneous intense pain, felt notwithstand-
ing the prostration and stupor, and which becomes, upon the slightest
pressure, upon the abdomen, excessive and intolerable; the alteration
of the features, the smallness of the pulse, the rapid clamminess of
the skin and the excessive distension of the bowels, the nausea, the
bilious vomiting and the suppression of the dejections are the usual
accompanying symptoms. The effusion of air into the abdomen, in
consequence of a perforation, produces the effect of removing the
abdominal walls from the liver and of making the full liver-sound
disappear. Perforation is an accident rapidly fatal in almost all cases;
at the same time, adhesions, produced by the inflammation of the
peritoneum, may impede or circumscribe the effusion of the matter
contained in the sack, but the danger is extreme.
Peritonitis.- Peritonitis may be produced without perforation and
by simple extension of inflammation from the mucous coat to the
serous. The symptoms are nearly the same as those of perforation, but
their course is less rapid and the full liver-sound does not disappear
completely.
Alterations of the Cornea and Loss of the Eye.- This accident is not
proper to Typhoid fever and may be observed in all the meningites
and even in all diseases accompanied with cerebral disturbances; it is
due to an inflammation of the eye, aggravated by defective closure of
the eyelids, as has been fully set forth in the symptoms of the eye.
At first, there is redness of the conjunctiva, pain and photophobia;
then the patient, immersed in stupor and somnolence, no longer feels
the necesstiy to wink; the eye remains constantly open, the lower
segment of the cornea becomes obscure, whitish, swollen, and, if haste
is not made to keep the eye closed by means of compresses of cotton
and a bandage, the cornea is perforated and the eye lost.
Edema of the Glottis and Necrosis of the Cartilages of the Larynx.—
The necrosis of the cartilages of the larynx is sometimes primary,
and, more frequently, is owing to the extension of the ulceration of
the laryngeal mucous membrane; its symptoms are oedema of the
aryteno-epiglottidean folds, dyspnoea and attacks of suffocation, with
difficult and sibilant inspiration.
Relapse. Most practitioners say that they have never observed
causes of relapse, but physicians are not wanting who say that they
have seen them. These various assertions perhaps arise from having
confused Typhoid fever with other fevers. I have never seen patients
relapse whom I have treated in the last ten years, and, as this is but
THE COURSE OF TYPHOID FEVER.
169
few years, I think it better to pay more attention to the subject and to
wait for the common consent of physicians of long practice.
Physicians who say that they have observed relapses in Typhoid
fever say that they should be divided into immediate relapses (or after-
fever) and remote. The first is constituted by a return of the disease,
a week or more after convalescence has been established. The remote
after-fever is the return of the disease after one or more years. The
second attack is usually less severe than the first. These after-fevers
are very rare.
2. VARIETY
PROLONGED TYPHOID FEVER.
This is characterized by the return of the period of acme after a
period of declension, more or less marked, and by a duration, habit-
ually prolonged, to the fortieth and, sometimes, to the sixtieth day.
The symptoms and the course of the disease are the same as that of
the preceding form. Only toward the twentieth or twenty-fourth day,
after a marked remission, and, when everything encouraged the hope
that convalescence was near, the period of acme re-appeared with its
eruption and all its train of symptoms. This period continues a
week.
This return exposes the patient to great danger, not only by its
length, but, also, because it found the organism in a very enfeebled
state. In this variety, the eschars take on an alarming development,
they occasion a considerable destruction of tissue, sometimes produce
necrosis of the sacrum and the extension of the inflammation to the
rachidian canal and the medulla spinalis. It is necessary to distin-
guish carefully, from the prolonged common form, cases of the common
form in which the fever continues often after the third week, by the
development of an enteritis, or, by a subsequent broncho-pneumonia.
Convalescence is longer and more difficult in this variety of the corn-
mon form.
3. VARIETY — PUTRID TYPHOID FEVER.
Is characterized by a considerable febrile heat, prostration and a
stupor, premature, and, more intense, than in the other forms; a
tendency to gangrene and hæmorrhage; an extremely serious condi-
tion.
This most distinct, but quite rare variety, was well known by the
ancients, who gave it its name. This is the adynamic form of the
moderns.
The precursory symptoms are prolonged, very severe, accompanied
D 10
170
A TREATISE ON TYPHOID FEVER.
with epistaxis and diarrhoea, with a great diminution of strength, and,
from the beginning, with stupor.
In the first period, the febrile heat is already considerable, the pulse
very soft, the face is swollen without being livid; the prostration and
stupor are marked and there are already involuntary evacuations.
At the period of acme the heat rises above 105.80°; the pulse is very
frequent and has become softer, feebler and unequal; the face and
extremities are livid; the tongue is coated, tremulous, and covered, as
well as the gums and teeth, with blackish and fetid fur; the stupor
and prostration are at their height; the delirium is tranquil; there
are mussitation, carphologia, deafness and paralysis of the bladder
requiring the catheter; there is excessive tympanites; the evacuations
are abundant, involuntary and putrid; the eschars much developed;
frequent hæmorrhages supervene and the petechiæ are confounded
with the lenticular spots; the sudamina become purulent. All the
symptoms increase, the evacuations are suppressed, the tympanites
becomes enormous, the patients are covered with a clammy sweat and
die within the space of two weeks, or, at the beginning of the third.
Some nevertheless recover. The evacuations are re-established,
the meteorism diminishes, the tongue becomes moist, consciousness
returns; but, above all, the heat diminishes, the face becomes pale, the
pulse falls and convalescence begins; this is very tedious, and more
subject, than all the others, to perforations and hæmorrhages, and
may even be interrupted by the elimination of very deep eschars, and,
sometimes, by the formation of manifold abscesses.
II. THE BENIGN FORM
is characterized by the mildness of the symptoms, by the slight
intensity of the febrile action, by the shorter duration, terminating
between the fourteenth and seventeenth days.
This has been very generally set forth and has been described under
the names of latent form, arthritic, abortive, ambulatory (because some
These
patients are able to be about during its course), mucous.
denominations are very faulty, because applied, at other times, to a
febrile state which is considered as an essential disease.
The benign form of Typhoid fever is often confounded with an
enteritis or bronchitis, according as the intestinal or pulmonary affec-
tion predominates.
In the first case, the diarrhoea is abundant, green, blackish, fetid.
accompanied with gurgling, slight pain in the ileo-cæcal region, and
tumefaction of the belly.
THE COURSE OF TYPHOID FEVER.
171
In the second case, the patients cough much, have a sibilant rale,
and all the signs of a bronchitis; sometimes the local predominant
affection is an arthritis, variously located, quite analogous, in this
regard, to acute articular rheumatism,
The fever is not very intense, sometimes quite gone in the morning.
Some patients can rise, attend to their daily occupation, make a
short journey and take light food.
The eruption of the lenticular spots takes place about the seventh
or eighth day, and is sometimes quite abundant.
Notwithstanding its great mildness, and that, for the most part, it
terminates happily, yet this form exposes the patient to the terrible
accidents of perforation and intestinal hæmorrhage, and to die very
suddenly.
The post-mortem reveals numerous intestinal ulcers, gangrenous
eschars, and encephaloid infiltration into the mesenteric glands. To
explain these facts, we can only say that the infection of Typhoid
fever may, sometimes, produce grave local alterations in the intestines,
without producing more than the slightest alteration of the blood,
and, by the material change in the organism, no remarkable disturb-
ance in the exercise of the functions occurs.
If no accidents supervene, and the patients get well, the convales-
cence is long, and accompanied with falling out of the hair.
1.
III.
MALIGNANT FORM.
Fulminating Variety.—This is clearly characterized by an
extremely violent febrile action; by an irregularity and versatility of
the symptoms, by a duration rarely exceeding the ninth or tenth day;
by its malignity, and anatomically, by the hard patches very project-
ing, and as if pediculated.
This is the malignant fever of the ancients, the ataxic of moderns.
The precursory symptoms are shorter than in the other forms, and
the disease begins abruptly, with a violent attack of fever, preceded
by a chill.
On the first day, the pulse rises to 130 or 140 beats, is large and
strong, the heat is already excessive, as high as 105.80° or higher;
anxiety is observed, jactitation, tendency to fainting.
The headache is atrocious, with excessive pain, principally in the
region of the loins and in the limbs. There are, often, repeated vom-
itings, and failure of evacuations. The thirst is very marked. The
morning of the second day there is a remission, more or less marked,
but the attack returns more violently during the day, with delirium,
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A TREATISE ON TYPHOID FEVER.
agitation, fury, dyspnoea, without pulmonary lesion. The febrile
action increases every day; the heat above all, is very intense; the
remission is marked by somnolence, and the exacerbations by agita-
tion, by delirium, more or less violent and furious, by cries and vocif-
erations, by agitated sleep, and by hallucinations of every sort; the
face changes rapidly; the patient often refuses drink a species of
hydrophobia; there is trismus, subsultus tendinum, floccilegia, (flocco-
rum venatus) and sometimes even convulsive phenomena, tetanic con-
tractions of the limbs, strabismus. and the sudden exaltation of the
muscular forces, followed by a rapid prostration. Sometimes the
tongue and the limbs are moist, notwithstanding the gravity of the
disease; the heat is unequal and variable. There is diarrhoea or con-
stipation; abdominal and thoracic symptoms are generally not very
marked.
This variety of Typhoid fever is, of all others, the most fatal; it
strikes the patient as if by lightning, and death has been known to
occur on the third day. Trousseau has seen it on the fourth day, but
the patients usually reach the seventh day and the beginning of the
second week. The pulse becomes small, irregular, weak; the patients
have a cold sweat, and perish with syncope; at other times, with con-
vulsions, or, with the violênce of the febrile action.
Lesions. These are the hard patches of authors; they are very
prominent, enormous, hard and pediculated, more or less red and
scarcely ulcerated. The mesenteric ganglia are much swollen, are of
the size of a hazel nut or a pigeon's egg, are very soft and sometimes
suppurate; the spleen is enormous, blackish, soft.
2. VARIETY SLOW, NERVOUS.
Under this name the ancients have described several forms of
typhoid, and even puerperal, fever. Nevertheless, there is found, at
the bedside, a form which corresponds very well with the description
of Huxham.
This form is characterized, chiefly, by the apparent benignity of the
first period, and the unexpected malignity of the last.
The precursory symptoms are long, the beginning insensible, the
febrile action but little marked, but presenting, at the outset, symp-
toms of ataxia. Thus, the skin is cool and the pulse frequent, or the
skin is burning, and the pulse at 80. Sometimes there is consti-
pation; more frequently serous diarrhoea; the tongue is moist, with
great thirst, or the tongue is dry without thirst. The delirium is
calm, without incoherence, and resembles alienation, sometimes is
THE COURSE OF TYPHOID FEVER.
173
sad, sometimes gay. At other times it is prattling; almost always, in
course of the second week, tremors are observed, with subsultus ten-
dinum and carphologia; the urine is thin and clear.
Towards the end of the second week, or the beginning of the third,
the economy being insensibly weakened, a sudden aggravation
appears; alteration of the features, contractions, convulsions, faint-
ing, a very frequent pulse, falling below the normal state, and giving
rather the sensation of trembling than of real beating; its vibrations
being so weak and, so quick, that they can scarcely be distinguished;
the extremities become cold, and the nails pale or livid; the fæcal
matters and the urine escape involuntarily. The delirium ends in a
profound sleep, to which, very soon succeeds a general coldness and
death.
Some patients, however, recover, and have a very tedious conval-
escence.
This variety of fever, so very severe, is wont to be but slowly
inclined to resolution. This has never been observed in the first
three weeks, and although it is attained by imperfect coction on the
twentieth day, it usually runs to the fortieth, alternating between
recrudescences and imperfect crises, never observing a marked crit-
ical course, but always an unsettled one.
3. HÆMORRHAGIC VARIETY.
Under this name authors have described epidemics of Typhoid
fever, malignant scarlatina, and purpura hæmorrhagica.
But does there really exist a form of Typhoid fever different from
that of the putrid fever already described, characterized by a
tendency to hæmorrhage, and, principally, by a petechial erup-
tion? This can only be decided by future observations; to-day, we
chiefly wish to distinguish typhus from Typhoid fever, in which some
see no difference, or only the slightest, and they say that they can
only be distinguished by the degree of severity, typhus being much
more dangerous than Typhoid fever, the febrile symptoms more
marked, the cerebral symptoms more violent, the exanthem on the
skin being more abundant, and known as purpura typhosa, that is, a
true cutaneous hæmorrhage, which is most rare in Typhoid fever.
Moreover, the duration of typhus is but two weeks, while Typhoid
fever lasts longer.
IV. DURATION AND TERMINATION.
From this brief and succinct exposition of the succession and
combinations of the symptoms of Typhoid fever, we see clearly that
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A TREATISE ON TYPHOID FEVER.
its course is most irregular, from the precursory symptoms to its end,
and so its duration is very long compared with other acute diseases, and
takes, in a great number of cases, (each in its own period,) forms, often
different from those of a former period, or, of succeeding ones; from
all this we may see how important it is, not only to study these morbid
phenomena separately, but above all, to consider them in the connec-
tions which they have among themselves, and with those preceding,
thus to acquire an exact idea of the disease, and to be able to select
the most suitable remedy to promote the cure.
Seeing then the great irregularity of its course, the duration is
various, according to the diversity of the cases, and hence nothing can
be said in general. Taking then, that which has been declared, by the
most distinguished practitioners, upon this point, we see that each one
assigns to this disease a duration according to his own observations.
Louis says that the mean duration, for severe cases, is thirty-two days,
and, for those of medium intensity and light, it is twenty-eight days.
Forget says that, in light cases, the mean duration is seventeen days,
in those of medium intensity, twenty-two days, and in severe cases,
thirty-one days. It would not avail to give results from all the other
practitioners; suffice it to say, that the longest duration of Typhoid
fever has been sixty-seven days, and the shortest twelve, from which
the mean duration might be set down between the twenty-first and
twenty-eighth day, as precise statistics have not determined it exactly,
and it depends largely upon the mildness, the gravity and the malig-
nity of the cases, the intensity of the causes which have determined
them and the duration of their action, the constitution of the individ-
ual, the circumstances in which he is placed, the complications which
present themselves, the method of treatment practiced, etc.
As regards the termination, then, we may say with assurance, that the
most usual termination is in recovery; this occurs in about three-fourths
of the patients; but epidemics may appear which are much more
malignant, and on the other hand, there are those whose mortality is
much less. In most cases death comes in the second or third week, at
the acme of the disease; but, as already said, in cases with a tumultuous
course, it may occur even during the first week, and, in protracted
cases, also, during the fifth or sixth, or even later. The particular
causes of death have been sufficiently set forth already.
We must not fail to say, that while convalescents, in general, recover
entirely and completely, and afterwards enjoy better health than
before, in some cases Typhoid fever terminates in an incomplete cure;
THE COURSE OF TYPHOID FEVER.
175
there remain behind true consecutive maladies, especially disturbance
of innervation, like neuralgia, partial paralysis, anæsthesia, and psychi-
cal disturbances. Sometimes it is followed by tabes, not well
explained, and by lasting anæmia and hydræmia. Anatomical
researches, thus far practiced, have not succeeded in showing the
material alterations on which the disturbances of innervation depend,
and the opinion that the residual cachexy and the defective sanguifi-
cation arise from the destruction of the intestinal glands, and from
the impermeability of the mesenteric, is entirely hypothetical.
THE LOCATION
of Typhoid fever, according to the French pathologico-anatomical
physicians, is in the small intestines, and especially in the follicles
and in the glands of Peyer and Brunner, particularly those located
owards the end of the ileum, because, in the examination of cadavers,
these parts are constantly found more or less changed. But consider-
ing that the symptoms presented by patients, in this fever, are not in
perfect rapport with lesions found in the cadaver, these points are not
held by all to be the true location; and this opinion, now, gathers
some weight from the fact that Louis, Andral, Lombard, and some
English physicians, have reported cases in which the follicles, and the
glands of Peyer and Brunner, were in a normal state, and not affected
at all. Hence, a goodly number of physicians are disposed to think
that the seat of Typhoid fever should be located in changes in the
intimate constitution of the organic fluids and solids, and more in the
former than the latter, since, of the parts which constitutes the entire
organism, we do not see any that offers to the influence of external
agents, a feebler resistance than the blood, the most important of all
the fluids of the animal economy, which is found in a constant state
of formation, and which is the generator of all the organs and living
tissues.
Some physicians, considering the imposing train of nervous phe-
nomena, which do not delay their appearance in this fever, say that
we should insist that its location is in the nervous tissue, the extreme
ramifications of which are so delicate that no anatomist's scalpel can
detect them, nor have we any instruments capable of showing the
alterations of which they may be the subject.
It is admitted by all, that, considering the changed motion of the
cardio-vascular system, the change of calorification, the alteration of
many or all of the secretions, the production and expulsion of unusual
humors, the wasting manifest in the mass of the sick body, the lan-
176
A TREATISE ON TYPHOID FEVER.
guor, the weakness, the sinking of the forces, which are renewed only
with great difficulty, and only by means of a proper nutrition and
repairing of the materials subservient to the organism, the stupor, the
coma, the delirium noticed in patients in this fever, are phenomena
quite different in their complex, from those arising from simple
dynamic disturbance; they denote most clearly that the intimate
structure of the body is compromised in these fevers; and not only is
there derangement of the apparent motions, but there is a profound
lesion, greatly disturbing the organic functions, and those assimilative
acts by means of which the living machine is subject to a continued
re-mingling of the material principles, in the order, or disorder of
which, resides health or disease. And since the blood and the nerves
are the principal factors of the organization, so we may maintain that
the seat of Typhoid fever, at first, is in the blood and nervous system,
and hence, in the concurrence of the various circumstances particular
to each case, it may be localized, more in one tissue or organ than in
another, and we do not find any that is not affected, this fever having,
from its very nature, a diffuse and varying location; the skin, the
mucous membrane, and principally the gastro-enteric mucous mem-
brane, and the nervous tissues are chiefly affected by it, but it does
not fail to extend, more or less, to the muscular, the fibrous, the serous
and the vascular, and it seems that it never fails to attack the hair
and the epidermis, as the falling out of the hair is constant in conval-
escence, as well as the renovation of great scales of the epidermis.
Only by hypothesis then, in such an amplitude of locations, can we
pretend that one only, as the glands of Peyer and Brunner, forms its
primary location. In fact there is no constant proportion between the
gravity of the symptoms and that of the alteration of these glands;
and then, these alterations fail in subjects in whom, during life, were
manifested all the symptoms of Typhoid fever; hence, we may insist
that Typhoid fever has not constantly and essentially its location in
the follicles of the intestinal tube, nor does it consist in inflammation
of the same, this inflammation being one of the phenomena of the
disease, and belongs, as the greater part of scattered inflammations
do, to secondary inflammations. It is necessary, however, to say
that, if this lesion is not constant, in the rigorous sense of the word, it
very rarely fails, as is the case, indeed, with all the other lesions exist-
ing in the other organs.
Neither can it be said that, in other parts affected, there is a genuine
and pure phlogosis, as was once thought, since the phlogosis of such
THE COURSE OF TYPHOID FEVER.
177
parts participates in the congestion, and in cases more unfortunate,
we see the congestion prevail over the phlogosis, as we see the blood
rather massed and stagnant than injected and circulating. And where
the disease concentrates itself in any organ, the tissue is found soft.
ened and ecchymosed, rather than inflamed; thus, if we see a true
inflammatory disease lit up, constituting a resemblance to Typhoid
ever, yet we observe congestion predominating in the inflammation,
which inclines it to disorganization and to gangrene. The gangrene,
itself, in such a disease, we see surrounded by accumulations and
stagnations of blood, more than the destruction of the flesh would
account for. Hence the suppuration is never rapid, and complete;
this rapid purulent deposit takes place by congestion in flesh already
broken down, or as a tedious process in firm flesh, which chiefly
occurs in granular bodies.
Such pathologico-anatomical forms preserve, in all the course of
the disease, the wandering nature of the papules, which appear under
the skin, because they readily appear, disappear and re-appear, spon-
taneously, however, changing their place and form.
The blood rarely and scantily has true inflammatory characters, and
only where we find an inflammatory disease prevail over the Typhoid
fever, or where the morbid phlogosis, investing the heart and large
vessels, produces an angioitis. But usually the blood has much cruor;
more or less dark, with little serum, usually sanguineous, either yel-
lowish or greenish. In extreme cases, the blood may be found much
altered, both in the heart and in the serum, as it is well known that it
is, in a disorganizing disease. It has been observed with the micro-
scope, that the globules of the blood in Typhoid fever, become more
scarce, thinner, smaller, mis-shapen, etc., as has been already set
forth, when speaking of the symptoms which the state of the blood
presents in this disease.
The investigation of the seat of Typhoid fever is of great impor-
tance, and every physician, to whatever school he belongs, looks there
in all his studies, in hopes of arranging a rational curative method.
But much more is the knowledge of this seat essential to the Homœo-
pathist, because we have established the maxim, that there can be no
specific medication for Typhoid fever, but only for an individual case
of a species of this fever, which cannot be individualized without
minutely scrutinizing the seat of the disease. Now, as this is, from
the beginning, diffused through the entire organism, and consequently
is found in some organ, more or less important to the maintenance of
1
178
A TREATISE ON TYPHOID FEVER.
life, it is clear that the medicine which is suitable, at the beginning of
the disease, is useless and inefficacious in its acme, or in its decline,
since the disease is entirely different, as we have seen, and new symp-
toms present themselves; and thus Hahnemann, in his Organon, says:
"The most skillful observer can see nothing, in a disease, but the
morbid signs, the accidents, the symptoms; and the totality of these
symptoms is all that he has to know, distinguish and cure.” And if,
among the number of symptoms, we should comprise those which
each organ presents, arising from its organic lesion, which are called
material symptoms, and it is necessary to gather together all the
symptoms of whatever nature, to arrive at a clear and complete knowl-
edge of the disease, who cannot see that we should not neglect that
furnished by the seat of the disease? That Hahnemann thus thought,
we have only to give a rapid glance at his Materia Medica, and we
shall soon see that, under the title of simple symptoms, he has indi-
cated, not only the functional and sensorial lesions, which could be
observed with certainty, but also the organic lesions or inflammations,
engorgement, softening, suppuration, induration, scirrhus, cancer, whether
of the lips, the tongue, the throat, the tonsils, the eyes, or any other
part. From this we have the right to conclude that he taught the
same thing regarding the larynx, the bronchi, the lungs, the pleuræ,
the heart and the parts belonging to it, the liver, the stomach, the
spleen, the kidneys, the uterus, in fine, of every internal organ
whatever, if these organs are accessible to observation and explora-
tion.
If it is seen that, in his researches he did not use the mediate means
of exploration, which we now have, as auscultation, percussion, the
speculum, etc., this does not prove, at all, that he rejected their use,
since the greater part of these means were unknown in his time.
But, on the other hand, it may be observed, that he indicated with
great care, all the external pathognomonic signs which could be
otherwise used to discern the state of the internal organs, whence
with certainty, we may conclude that, if all the diagnostic means,
to-day at our disposal, had been known fifty years ago, he would
surely have been one of the first to employ them. Hence the doctrine
of Hahnemann, requiring the collecting of all the symptoms, should
exclude none of the lesions of the internal organs which constitute
the seat of the disease. Consequently modern Homœopathists are
obliged to add the means of investigation used to-day, to those which
the master had in searching for symptoms, from the totality of which
THE COURSE OF TYPHOID FEVER.
179
we obtain a clear picture of the disease; we must profoundly study
anatomy and physiology, the basis of medical knowledge, and, with-
out which, we cannot distinguish the healthy organ and function
from the diseased; we must reflect well on the relations of morbid
symptoms with drugs so as not to prescribe these empirically and
without fixed rule; we should meditate night and day upon the
Materia Medica Pura and `not think of the self styled reforms, which,
instead of perfecting science, transform and corrupt it, so that by
destroying its fundamental principle, they end by our learning nothing
more from them, neither does it open the certain way to indicate, in
each particular case of disease, the suitable remedy which is alone
capable of certainly producing the desired cure.
CHAPTER V.
ANATOMICAL CHARACTER.
Many authors have described, with accuracy, the anatomical lesions
found in cadavers of those who have died with Typhoid fever, and,
not being able to refer to my own observations, because it has not
yet become the custom to make post-mortems on those who die in
their own homes, to avoid any lack in this exposition of the fever, I
have gathered them from other writers on medical science, who have
given them their attention.
The anatomical lesions found at the post-mortem are of two kinds;
the one constant, or, almost so, and constituting the anatomical char-
acter of the disease, and thus considered by pathologists who
compare them with the external signs called symptoms, as the same
disease, in the knowledge of which they see the true and ultimate
problem of diagnosis; others, on the contrary, appear only in a few
numbers of subjects, and, consequently, are less characteristic, but do
not cease to be important, since the doctrine of Hahnemann, requires,
in order that we should know diseases, that we should unite all the
symptoms, external, as well as internal, and these latter are the organic
lesions of whatever nature, and all united together give a complete
idea of the disease.
I.
EXTERNAL STATE OF THE BODY.
It has generally been noticed and acknowledged by all, that, in the
typhoid affection, the cadaveric decomposition proceeds with greater
rapidity, than in any other. However, I think it very difficult to
obtain exact statistical data, on this subject, since it is necessary,
in
order to obtain such results, to take account, First, of the quantity of
fluid contained in the body. Second, of the temperature, the moisture
and the electricity of the air. Third, of the place where the bodies are
deposited, etc. These numerous and varied circumstances have great
influence upon the putrefaction, and, hence it remains difficult to
judge whether one, dead from this disease, becomes decomposed, in
less time than in any other.
ANATOMICAL CHARACTER.
181
It is equally difficult to distinguish, exactly, the lesions proper to the
disease from the cadaveric alterations. And the difficulties increase
very much when we attempt to decide whether the softenings, the
congestions and the discoloration of the tissues took place before death
or after. The greater fluidity of the blood, the process of mortifica-
tion, so easily produced during life, the diminished consistency of the
parenchyma and the stasis of the fluids in the dependent part of the
subject, and of all the organs, are all conditions which dispose the
solids to putrefy with much promptitude.
Thus the bodies of those who die with Typhoid fever, during the
first week of the disease, do not present, to inspection, marked symp-
toms of emaciation; the cadaveric rigidity is very marked; in the
lower parts of the body is seen a cadaveric hypostasis in a high degree,
and, in the sacral region, sometimes, the beginning of a decubitus.
The nostrils often look as if they had been fumigated and the teeth
and gums are covered with a blackish layer. Upon the skin are seen
the remains of the sudamina, of the typhoid spots of the petechiæ, in
a word, of the different eruptions which have existed during life: the
skin of the abdomen is often green and violet-colored, and presents
the signs of cadaveric decomposition. Blisters are covered with a
bloody crust, brownish or bright red; sometimes the ulcerated skin
permits one to see here and there, a kind of excavated cellule in
the skin itself; the punctures of the leeches are found ulcerated and
roundish in form, and, in the lower limbs, there are large sugillations.
In those who die in the third or fourth week of the disease, or even
later, an emaciation, more or less considerable, is observed; the cuta-
neous integuments are pale, the rigidity is moderate and the cada-
veric hypostasis, if the anemia was considerable, is not very marked.
In the region of the sacrum, the trochanters and the elbows, there is
found, in the more advanced decubitus, a destruction, more or less
extensive, in the skin, and the remaining soft parts, which sometimes
reaches to the bone. In the inferior extremities, many patients present
a slight œdema, and one or the other femoral vein is closed by a
thrombus and there is also a considerable dropsical tumefaction of all
the corresponding extremities. In some cases abscesses are seen, in
the subcutaneous and intermuscular, cellular tissue, and suppurating
parotid tumors.
Sometimes a cadaveric emphysema is noticed, appearing frequently
in the connective tissue of the neck, of the parenchyma and the intes-
tines, principally under the mucous tunic of this membranous canal..
182
A TREATISE ON TYPHOID FEVER.
In some cases, this emphysema, some hours after death is observed to
attain, spontaneously, an enormous size, while, in other cadavers,
apparently in the very same circumstances, nothing of the kind
is observed. "We are allowed to believe," says Chomel, “that the
nature of the disease of which these patients died, combined, no doubt,
with other unknown causes. could not be entirely foreign to the sudden
production of a great quantity of gas in the economy, or, to speak in a
more precise manner, to the rapidity of the decomposition of the cad-
aver, in which the development of gas and cadaveric emphysema is
but one of the first phenomena.
II. INTESTINAL LESIONS.
The characteristic lesions of Typhoid fever, which never fail accord-
ing to some writers, exist especially in the small intestines and are most
frequent in that part of the digestive tube nearest the juncture with
the large intestine, upon the surface opposite to its insertion with the
mesentery. The follicular groups, described under the name of Pey-
er's patches are the seat of these alterations which are observed,
always more deep and more numerous, near the ileo-cœcal valve, and
diminish in proportion as we go up from the cœcum toward the jeju-
num. These lesions vary according to the time in which the patients
died. It is difficult to determine the exact time when they begin,
being rare in patients who die before the end of the first week.
The alteration presents itself under two distinct forms; the patches
are at first lightly swollen and prominent, of a rosy color; their sur-
face is almost always smooth or granular, or, as if papillated. The
mucous membrane, which it covers, is sometimes softened, sprinkled
with greyish and depressed points which give them a reticulated
aspect. In a second form, which manifests itself simultaneously with
the first, and is observed in about a third of those who die, the sub-
mucous tissue is transformed, through the whole extent of the patches,
into a yellowish-white, homogeneous matter, hard, fragile, with brill-
iant edge when cut, from four to seven millimetres thick. The
mucous membrane presents the same alteration on the soft patches.
The alteration of the sub-mucous tissue seem to precede, in this case,
that of the mucous. The course of the ulceration is more rapid and it
has been thought that it was observed that the termination was more
often fatal and that death was more prompt. The follicles of Brun-
ner present the same alteration as the agglomerated follicles; they are
more or less swollen, red or white, with hypertrophy of the cellular
tissue, but rarely ulcerated.
ANATOMICAL CHARACTER.
183
If the alteration, the thickness, the redness increase, the softening
of the mucous membrane, or, of the subjacent tiss e is yet more pro-
nounced, and the reticulated appearance is no longer seen. From the
ninth to the twelfth day the patches begin to ulcerate; though, some-
times, the ulceration begins earlier. It is formed in two different
manners; at one time, we observe a destruction at first incomplete,
then complete, of the mucous membrane and afterwards of the
patches; or, on the contrary, a process of softening or of gangrene
attacks, at first, the yellow matter of the patches and extends after-
wards to the mucous membrane which falls off in scales with the
substance of the patches. The ulcerations which succeed the destruc-
tion of the follicles vary much among themselves. Those which
occupy Peyer's patches are oval or elliptical and may attain a length
of six or seven centimetres; those which are situated in the isolated
follicles are circular, much smaller, and, appear to have been made by
a press. In general, they represent exactly the form of the follicles
destroyed; some have a hard border, raised up, in others they are very
thin; the mucous membrane may be seen loosened about them for the
distance of from four to six millimetres, or else, on the contrary,
adherent. The bottom of the ulceration is red, brownish or of a
slate gray and more or less granular and smooth, and permits one to
see, now the muscular tunic, hypertrophied, now, on the contrary,
destroyed, and the bottom of the ulcer is formed by the peritoneum.
Finally, the peritoneum itself is sometimes perforated, producing, in
the abdomen, an effusion of stercoraceous matter rapidly fatal. The
perforations correspond, in general, to a slight ulceration; they are
situated almost constantly near the cœcum; the accidental aperture is
generally very small, rarely the size of the eighth of a millimetre.
Then, if the small intestine is examined, in patients who died after
six weeks, or two months of the disease, a certain number of ulcera-
tions are found in which cicatrization had begun or was completed
and which had their seat in the neighborhood of the cœcum, where
the alteration first took place, which proves that nature always follows
the same course in the production, as well as in the reparation of the
disorder. The ulcers which commenced to cicatrize, are distinguished
from the others by the sinking or sharpening of their edges which are
somewhat confounded with their base, which is uneven, as if there
had existed small vascular papules. There are found, on the other
hand, at points, corresponding to the agglomerated follicles, a delicate
follicle, smooth, without villosity and continuous with the sub-mucous
184
A TREATISE ON TYPHOID FEVER.
tissue situated about the ulcers. Prof. Louis has not found cicatrices
of this kind till after the thirty-seventh, fortieth or forty-third day.
But, at the end of some months, this tissue of new formation has
undergone, entirely, the mucous transformation and presents no
difference, in color or texture, with the adjacent mucous membrane.
Prof. Trousseau, assisting in the pathologico-anatomical studies of
Bretonneau, to clear up the question of the lesions of the intestines
in Typhoid fever, had the opportunity to follow the course of the alter-
ations of the intestinal glands, and, to describe, from day to day, the
appearance which they present, which he published in a paper in the
Archives Generales de Medecine, January, 1826. To avoid all obscurity I
think it best to transcribe his precise words as follows:
"This characteristic dothinenteric eruption, formed at the expense
of the agminated and isolated glands of Peyer, does not begin to
appear till the fourth or fifth day, and, sometimes, not till the seventh
or eighth; this takes place in a successive manner in the first two
days, all the glands which are to be affected not being attacked on
the same day; but it is complete, at the latest, on the seventh day.
The agminated follicles, in length and breadth are tumefied; the
isolated follicles project within the intestine; at the same time, the
pathological operation of which they are the seat, reflecting upon the
corresponding mesenteric glands, gives, to them, a volume greater
than normal. The tumefaction increases till the ninth day; on the
tenth, the affection enters upon resolution or runs through all its
courses.
56
'In the first case, this tumefaction of the agminated and solitary
glands, and, at the same time, that of the ganglia begins to diminish
and declines gradually till the fourteenth day, at which time the dis-
eased follicles are still a little swollen; but, at the end of the third
week, the resolution is complete and the ganglia always preserve, for
a little longer, traces of the alterations which they have suffered.
'In the second case, some parts of the agminate glands of Peyer
follow this retrograde course, which we have just indicated, while the
others continue to increase in volume; the same thing is observed for
the isolated glands, of which some are healed, while the others con-
tinue to get worse. However, in either case, the mesenteric ganglia
have diminished in volume.
"On the twelfth day the intestinal affection, till then papular, has
become partially furuncular. The diseased glands elevate themselves
under the form of red conical fungosities, presenting on their apices,
slight erosions which, enlarging, constitute, on the fourteenth or
fifteenth day, a purulent patch of reddish hue, or with a color like the
deep yellow of the bile, which, at this stage of the disease, flows in
the greatest abundance, and has a very peculiar tint; this sphacelated
tissue is imbedded in the centre of a vast ulceration and still adheres
ANATOMICAL CHARACTER.
185
there with its base. The next day, this purulent putch, loosened
interiorly, yielding to the least force, leaves, in its place, a deep ulcer,
whose base usually rests upon the muscular coat. Sometimes, five or
six ulcers of this nature are seen upon one single agminate gland of
Peyer, giving it a fungous appearance, and uneven, and well calcu-
lated to conceal from view the existence of the gland which is the seat
of such a disorganization. Within, isolated ulcers occupy the place
of the solitary crypts destroyed by the same inflammatory process.
The mesenteric glands, of the color of wine dregs, are softened, in a
great measure, and are resolved almost into a papescent matter, when
they are cut or pressed between the fingers.
"On the seventeenth or eighteenth day, the margins of the ulcers
become depressed, their depth decreases, the tumefaction which sur-
rounds them begins to disappear. On the nineteenth, twentieth,
twenty-first day they have become superficial and tend to cicatrization
which is complete on the twenty-fifth day; but the cicatrices are not
generally consolidated till the thirtieth; some ulcerations persist even
fifteen, twenty or thirty days longer, especially in the glands occupying
the end of the small intestine.
"Such is the dothinenteric eruption; such are the different phases
through which it passes. Its chosen location is the last portion of the
ileum; and when the papules occupy only three, six or ten inches of
the small intestine, they are the three, six or ten last inches of the
ileum, the eruption appearing the more confluent as one examines it
nearer the ileo-cœcal valve; we have never seen pustules beyond the
second part of the jejunum ascending towards the duodenum and
the stomach; while, in the large intestine, they are the more numer-
ous, the nearer they are to the cœcum.
"You will always find these intestinal lesions on opening the bodies
of those who have died with Typhoid fever, whatever may be the form
which this fever has taken on, whatever may be the intensity or the
variety of the symptoms which accompany it, provided these indi-
viduals died after the fifth day, the time, at which, as we have already
seen, these lesions begin to appear."
The matters contained in the intestines are usually fluid, yellowish,
sometimes mixed with blood. This blood is either fluid or coagulated.
In some cases, but a small quantity is found deposited in certain parts
of the digestive tube, while, in other cases, these are full of blood and
then death was the result of a gastric or intestinal hæmorrhage. This
hæmorrhage, moreover, is not dependent upon any special lesion of
the mucous membrane, which does not present, under the blood, any
thing more than a mere redness, ecchymoses, various degrees of soft-
ening, and presents, in the intestine, the same alteration, or traces,
either of exanthems, or ulcerations; the cause of the hæmorrhage does
not appear to be the solution of continuity of any great vessels.
D 11
186
A TREATISE ON TYPHOID FEVER.
Modified by its delay in the stomach, the blood accumulated there,
sometimes, assumes such an appearance that it becomes quite similar
to the black fluid which constitutes the matter of the vomito in yellow
fever. Andral cites a case of this kind. Bouillaud reports another in
which, in connection with the yellow tint of the skin, the patient, at
the same time, passed blood by vomiting and purging. A brown
liquid was found in the stomach, like a concentrated decoction of
coffee. The gastric mucous membrane, presented towards its grand
cul-de-sac, several patches of a winey red, like ecchymoses. Nothing
but bile was found in the duodenum, but, in the rest of the smal
intestines there were found collections of blood, coagulated in certain
points, liquid in others. Many abscesses were found in the liver.
The colon is the part of the digestive tube in which is, most
frequently, found the greatest quantity of gas, in those who die of
Typhoid fever. In many cases, the distension of the colon by gas is
so considerable that the intestine makes itself apparent, through the
abdominal walls, pushes the diaphragm upwards, and conceals to a
great extent, the rest of the digestive tube and the other abdominal
viscera. It occupies, in particular, the epigastrium, where, during
life, it may be taken for the stomach. Louis thinks that the meteor-
ism may be more common in patients who die between the twentieth
and thirtieth day, than in those who die before that time or after it.
The cause, under the influence of which, this great developement of
gas in the colon is accomplished, is as yet unknown. It can not be
attributed to inflammation or ulceration of the colon, seeing that this
meteorism exists, with the same frequency, in cases in which after death
the colon is found exempt from any perceptible change, as in those in
which there has been a morbid change. Besides, as Louis observes,
the small intestine is much more often inflamed or ulcerated than the
colon, without there being the same amount of gas in the ileum as
there is in the large intestines. All that can be said is, that this great
development of gas belongs, almost exclusively, to the nature of this
disease.
When one can overcome the repugnance inherent to the study of the
matter contained in the colon, we find yellowish, liquid fæcal matter,
seldom solid, of an insupportable odor, at other times reddish or
greenish. Studied under the microscope, the matter of the alvine
evacuations presents various bodies of which we have spoken, and,
also a great number of worms, of the species tricocephalus. These
worms are visible, even to the naked eye, appearing under the form of
I
ANATOMICAL CHARACTER.
187
little filaments in the fæcal matter, found in the cœcum. The genera-
tion of these animals, it seems, may be favored by certain epidemic
constitutions which are rare at present. In the mucous fever
observed by Roederer and Wagler, they were so numerous, that they
were considered a cause of the disease. The presence of these worms.
however, is quite accidental.*
Schoenlein has described prismatic crystals which he discovered in
the evacuations of patients affected with Typhoid fever. Gluge hav-
ing studied these crystals accurately, says that they are often met
upon the intestinal mucous membrane, and, in the alvine evacuations,
in diseases the most diverse.
Intestinal worms may also be found; this, however, does not occur
in any general way, except in certain epidemics.
The mucous membrane of the small intestines, between the diseased
follicles, is sometimes healthy; the morbid process concentrates itself,
in these minute organs, and but rarely passes out of the circle in which
they are found circumscribed. It is the result of observations made
by Louis and Chomel, that the mucous tunic more generally preserves
its color and its natural consistence between the indurated or softened
patches, and the integrity of the same contrasts with the disorganiza-
tion taking place in the follicles; the ulcerations which proceed from
the softening of the patches of Peyer, or of the isolated follicles, are
surrounded by a mucous membrane, untouched by any alteration.
At other times, this is white or grey, and sometimes, in certain points,
it is of a redness more or less bright and injected, or of a brownish
color and softened; in a word, it presents alterations which evidently
depend upon a morbid process produced by the disease of the patches.
Such a case presents itself now and then in individuals who die in the
first fortnight. Among the partial red colorings, which the intestines
present, there is one distinguished from all others, by its form and
its nature. It is produced by the effusion of blood in the mucous
tunic, which presents a reddish or black color; one would call it a
layer of black gelatine, reddish or merely rosy, spreading a lucid
and tremulous appearance over the surface of the mucous membrane.
On pressing with the scalpel, the membrane, which has become red
to a certain degree, an abundance of reddish fluid may be made to
exude. In one who died of intestinal hæmorrhage, in the course of
a Typhoid fever, all the mucous membrane at the end of the ileum,
* NOTE.-There is a wide field of inquiry open here and the subject can not be so
summarily disposed of, as this sentence attempts to do.- TRANS.
188
A TREATISE ON TYPHOID FEVER.
•
was found colored with a reddish violet, by the hæmorrhage of the
internal membrane, and the blood was extravasated also into the
other tunics. In some cases the redness, from the interstitial hæmor-
rhage, is situated within the ulceration, from which the flow of blood
took place.
The mucous membrane may preserve its white color in all its extent,
or, partially; the first case is much more rare than the second, and this
natural color was seen by Louis, only in cases in which death took
place at an early period of the disease. This natural color was seen
in a subject which died from intestinal hæmorrhage occasioned by
ulceration of one of Peyer's patches. The natural color of the mucous.
membrane is observed also, partially, either within the patch, or in
contact with other parts, more or less rosy-colored.
The grey or slate color of the internal membrane is not met except,
in cases in which death occurred after the twentieth day, or a little
later. It is seen in the mucous membrane, as in the mesenteric
glands, in the elliptical plates of the ileum, and in the stomach.
The yellow color, which is found mostly in the upper part of the
intestines, comes from the presence of bilious matter with which the
tissues are impregnated.
The consistence of the internal membrane is normal. In forty-two
cases of which Louis speaks, nine only had a normal consistence of all.
the mucous membrane of the small intestines; more or less dimin-
ished in the whole extent of the intestines, thirteen times; diminished
in the last portion of this organ, twenty times.
This softening is accompanied neither by redness, nor enlarge-
ment, and that which is more common than all, it does not appear
to Louis that it is of an inflammatory nature. It is very rarely
observed in the autopsies made by dissectors; it was partial and lim-
ited to the end of the small intestine, in three cases only, out of
thirty, and it was manifestly to be attributed to the presence of fluids,
to imbibition, or to the cadaveric state.
Bouillaud says that he has frequently found this phlogosis in the
mucous membrane, which, in the first period, is characterized by a
state of redness and of thickening, while the wasting away, the pallor,
the discoloration, belong to the second period. This morbid process
is only accidental, and consecutive to the lesion of the plates of
Peyer, and that in a very few cases.
The lesions of the great intestines are of the same nature as those
which are found in the small intestines; nevertheless the plates and
ANATOMICAL CHARACTER.
189
the ulceration diminish in frequency from the cæcum towards the
rectum. The pharynx and the œsophagus do not usually present any
change, except certain ulcerations, superficial, and few which are
seen in some cases. The stomach, normal as to size, does not present
any changes which may not be seen in subjects dead of any other
diseases.
III. MESENTERIC GANGLIA.
The mesenteric ganglia, constantly affected, as well as the patches,
are more voluminous, and tumefied to such a degree that they attain to
the size of a kidney bean or filbert; their tissue is red or brownish, tears
under the finger with the greatest facility, and it is not rare to find, on
making an incision, some points of suppuration scattered through
their tissue, within one or more ganglia. Soon after the falling off
of the eschar, from the intestinal mucous membrane, the mesenteric
glands begin to grow less, but they still remain larger, and richer in
blood, for a long time, than in the normal state. From the twentieth
to the thirtieth day they decrease in volume, and assume a brownish
or violet hue; finally, this time being past, they become grey, of a
lavender color, and acquire greater consistency. During the healing,
then, of the intestinal ulcers, they return to their normal volume
and often shrivel up in the form of minute solid corpuscles, of a slaty
grey color. Some of these lie beneath a caseous degeneration, and
somewhat later calcify. The alteration of the ganglia almost always
bears relation to that of the intestine, which explains, perhaps, why
the ganglia the most affected are those which border on the cæcum.
IV. THE SPLEEN.
The spleen is, next to the intestinal follicles, the organ which is most
frequently found changed.
In almost all cases, the spleen has a volume more considerable than
in the normal state, and it may be conjectured that a Typhoid fever
had existed, whenever we find an increase in its size in the cadaver.
Sometimes this increase of size is barely appreciable; at other times
it is twice, three times and four times the usual size.*
In half the cases, or thereabouts, it is found twice the usual size;
in a very few cases, it is four times this size.
*NOTE.―This assertion, and the following, must be taken with some allowance;
enlarged spleens, in miasmatic districts, are far from unusual, and are much
oftener seen without Typhoid fever than with it. Hoffman found nine cases of
infarction of the spleen in 250 post-mortems. Giesinger thinks it is found in 7 per
cent of the fatal cases. Liebermeister on Typhoid Fever-TRANS.
190
A TREATISE ON TYPHOID FEVER.
Although the volume might be generally more considerable, in sub-
jects who died in the most acute period of the disease, that is to say,
before the twentieth or twenty-fifth day, it has, nevertheless, been
observed that there is a notable difference between the volume of
this organ in those who die in the first days of the disease, and that
which it had at a period a little more advanced; after the twenty-
fifth day, the spleen was usually found less voluminous. Dr. Barth
says that, in thirty-two cases of this fever, the spleen was found much
smaller than usual only once, and, in this case, death took place in
the eighty-fourth day of the disease. Chomel reports the case of a
woman who died about the forty-second day, and whose spleen was
found, at the post-mortem, three or four times larger than ordinary,
and, in another individual, who died after more than a month of con-
valescence, the spleen was yet twice its normal size; whence, although
the spleen, both in its increase and decrease in size, is subject to the
same law as the follicles, and the mesenteric glands, yet certain
exceptions are observed.
In a certain number of cases, the spleen, at the same time that it
increases in volume, remarkably loses density. And when this altera-
tion is carried to an extreme degree, the finger readily penetrates the
parenchyma of the organ, which, upon pressure, is reduced to a kind
of pulp of the color of wine dregs. Equally with the hypertrophy,
from which it is almost inseparable, the softening is the most notable,
from the beginning of the disease, and almost constant in all cases.
Some, however, say that the softening of the spleen does not belong to
any precise epoch of the disease, and neither is it to be attributed
to a vast suppuration produced by the ulceration of the eschars,
since, in one subject, none of the isolated follicles, which alone were
altered, were ulcerated. In other cases, instead of being softened, it
has a degree of consistency rarely seen in a state of health; thus, in
a patient whose spleen was twice the normal size, it was, at the
same time, very dry, and appeared as if it contained no blood. This
modification is usually observed after the thirtieth day, and when
the other organs return to their normal state.
In the color of the spleen we meet no less variety than in its vol-
ume and consistence, but we cannot refer to any other condition,
for, as regards time, volume, or consistence, they are of but little
interest.
All these different alterations, whether of consistence or of vol-
ume, are not attached to any particular symptom, nor to any form
ANATOMICAL CHARACTER.
191
of the typhoid affection, and are met, even in other fevers, as in the
pernicious, the yellow fever, in pyæmia, etc., although in a less con-
stant degree; thus we may say that they are not proper to Typhoid
fever, nor do they constitute its essential anatomico-pathological
alterations, but are connected with a general alteration of the fluids
of the organization.
V. LIVER.
The only lesion of the liver often met, in Typhoid fever, and cal-
culated to attract attention, is its softening. In a certain number of
cases, its tissue presents less resistance than that of the ordinary
state, although it may always be very considerable. In others, the
softening is greater; the finger readily penetrates it. Louis says
that he has observed a marked softening in about half his cases.
In some cases there has also been observed a change of color,
which is ordinarily more rosy; but as this is, in fact, very rare, it
cannot be considered as belonging, in a special manner, to Typhoid
fever.
The softening of the liver, as well as that of the spleen, is usually
accompanied with softening of the other organs, and of those also
which are very important to life. In this circumstance we find
a proof that this very alteration is not an effect of inflamination,
as it would be difficult to comprehend, how so many important
organs can be inflamed at the same time, without life being at
once extinguished. Such circumstances serve also to explain, at
least in part, how these lesions do not make themselves manifest
during life by any particular symptom.
VI. PANCREAS.
The pancreas is affected less frequently than the other viscera.
Louis observed a violet color in the pancreas of a patient who
died on the fortieth day. It is credible that this color might be a
transformation of the red color, which had existed at a certain
epoch. The pancreas has been examined by many physicians, in
a very great number of cases, and the greatest variation in color
has been observed in this organ.
VII. KIDNEYS.
The kidneys are almost always in their normal state. Rayer
declares that there is hardly a general disease which, more fre-
quently than Typhoid fever, produces inflammation of the kidneys;
this inflammation is double, and the two hypertrophied kidneys
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A TREATISE ON TYPHOID FEVER.
are engorged with blood; besides, upon the external surface of
these bodies, a certain number of small reddish points are seen,
intermingled with purulent points and surrounded by a red circle;
these points, slightly protuberant, sometimes unite so as to form
a patch somewhat elevated. The renal lesion, however, can only
be considered as a complication, as it appears but very seldom.
There is likewise seen, in more than a third of the cases, and
in separate cases which died after the fifteenth day, a congestion
of the cortical substance, manifested by injection of the Malpigh-
ian granules and the small vessels; much blood flows when a
section is made of the organ. In one case there was seen, in the
cortical substance, an intestinal hemorrhage, two centimetres in
size, the patient was struck with death, as by lightning, from
intestinal hæmorrhage.
The bladder is distended by urine in some cases. The internal
membrane of this organ is injected, rose-color, or ulcerated; its
consistence is normal.
VIII. THE ENCEPHALON AND ITS ANNEXES.
The marked disturbances observed in the functions of the brain,
in Typhoid fever, and which often surpass in gravity those of all
the other organs, would lead one to suppose, that, in this organ
we should find the most severe and most important lesions. But
it is not so, since, upon examination, the brain is found with the
fewest and slightest alterations, or at least, they are less percep-
tible, compared with other organs.
The delirium, almost always observed in Typhoid fever, is not,
for the most part, represented in the brain by any notable lesion.
It is true that we find, in a certain number of cases, two condi-
tions of this organ, which show a notable deviation from that
commonly considered normal; that is, the oedema of the meninges
and congestion of the cerebrum; but even these conditions are
also met quite often in those cases in which there has not been
any disturbance of the cerebral functions, as well as in those in
which this disturbance has been observed, and being frequent
in other diseases, as well as in typhoid, we cannot draw any
induction therefrom.
The pia mater is sometimes infiltrated with a small quantity of
transparent or opaline serosity, chiefly accumulated along the great
cerebral commissure, or towards the posterior lobes; it is easily
loosened from the cerebral substance, which preserves its smoothness
ANATOMICAL CHARACTER.
193
and its natural texture, at least, if the meninges are not inflamed. In
this case, the arachnoid and pia mater are injected, while the same
appearance is extended to the more superficial portions of the grey
substance. With the redness which belongs to meningitis, we must
not confound the patches of bright red, and a little violet, which
are often met with in the lateral and posterior parts of the cere-
bral lobes; such patches are most commonly derived from a simple
cadaveric congestion and are not accompanied with softening of
the membrane, nor any pseudo-membranous secretions. If we reflect
that the oedema of the meninges and the red color fail in cases in
which the patients were affected with the most violent delirium, con-
tinuing for many days, while they are also met in cases in which
the patients presented but very slight nervous disorders, or none
at all, we must conclude that such alterations are not of an
inflammatory nature, nor the cause of symptoms observed during
life. And some have happened to find the meninges pale and
discolored, in those who died from the twelfth to the twentieth
day of the disease.
Z
We likewise find the venous sinuses and the principal trunks of
the meninges engorged with blood, a little quantity of serum effused
into the ventricles, and very rarely, the alterations proper to meningitis.
When these alterations are met they are evidently to be referred to a
complication.
The substance of the brain very seldom presents any change;
the only condition which can be considered as very common is
the punctated state of the cerebrum, but it is known that this
state is observed in the most different morbid conditions, and that
it avails nothing in explaining the morbid phenomena presented
by the patients. Louis, in the greatest number of cases, found
the cortical substance more or less rosy through all its thickness,
and, throughout the whole extent, there was no alteration of texture.
This rosy color, sprinkled with blackish spots, was more frequent in
those who died from the eighth to the fifteenth day, than those
who died at any other time. In some cases, the more superficial
stratum of the cortical substance remained adherent to the pia mater,
when this is removed, which circumstance depends upon a softening
of the grey substance. Sometimes this membrane may be easily
removed, but touching the grey substance with the nail or with the
back of the scalpel, we see that it is softened. Piedagnel, who has
accurately studied the alterations of the brain in Typhoid fever, says
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A TREATISE ON TYPHOID FEVER.
that he has often seen the cortical substance separate in laminæ, in
strata, more or less profound, from the strata below. Sometimes we
may see that, even when the lesions of the cerebral functions were
the most marked, the substance of this organ was seldom found
altered, unless, at least, there had been some signs of a meningitis,
or meningo-encephalitis, in which case the disorders peculiar to this
disease were observed.
In some cases, softening of all the cerebrum was seen, which
alteration is cadaveric, or the result of that tendency which all
the organs have, to lose their consistency in Typhoid fever. In
the greater number of cases, the density of the cerebrum is nor-
mal, seldom increased.
The alterations of the cerebrum, and of its membranes, are
hence rare, and cases in which it is met, are not always those
in which the patients present the most violent and lasting disor-
ders of the cerebral functions; and besides, these alterations are
seen also in other diseases, and are not the real and demonstrated
causes of the symptoms presented by Typhoid fever patients. Louis
regards them as accessory, secondary and not essential to the disease.
The cerebellum, the cerebral protuberance, the medulla spinalis, do
not present any appreciable alteration. Drs. Bierbaum and Gross-
heim observed, in subjects who had presented phenomena due to
a lesion of the medulla, serous and gelatiniform exudations, and
the injection of the spinal marrow. These alterations belong to
accidental complications which need not be described in this place.
IX. ALTERATIONS OF THE RESPIRATORY APPARATUS.
The alterations in this apparatus vary according to the organ
in which they are examined.
At other times ulcer-
The epiglottis is but seldom œedematous.
ations are observed and the cartilages are denuded. Chomel says
that he has found it, in one case, denuded at its extremity, and
the mucous membrane loosened over a large extent, presenting
the appearance of a prepuce. In another case it presented, upon
its anterior and inferior surface, three small ulcers, penetrating to
the cartilage. Louis, examining with diligence, found ulceration
of the epiglottis in seven cases, in which death had happened on
the fifteenth day, when the disease was present in all its intensity.
The superior aperture of the larynx presents its lips rugous and
œdematous, or really red and enlarged. At other times, it pre-
sents ulcers, as the larynx itself does, and these ulcers, in certain
ANATOMICAL CHARACTER.
195
epidemics, are very frequent, occupy different points, and are more
or less severe. Louis, however, met it twice only, in fifty cases,
and says that he has never seen them in the trachea, whose inner
membrane always preserves its color and its normal consistency.
The bronchi often contain a whitish viscous mucus, or red, and
its mucous membrane is colored in the same manner. It is well
known how constant, in Typhoid fever, are symptoms of a catarrh,
which extend to the minutest bronchi, with deep redness of the
mucous membrane, and with scanty and tenacious secretions.
The lungs are seldom found unchanged in persons affected with
this disease, at whatever period death may occur. In the second
or third week, the most numerous and intense alterations of these
organs are observed. In their lower part they present more or
less extensive hypostasis, at other times, only a hypostatic hyper-
æmia of a high grade, and an enlargement of the pulmonary
parenchyma, dependent upon tumefaction of the walls of the air
vesicles, (splenization), or an hypostatic œdema, and at others, the
so-called hypostatic pneumonitis. Often, more or less extensive
tracts of the pulmonary tissue are found, whose bronchi have
become impermeable in consequence of tumefaction of the mucous.
membrane, and accumulation of the secretion, presenting the
symptoms of atelectasia. The croupous pneumonitis, also lobular,
or lobar, not affecting the lower portions of the lung, and not
depending upon hypostasis, occurs in single cases, near the acme
of the typhoid process, although they may be much more frequent
after the disease has been overcome. The bronchial glands are
tumefied, rich in blood, and sometimes present an aspect similar
to that of the brain, and common also to the mesenteric glands..
In some circumstances, we observe an emphysematous state of dif-
ferent parts of the lungs, and in other cases, more or less consid-
erable pleuritic effusion, but these different alterations have only
a remote connection with Typhoid fever, and appear rather to
depend upon the state of weakness in which the patient is found,
a state of weakness which increases the susceptibility to be
affected by morbid causes. In fact, this species of complication is
never observed when the patient dies soon after the beginning of
the fever, but only when death occurs at a more remote period.
The pleuro are seldom found altered. The false membranes and
the effusions, sometimes observed, and the inflammation, which
gives origin to them. do not occur except at an advanced period
196
A TREATISE ON TYPHOID FEVER.
of the disease. Puro-sanguinolent effusions have also been seen.
X. ALTERATIONS OF THE HEART.
In very many cases the consistence of the walls of the heart
is sensibly diminished, and in none does it seem to be enlarged.
Sometimes the softening is so striking that the muscular substance
of the heart gives way with the greatest facility, under moderate
pressure with the finger. In other cases it is difficult to judge if
it is really softened. Commonly, this diminution of consistence
of the muscular tissue coincides with the softening of the spleen,
the liver, etc.
In some cases, in which the consistence of the heart is not
changed, to such a degree that the fibres lacerate under light
pressure, it has undergone another modification no less remark-
able; there is such a flaccidity, such a softness of the tissue,
that the walls collapse, and the cavities are obliterated, as if they
were a simple membranous sac; sometimes this flaccidity exists
alone, without softening, just as the reverse happens, but not so
often, that there is softening without flaccidity.
This softening and this flaccidity of the tissue of the heart are
especially observed in subjects who die a little while after the
development of the disease, and only in such cases, at an advanced
stage. The flaccidity and the normal state are met especially in
those who die at a more remote epoch; but even this rule suffers
many exceptions.
Alterations of Color.-In the color of the internal membrane of
the heart, notable variations are observed, and which, sometimes,
are not the same on both sides. In some, the natural red is more
lively, in others rather heavy, and less livid; in the most the
internal membrane is almost discolored, and especially in cases
where there has been softening. In no case have the proper
symptoms of inflammation been seen, since pus bas never been
found there, nor false membranes, nor the granular aspect, which
are the only incontrovertible indices of the inflammatory process.
As regards the uniform redness of the internal membrane of the
heart, or of the large vessels, which has been considered a sign
of the phlegmasia of these organs, and to which inflammatory fever
has been attributed, it is vainly sought for in the majority of
these cases. In some, the internal membrane of the heart alone
had a very lively color, while that of the aorta, and of the large
arterial trunks, had preserved its normal whiteness. Patches of a
ANATOMICAL CHARACTER.
197
reddish brown are often noticed, and which, not being the result
of a phlegmasia, but of a species of staining, present no arborifica-
tions, no punctate appearance, no tumefaction. These spots exist,
and are very dark in points, where the blood tarried, (the heart, aorta,
large veins,) and when the blood is abundant and very liquid, about
which cases there is no difference of opinion among physicians, who
consider them as the product of the imbibition of very fluid blood
in the membranous tissues.
XI. ALTERATIONS OF THE BLOOD.
The alterations observed in this fluid, after death, are very different
from those usually met, after other diseases, so that they deserve par-
ticular attention. For the most part, the blood is black, in fact,
dissolved; very rarely we find fibrinous coagula, not very volum.
inous in the heart, and still more rare in the other blocd vessels.
Sometimes the blood, without being really dissolved, is found in
the heart, or in the aorta, under the form of black coagula, very
different from those found in cadavers of persons dead from other
acute diseases. The lack of fibrine in the blood of subjects who
die from Typhoid fever, is the more notable, and perhaps, the
most important modification of all observed in this fluid. And this.
lack of fibrine is all the greater in the severer cases of Typhoid
fever.
In slight cases, the blood offers characteristics only purely neg-
ative. The globules often remain in a physiological state, and
we notice there an excess in regard to the fibrine. The material
solids of the serum do not undergo any marked change. The
greatest alteration of the blood is, then, the defibrinization of the
blood, whether it is absolute or relative. To this alteration we
attribute the softening and hypertrophy of the spleen, and other
organs, and the frequent hæmorrhages which are observed.
Another alteration which is sometimes, but more rarely, met in
subjects dying with Typhoid fever, is the development of a more
or less considerable quantity of gas, within the blood vessels,
and especially, within the veins. If, in any subject, we undertake
to open a large vein, at a point at which it receives no branches,
we observe, sometimes, a few bubbles of gas, which readily escape,
and which penetrate the delicate and almost transparent mem-
branes in these vessels. In such cases, which, in this regard,
resemble those in which persons die from asphyxia, produced by
mephitic gases contained in vaults, or from carbuncles, similar
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A TREATISE ON TYPHOID FEVER.
signs of advanced decomposition are observed in the blood; some-
times it resembles coffee grounds, with which has been mixed an
oily fluid, which tends to separate from it.
It is in these cases, in which the blood presents, after death,
undoubted signs of decomposition, that there are very often
observed, during life, the large bluish spots, like those appearing
in scorbutus, or from a severe contusion, or petechiæ, even, which
minute spots so much resemble flea-bites, and which are also due
to a sanguineous infiltration into the same texture of the skin,
while, in the large bluish spots, the blood is ordinarily infiltrated
into the sub-cutaneous tissue; it is probable, then, that these alter-
ations of the blood and the tendency to decomposition, already
existed during life.
XII. MUSCLES.
Bouillaud has observed the pitchy state of the muscles, their ver-
million or brownish color, in persons dying of adynamic fever.
Nothing similar was seen by Louis, and other authors.
Prof. Zenker discovered the existence of interesting anatomical
alterations in the course of Typhoid fever, that is, granular and
waxy degeneration of the striated muscles. We need not believe
however, that this degeneration is exclusively proper to Typhoid
fever, as it has been observed, also, in other morbid states. How-
ever this may be, this is what has been observed. Several groups
of striated muscles are the seat of a degeneration, which is varia-
ble both as to its extent, and its intensity, but it is no less con-
stant than the characteristic lesions of the mucous membrane of
the intestines. This degeneration is granular and waxy.
The granular degeneration is characterized, under the microscope,
by the deposit of extremely fine molecules in the contractile sub-
stance of the muscular fasciæ. Hence results an extreme fragility
in the contractile substance, and, in fasciæ thus invaded, solutions
of continuity are possible during life, whenever a contraction of
the muscle takes place.
In the waxy degeneration, the contractile substance of the primitive
fascia is transformed into a mass completely homogeneous, without
color, presenting a very manifest reflexion, analogous to that of wax.
The transversal striæ and the nuclei have then completely disappeared,
while the sarcolemma remains untouched as in granular degeneration.
This matter, of a waxy aspect, is a protein substance which, probably,
arises from a transformation of the muscular or tendinous fibrine.
ANATOMICAL CHARACTER.
199
The altered fasciæ are always increased in volume and have, some-
times, acquired a diameter twice what is natural. In the same way,
as in case of granular degeneration, they become extremely fragile
and are the seat of multiplied transverse fissures.
Independently of this rupture of the muscle, vascular ruptures may
occur from the granular or waxy degeneration; whence the produc-
tion (in the thickness of the altered muscle and according to the
diameter of the broken vessels) either of minute ecchymoses or san-
guineous infiltrations more or less extensive or true hæmorrhagic
centres. These hæmorrhages occur, most generally, in the second or
third week of the disease.
An accident, much more rare, which follows muscular degeneration
is suppuration. It would seem even that the degeneration of the con-
tractile tissue represents only an occasional cause and that the suppu-
ration might be the consequence of the irritation of which the
perimysium (or the enveloping membrane of the primitive fascia) is
the seat. Therefore it would be the perimysium that would suppurate.
In ordinary cases it is only the cellular proliferation of the perim-
ysium and this hyperplasia, which ends in a regenerating work in the
muscle; but if a more energetic local irritation takes place and goes
beyond the limits of normal hyperplasia, then, a quantity of cellule
will be formed too considerable to be able to pass through the ulterior
fibres which should become transformed into contractile substance;
these cells, too numerous, are destined to be destroyed and are trans-
formed into pus. Thus we may explain, histologically, the inflamma-
tion of the muscular tissue and finally its suppuration.
The association, in one and the same muscle, of both kinds of
degeneration, the granular and the waxy, does not prove, according to
Zenker, that the waxy degeneration, which is the more serious of the
two, is the ultimate consequence of granular degeneration; both
forms, in fact, are distinct from each other, from their very beginning.
Here now, are the characters of muscles thus altered, as they
appear to the naked eye; these muscles seem entirely intact in all
cases in which the degeneration is but little advanced and this shows
us why it must have passed unnoticed before the microscope was used.
When the lesion is more considerable and there is a manifest change
of color, just as the degeneration increases, the loss of color is more
apparent; thus the muscles present, from the first, a gradation of
rosy-grey color, becoming all the time paler, and, finally disappearing
in a yellowish grey, with a very slight reddish or brownish tint which
200
A TREATISE ON TYPHOID FEVER.
may indeed fail altogether. This discoloration takes place by very fine-
spots or by striæ, corresponding to the points in which the degenera-
tion resides. Upon an incision, the muscles thus altered present an
appearance which may be compared to the flesh of fish.
In the first phases of the disease (in the second or third week,) the
affected muscles are generally very tense, their surface is smooth, their
substance dry, friable and easily lacerated. Besides, they are increased
in volume, which fact depends upon the condensation which the
degenerated muscular fasciæ have experienced. Finally, in the more
advanced phases of the disease, the muscles are relaxed, the cut sur-
face often presents a moist appearance and, sometimes, there is a
serous infiltration, more or less manifest, not only of the muscle, but,
also, of the relaxed cellular tissue which surrounds it, without there
being any analogous infiltration in any other part of the body.
This proves clearly that the oedema is here the consequence of the
complete morbid action in the muscle. Wolther says, "I have often
seen on the living and on the surface of the abdominal recti muscles,
a slight oedema corresponding to the lesion which I here indicated and.
recognizable by the depression left by the finger firmly pressed upon
the skin."
The muscles invaded, according to Zenker, are, in the first place,
the adductor muscles of the thighs and some neighboring muscles;
in the second place, the grand recti of the abdomen and the pyramid-
ales. It is chiefly in the grand recti that hæmorrhages are observed
and the microscopical lesion of these muscles has also conducted to
the discovery of the degeneration of which the microscope has
revealed the nature. After these muscles, come the pectoral, the
transversalis abdominis, the obliquus internus, the sub-scapular, the
triceps brachialis, the gemelli, the quadratus femoris and the vastus
internus. However, we should not give to this order of frequency
more importance than it deserves, seeing that it is difficult always to
examine all the muscles of a body at an autopsy.
According to Zenker, the muscular degeneration must always be
constant in Typhoid fever; in fact, he has found it in all the autopsies
where he has sought for it. The waxy degeneration is much more
frequent than the granular, as this anatomist has met the first seven
times and the second nine.
The degeneration is generally at its apogee at the end of the second
week, which permits us to presume that it commenced with the dis-
ease itself. The alteration persists with an equal intensity during the
ANATOMICAL CHARACTER.
201
third and fourth weeks. About this period the absorption of the
detritus of the degenerated contractile tissue seems to take place;
whence the softening of the muscles, often accompanied with serous
infiltration and, clinically, the possibility of recognizing a slight
oedema, as it has been said that Walter observed.
The constancy of the alteration of the muscles in Typhoid fever
proves that this alteration makes an integral part of the same and the
generalization of this very lesion shows that it is not an accidental
result of a morbid effort quite local, but the expression of a general
disturbance in the economy; the muscular system, then, is affected by
it, as all the other systems are.
However, I fear very much that, here too, a consecutive effect has
been taken for a primary cause, since evidently, the weakness and
disorder of the function of locomotion, which make the patient stag-
ger from the very beginning of the disease, are not, in fact, due to a
muscular alteration which does not yet exist, because there has not
been time to produce it, or, in any case, it has barely commenced.
That which produces these functional perturbations is the morbid
state of the cerebro-spinal system. Since innervation, goes on badly,
in Typhoid fever patients, the derangement of all the functions, in
general, is observed, and those of the muscular system, in particular,
and, but a little later, they produce the granular and waxy degenera-
tion of the muscles, in consequence of the alterations of nutrition
which the disturbances of the circulation occasion. These disturb-
ances of circulation are those which produce hyperæmiæ everywhere,
and, everywhere consecutively, or spurious inflammations, set forth
previously, or the degenerations of which I have just spoken. Still
more,
at an advanced period, and, particularly, in convalescence from
this fever, the granular and waxy degeneration of the muscles
explains materially the weakness experienced. The degeneration, in
a word, specially affects, in the highest degree, the recti muscles of
the abdomen and the abductors of the thigh or whatever muscles take
a principal part in the act of locomotion. It is necessary then to
register, as important, these very anatomical researches, but to seek
elsewhere the cause of such weakness lasting so long, and this cause
is debility; debility from the infection, which has produced the dis-
ease; debility from the nervous disorders of all kinds, such as insom-
nia, delirium, convulsions; debility from diarrhoea, from suppuration
on the surface of the eschar, from the difficulty of hæmatosis; debility
in fine from inanition.
D 12
1
CHAPTER VI.
DIAGNOSIS.
All physicians say that diagnosis is the most important part of
medicine and it is certainly the most difficult; it is the sole basis upon
which we can form a correct prognosis and a rational therapeutics; in
a word all the science of medicine rests on diagnosis. And of what
use are all other knowledges if we have not a knowledge of the dis-
ease which we are to cure? In order that the knowledge of a disease
may be complete, it does not suffice, analytically, to study the cause,
the symptoms, the course, the seat, the pathologico-anatomical altera-
tions; it is necessary, besides, that, by an operation of mind, more
easy to indicate than to describe, we re-unite that which has been
separated, that we may know the connection between the cause or
causes and the symptoms and, from this comparison, to draw a pre-
cise indication, which is the work of diagnosis. I have said the con-
nexion between cause and symptoms, without speaking of the course,
the seat, etc., not because Hahnemann and his disciples have denied
the importance of this knowledge, which reflects a clear and vivid
light upon therapeutics; but because they consider the course, the
seat and the pathologico-anatomical alterations, as making part of the
symptoms, and, having no other value than a general symptomato-
logical value, and not a particular value and one which should deserve
consideration, separately, for a therapeutic indication.
Hahnemann said that a disease would be known when we took into
consideration the totality of symptoms, considered in themselves, that
is to say, in their nature, then in their type, their location, and their
reciprocal relations. He said, moreover, that the relative value of
symptoms was received, first of all, from their relations with patho-
genetic symptoms presented by drugs.
In Allopathic pathology the symptoms are so much the more charac-
teristic and more important as they show the suffering of an organ
most important to life, that is, as they are more physiological, more
pathognomonic.
DIAGNOSIS.
203
In Homœopathy, those symptoms which indicate the organic lesion
are not of great importance as they give us to know, one side of the
disease only, not the entire disease and hence they can have but little
influence upon the selection of the drug to be used.
The diagnosis should be made, not to determine what place a given
disease should occupy in a nosological table but to know what drug we
should use to cure it.
To gain this point, it is not sufficient to consider one side of the
disease only, and to make the diagnosis from the seat or nature, as is
said now in the schools, nor the causal diagnosis, considering the
cause or causes producing the disease, nor the differential diagnosis,
to distinguish a disease from others with which it may be confounded,
nor the nominal diagnosis, to see if the disease is like one to which
nosologists have given a certain name, since all these kinds of diag-
nosis are made separately and give us to know but one side of the
disease and avail nothing as regards the cure, but all these diagnoses
must be united in one, that is, we must unite all the symptoms which
serve as a basis for this diagnosis, and compare them with the patho-
genetic symptoms of drugs, to see which of these drugs, given to a
man in good health, produces all those united symptoms, which the
given disease produces, since this is the remedy which experience has
shown, by many and repeated tests, to be the only one capable of
curing it.
If the diagnosis of Typhoid fever should be made so as to treat it
efficiently, it is necessary to examine the patient every day to see what
new symptoms appear, what have ceased to exist, and to compare the
disease with the pathogenesis of the drugs, and, by this comparison
especially, to search for the more individual symptoms of a given case,
which, in the schools are called accessory, and to select that remedy
which, while it presents these symptoms in the greatest number, does
not fail to correspond, with the greatest exactness, with all the others.
And this mode of making a diagnosis is more rational than that
which, being based upon the pathological name of the disease, goes
directly to those medicines which are reputed specific for the same; as
for specifics, for any disease, taken under its general pathological
name, there is no such thing, but there are specifics only for a given
individual case; and hence, remedies indicated in the repertories,
often prove inefficacious, and are of no benefit, because they do not
correspond to the individual symptoms of the disease and how ever
much writers of repertories strive to indicate, with the greatest pre-
204
A TREATISE ON TYPHOID FEVER.
cision, the corresponding drugs, we can never be sure that we have
the drug proper to the case in hand. Hence it is of the greatest
necessity to make the Homœopathic diagnosis, that is, to establish the
comparison between the given case of disease and the pathogenetic
symptoms of drugs, if we wish to prescribe with exactness and
readily to succeed in our object to cure our patient tuto, cito, et jucunde.
This being established, we see clearly, how useless and vain
is what Allopathists have written about the diagnosis of Typhoid
fever, that is to say, it is difficult to make the diagnosis at the begin-
ning, and it is prudent not to pronounce upon it in an absolute manner,
because, at the very beginning, we may confound it with eruptive
fever at the beginning of invasion; but we should be able to dis-
tinguish it readily by proper care, because in measles we have coryza
and bronchitis; in scarlatina, angina; in small-pox, lumbar, abdominal
and pectoral pains, while all these diseases fail to present the special
abdominal symptoms which are found in Typhoid fever. It might be
confounded with ephemeral fever, when this presents very intense
symptoms, but the nervous phenomena proper to Typhoid fever,
always fail, and twelve, twenty-four, or at the farthest, thirty
hours always suffice to remove every doubt.
In some cases it may resemble intermittent fever, and Louis cited
a case of this kind; in such a case we must wait a certain time
before pronouncing, and the characteristic symptoms of Typhoid
fever will not delay to present themselves, and every doubt will
vanish.
Enteritis and simple continued fever may be confounded with
Typhoid fever, but by observing the following Tables, the differ-
ence is manifest:
SYNOPTICAL DIAGNOSTIC TABLE.
DISTINCTIVE SYMPTOMS OF TYPHOID FEVER AND SIMPLE
ENTERITIS.
TYPHOID FEVER.
Moderate diarrhoea, of long dura-
tion.
Visceral pains not very intense,
continue a long time.
No tenesmus.
Meteorism.
Spleen tumefied, at times painful,
No appetite.
Tongue dry, brown, cracked.
ENTERITIS.
Diarrhoea generally violent, read-
ily yields to simple treatment.
Visceral pains intense; yield sud-
denly.
Tenesmus sometimes.
Meteorism very seldom, slight and
of short duration.
Spleen normal.
Appetite often retained.
Tongue sometimes whitish.
DIAGNOSIS.
205
The pharynx often presents les- Pharynx normal.
ions.
Constant headache.
Prostration, somnolence, mental
disturbances, noises in the ears,
spasms, epistaxis.
Rosy, lenticular spots, sudamina.
Febrile appearance, more or less
intense.
Duration more or less long.
Mortality always marked.
Headache rare and slight.
None of these symptoms.
(6
Febrile appearance none, or very
slight.
Duration very short, the treatment
being simple.
No mortality.
DISTINCTIVE SIGNS OF TYPHOID FEVER AND OF SIMPLE
CONTINUED FEVER.
TYPHOID FEVER.
SIMPLE CONTINUED FEVER.
Pulse, at an advanced period, Pulse full and regular.
small, feeble, sometimes inter-
mittent.
Heat often intense, burning, dis- |
tressing to the patient.
Tongue dry, brown, cracked.
Abdominal symptoms marked.
Chills early.
Beginning gradual.
Heat moderate, mild, not annoying
the patient.
Tongue only whitish.
These symptoms fail or are light.
No chills, or seldom and light.
Beginning sudden.
Convalescence more or less pro- No convalescence.
longed.
Practitioners also seek to distinguish Typhoid fever from a cer-
ebral affection, or meningeal, from remittent fever, from pseudo-contin-
uous, from typhus fever, purulent absorption, etc., etc., but to what
advantage for the curative treatment? We should not use, in
Typhoid fever, the treatment belonging to other diseases, whence
comes confusion. Wisely said; for how often have we seen a mode of
treatment applied to every one, and no variation made, according to
the different accompanying circumstances. In nature there are never
two diseases perfectly alike, as there are never two individuals resem-
bling each other, in all things; on this account Hahnemann teaches,
as has been already said, that diseases cannot be divided into classes,
orders and species, etc., because each disease is individual, and hence,
in making our diagnosis, we should not refer the disease to a given
class, or seek to show the difference between it and some other, but
we must compare the symptoms present with the symptoms of each
drug, since, I repeat it, the drug, which. given to a man in health, pro-
duces symptoms most like those of the disease, is the drug most fit to
cure it, experience having shown, from antiquity, the truth of the
principle, similia similibus curantur. Hence, the medical practitioner,
in individualizing the disease, should make use of impartiality, of
good sense, of attention in observation, and of fidelity in tracing its
206
A TREATISE ON TYPHOID FEVER.
course, if he wishes to obtain his object. And an instructed physician,
versed in anatomy, physiology, pathology, and the pathogenesis of
medicines, will succeed without any difficulty, provided he does not
lack the natural gift of observation, nor spirit to enable him to give
himself to his researches, with all desirable independence.
**
[A word here to the junior members of the profession. Our author
gives a meaning of his own to diagnosis, including in it all that the
physician needs to know about the disease and the remedy, but this, I
submit, is logically inaccurate. The diagnosis of the disease is simply
to find out "what's the matter." This is quite important, and some-
times rather difficult, but it is far from being the most important or
the most difficult, and farther still from being any basis of either
prognosis" or therapeutics, and still farther yet from being a "basis
for the science of medicine." An absolutely perfect knowledge of
any disease would not shed a ray of light upon the question, "What is
to be done for it?" Hence those practitioners who content them-
selves with merely establishing the diagnosis, are worse physicians
than Job's friends were. Disease is one thing-what will cure it,
another-how to apply this, a third. To determine the first is
diagnosis - the second we learn in materia medica, and the applica-
tion of the second to the first is therapeutics-the best physician is
the one who is best in all three, and if one of these three legs be short,
there will be a very poor basis for medical science, or anything else.]
-TRANS.
CHAPTER VII.
PROGNOSIS.
This is the name given to the judgment which the physician
gives, by way of anticipation, to the changes which are to take
place in the course of the disease. Thus, wishing to make the
prognosis of Typhoid fever, it does not suffice to say, that it wil
have a good or bad end, but we must determine, besides, the par-
ticular mode in which it must terminate, what shall be its dura-
tion, the secondary affections, as well as the accidents which may
complicate it, the phenomena which will soon cease, or which, on
the other hand, may continue, even after the disease has ended,
and finally, the danger of relapses and after fevers.
The venerable old man of Coos wrote: "The predictions of
life or death in acute diseases are always uncertain." This aphor-
ism all physicians have received as most true, and especially as
regards Typhoid fever; for, although many patients with this
fever recover, yet it is regarded as a dangerous disease. In its
first days, it has a mild character, but, during its course, symp-
toms arise which, unexpectedly, place the patient in danger; while
on the other hand, the patient may recover by the concurrence
of more favorable circumstances.
Every physician knows, that, among all the febrile affections, the
most grave are generally those which depend upon the introduc-
tion of a deleterious agent, by means of an infection, which
changes profoundly the fluids and solids of the economy; a grave
fever, from infection, is usually fatal, while an intense, legitimate
inflammation, terminates, most frequently, in the return of health.
Hence, to establish a just prognosis, it is necessary that the diag-
nosis should be clear and complete, considering all the morbid
elements as being, at the same time, the source of prognostic
1.idications. Hence, the physician must gain exact notions relative
to the causes, the symptoms, the invasion, the course, the dura-
208
A TREATISE ON TYPHOID FEVER.
tion, the morbid accidents which complicate it, the particular
conditions of the individual, the age, sex, constitution, his peculiar
circumstances, as well as the prominent symptoms which manifest
themselves with the progress of the disease. In fact, persons with
delicate constitution, of very irritable nervous system, and who
have the viscera in a bad state, are violently affected by it. But
we should not forget that, as to these latter, the Typhoid fever,
sometimes, is a happy event. Those who were lean often become
very fleshy. Another thing has been observed, too, that those who
have a dry constitntion, as it is commonly called, who live con-
tinently, and do not abuse fermented. liquors, endure this disease
better than others. But from the fifteenth to the fortieth year,
Typhoid fever is most destructive. Before this period, the prog-
nosis is less grave, as appears from the researches of Dr. Taupin,
Barthez and Rilliet, but here it mows down the flower of the human
race. Men are more seriously affected than women, except when
these latter are pregnant or parturient.
Some say that, in the beginning of the epidemic, more women
always die, and at the end, more men. The rich suffer more
from it than the poor, which may be owing, in part, to their better
knowledge of their danger, and in truth, the greater mortality of
the disease proceeds from the greater development of the intellect,
which, in the poor, under the pressure of disease, becomes a dor-
mant faculty, while in the rich and educated, it is a cause of fear,
of tribulations, of sad presentiments, and of other morbid affec-
tions, which add their own proper force to that of the disease, to
increase the tumult and perturbation of the body. And, if this is
true, physicians certainly are scourged by Typhoid fever more
severely than others. The inhabitants of great cities are more
violently attacked. Those, also, who sleep in large hospitals, who
are not yet accustomed to the climate, and who suffer misery of
any kind.
The particular character of the epidemic makes the danger,
accompanying Typhoid fever, greater or less. In fact, in some
epidemics, and in spite of all imaginable care, hardly one patient
in seven gets well; in others, with less care, hardly one in
twenty dies. But it has been wrongly taught that epidemics of this
disease are more mild as they are more wide-spread, since it results
from observation that Typhoid fever spreads itself, at first, fur-
tively, in the provinces, and constantly gains in intensity, and then
PROGNOSIS.
209
loses it again anew. Physicians very often, in the beginning of an
epidemic, are deceived in the character of the disease, by the falla-
cious appearance which it presents, and, finally, all have observed
that more cases recovered, who were attacked during the middle of an
epidemic, than at any other time, whatever might have been the
course of the epidemic. The epidemic course of Typhoid fever gener-
ally lasts from six to nine months, and the seasons do not increase
or diminish the danger, as it has been seen, that in all seasons there is
an analogous mortality, and that, in different countries, there has
been a difference as regards the greatest mortality, in different
seasons, and writers have recorded, on this point, that at one time
the disease has been worse in the winter and spring, at another
that the patients have been more seriously affected during the
great heat of summer, and now, again, during the autumn, more
than in other seasons; from which it seems that nothing in gen-
eral can be asserted on this point.
The regular course of Typhoid fever announces, very soon, its fav-
orable termination. A similar result is indicated by the disease being
free from complications. And when the disease begins without com-
plications, and we find none concentrated in any organ, its severity is
all the less, and the hope that it will have a favorable termination all
the greater. And, on the contrary, the gravity is greater and the
hope less, if it happens, from any cause, that the disease is com-
plicated and already concentrated in any organ. The complication
most to be feared is inflammation, and especially as regards the
organ affected. Finally, we do not speak of inflammation merely
as inflammation, but also of its results, amongst which, besides the
exudations, there is gangrene, which does not fail to appear in
inflamed organs, in the course of this disease. When the inflamma-
tion and its effects afflict a part less essential, the danger is less, but
there is, nevertheless, danger of metastases.
The symptoms have much to do in making the prognosis, because
the more severe they are, the more grave is the disease; but cases of
Typhoid fever present themselves with such a varying array of symp-
toms, as regards their gravity, that it is necessary to descend to par-
ticulars. Prof. Louis, having examined these symptoms separately,
in patients who died, and in those who got well, has not omitted any-
thing which those who come after him could add in this regard, and
hence, we must refer to his conclusions.
An abundant and persistent diarrhoea, and involuntary evacuations,
210
A TREATISE ON TYPHOID FEVER.
announce a great severity in the disease. Intestinal hæmorrhages
also offer peculiar danger. Excessive meteorism is a dangerous
symptom. The same may be said of difficulty of swallowing, of som-
nolence and delirium, manifesting themselves soon after the onset
of the disease, of a certain perversion of intellect, which leads
patients to say that they are doing well, of spasms, and above all,
of permanent contractions of the limbs. Extreme prostration, the
appearance of erysipelas, eschars upon the skin, are also of evil
augury.
Among the symptoms just named, none is more grave than spasms
and contractions, but these do not necessarily announce a fatal end,
and on the other hand, individuals have been seen, who have not
presented these latter symptoms, nor the others except in a slight
degree, and yet, who died at the end of a period longer or shorter.
And this has given all, who have studied Typhoid fever, reason to
say that there is no disease in whose prognosis we should be more
reserved than in this.
When the pulse becomes thread-like, very frequent, feeble; when
it is intermittent and unequal, when the prostration is extreme, the
somnolence continued, and the intelligence abolished, death is immi-
nent.
The symptoms of pneumonia, or pleurisy, persisting till the nervous
stage, the permanent cough, the reddish expectoration, are bad
symptoms.
Symptoms, most of all fatal, are; blindness, involuntary tears,
severe hiccoughs, paralysis of the tongue, the continued low mutter-
ing, the total abandonment of himself, the gravity of the body like
lead, the petechiæ enduring a long time, the spasms of the urinary
bladder, violent intestinal inflammations, with great meteorism, the
continued gesticulations of the hand, as if to call some one or drive
him away, the projecting of the teeth by paralysis, or contractions of
the orbicular muscles of the mouth, the continued hiccough, etc., etc.
Convalescence, too, has its prognosis, and this also remains
uncertain, till every vestige of the disease has disappeared. The
relapses, properly so-called, are not to be feared, but we may
expect to see the disease return in the ears, or in the form of
headache, or nervous disorders, etc., and finally, after the disease
has disappeared, as long as there is yet tinnitus, or the least trouble
in the ears, the patient recovering from Typhoid fever can not
be said to be entirely well,
CHAPTER VIII.
TREATMENT OF TYPHOID FEVER.
The treatment of this disease should be divided into prophy-
lactic or preservative, and curative.
I. PROPHYLACTIC TREATMENT.
The prophylactic treatment is that which has for its object the
prevention of disease, and it is to be preferred to every other,
being the most useful and profitable, as those laws which prevent,
are of more advantage than those which punish crime.
II. PROPHYLACTIC REGULATIONS.
The basis of prophylaxis rests upon the early knowledge of the
presence of the disease. To obtain it, it is not only necessary
that the Chief Magistrate, watching over the public health, should
know what are the diseases which prevail at the time in the
provinces of his realm, but also, that all physicians are, all the
time, kept advised of the diseases which prevail, if not in distant
lands, at least in their own, or in the neighborhood of the place
where they live. It is truly shameful to meet physicians who have
no knowledge of diseases reigning in other countries, while every
merchant or banker is always well informed of the value of
exchange in the principal places. This should no longer be the
case, so that the appearance of an epidemic of contagious fever
would be hardly known, especially of Typhoid fever, in any place
whatever, and that we should in any event have, before our
eyes, the place where the danger takes its point of departure,
whence we may in the best possible manner, hinder the propaga-
tion of the contagion, and nip in the bud its first appearance, so as to
prevent its general diffusion.
But if, by reason of proximity, or from relations of any other
kind, the danger of infection should reach any individual, the san-
itary police should redouble its diligence to remove every cause
212
A TREATISE ON TYPHOID FEVER.
which might serve the occasion, or be auxilliary to the scourge,
and to use the precautions adapted to the degree of this danger,
without disquieting the citizens any more than is absolutely
necessary.
The local authorities should see to it that the food and
the drinks, which are on sale, for use by the population, should
be of the best possible kind, and not spoiled nor changed by
time; that the streets are cleanly, dry, and not encumbered with
dirt or other substances which multiply the product of putrid
decompositions: that the places of public meetings should be clean
and well ventilated, that the poor should be well clad, fed and
lodged, etc.
All possible precautions should be used to see that suspected
merchandise was, at least, exposed to the open air, and to expose
letters, even, coming from countries where the epidemic reigns, to
the usual precautionary measures.
If, after the manner of the English, we do not wish to construct,
in the large cities, hospitals expressly for contagious fevers, it is
necessary to secure for this fever, at least, a part of the general
hospital. The wards devoted to this purpose should be as much
as possible, exposed to the air and light, and spacious enough to
admit of a suitable interval between each bed. While the patients
are lying in one ward, it is necessary to purify another one, which
remains empty, and thus use them alternately, if not every week, a
least twice a month. The floors should be varnished so that they can
be easily washed with a moist sponge, not leaving any dampness.
Sand should not be scattered anywhere. The beds should be of
iron, simple and well cleaned. The linen should be changed often,
and if necessary, every day. The pillows should not be filled with
feathers, but hay,* so that that they may be burned when the patient
leaves. The straw, also, of the straw mattresses should be burned,
and that in the presence of the superior inspectors of the hospital.
The sheets and the coverlets should be placed at once, by the nurses
in portable barrels containing lye. They should not be washed till
after twenty-four hours. The laundress should take the clothes from
the barrel, in which they are brought, with a wooden stick, and put
them in lye. The urine and fæcal matter should be thrown into
sewers not used by other persons. The utensils of the ward, set
* NOTE.- Paper, cut fine, is better and cheaper.-TRANS.
TREATMENT OF TYPHOID FEVER.
213
apart for contagious fevers, should not be used by other patients,
except after having been many times washed in cold water.
The
same with the surgical instruments. The litters, which serve for the
patients affected with Typhoid fever, should not be employed for any
other use, at least, not till after having been exposed to the open air,
and washed and purified with the vapor of sulphur, or other disinfect-
ing fumigants.
Soldiers should not be allowed leave of absence immediately after
leaving the hospital. No stranger should be permitted access to the
wards devoted to contagious fevers, and communications between
the sick and well should be interdicted with the utmost rigor. In
the military hospitals, those prohibitions should be carried into effect
by bars and bolts rather than by soldiers, for fear that the soldiers,
who mount guard, might carry the contagion, which they had con-
tracted, to some part of the city. If, in certain cases, it becomes
absolutely necessary to permit ingress into the wards, it would be
proper to subject the person, before leaving, to a rigorous purification
and disinfection. The nurses should be selected, if possible, from
among those who have already had Typhoid fever, and they should
have no communication with other persons till they have been pre-
ventively purified and disinfected. Priests, physicians and surgeons
should not visit the sick while fasting, nor even when the body has
been exposed to a cold moisture. It is always better to drink a little
wine or brandy, or to have taken a little lunch, and also to make the
body less susceptible to the contagion by moderate warmth. One who
has not slept enough is much more susceptible to any contagion, than
he who has enjoyed plenty of restorative sleep.
When entering the fever ward, and standing by the bedside, it is
always well to blow the nose thoroughly, and to take care to spit out
the mucus. It is very likely that through these passages, the conta-
gion often insinuates itself. Hence, it is highly advisable, as a pre-
servative means, to hold under the nose, all the time, when in the
ward, strong odors of some kind, and to rinse the mouth. Tobacco
smoke, where propriety admits, has the same effect.
When we leave the bed of the patient, we should not neglect to
blow the nose, to gargle the mouth with water, to wash the face and
hands; then only it is permitted to take tobacco, and never during
the visit to the patient. Moreover, one should be careful not to stay
with the patients any longer than is absolutely necessary, and espe-
cially in the immediate atmosphere of the sick; above all, we should
214
A TREATISE ON TYPHOID FEVER.
avoid sitting on the bed, kissing the sick, or needlessly handling them
too much, or of staying too long among the dead.
All medical anti-
dotes, exciting and heating, are to be held as worthless; one should
live as usual, and it should be understood that those who are obliged
from a sense of duty, to maintain intimate relations with the sick, can
only do it at the peril of contagion. For myself, I consider hospital
fever as a tribute which such persons must pay. Let them present
themselves then, to these establishments, armed with the courage
which belongs to public functionaries, like intrepid soldiers who go to
storm a battery, and finally let them trust in God.
If we treat patients in their own houses, then each one should have
a room to himself, and another adjoining room for the one in charge;
there should be at least two nurses, and all communication with other
persons should be forbidden; every one, except the physician and
surgeon, should be denied access to the patient and nurses; means to
satisfy every want should not be lacking. Besides, a placard should
be put upon the house, showing that there is a patient within
attacked with the epidemic.
MEANS OF PURIFICATION.
The ancient physicians, who did not believe in contagion, and con-
sidered all epidemics as derived from infection, or from atmospheric
changes, had recourse to various means, out of use at present, but
perhaps more rational, notwithstanding their inefficacy, than the pre-
cautionary measures now admitted by the contagionists. Among
these means, which were directed against the general morbid cause,
one of the most used was fire; thus they kindled immense fires in the
localities infected, and sought to attack the disease in the beginning.
*
*
*
*
*
*
*
*
*
*
*
At the present day, all this sublime apparatus of pretended disin-
fectant means, has been renounced and we use only fumigation,
washing and ventilation.
The fumigations proposed by modern chemistry as disinfectants are
the following: The simple evaporation of muriatic acid, which
M. de Morveau proposes to accomplish in the following manner: On a
brazier of coals we put an iron pan containing ashes. In this pan we
put a glass or porcelain bell-shaped vessel. In this vessel, we put five
or six pounds of muriate of soda or, common salt, if it is somewhat
dry. Finally, we pour upon this about two pounds of sulphuric acid.
This acid attacking the soda at once, produces an immediate develop-
ment of muriatic acid gas or a whitish vapor which, diffusing itself
TREATMENT OF TYPHOID FEVER.
215
through all the infected parts, and meeting the contagious miasm,
decomposes and destroys it. These proportions are, for a large space,
like a hospital; for a smaller house, the quantity should be diminished
and every one using it can make it more or less, as it seems required
by the space to be fumigated.
Fourcroy rather recommends oxygenated muriatic acid gas to
obtain a more prompt efficacious and salutary effect. In a bell glass,
and apparatus, such as just described, put four ounces of the crystal-
lized oxide of manganese reduced to powder and a pound of muriate
of soda. Then pour upon this half a pound of concentrated sulphuric
acic, diluted with water, and you will have oxygenated muriatic acid
gas. When the sulphuric acid combines with the soda, the muriatic
acid is set free, and this, attracting the oxygen of the oxide of man-
ganese, is changed promptly into oxygenated muriatic acid gas, made
more active by the caloric.
Nitric acid gas is also an excellent remedy to purify infected places
and is highly commended by the illustrious Dr. Smith. Take a cer-
tain quantity of Nitrate of Potassa, put it in a vessel as above, pour
on it as much more sulphuric acid. This combines with the potassa,
nitric acid is given off in the form of gas and attacks the contagious
miasms. But, of these three purifying gases, the most efficacious and
most used is the oxygenated muriatic acid gas proposed by Fourcroy.
Others, by a process much more simple, disinfect with chlorine gas,
which they obtain by pouring any acid whatever upon Chloride of
Lime. The acid combines with the lime and the chlorine is set free
in form of gas, and destroys the contagious virus.
If we put a vessel on a brazier containing Nitrate of Potash and
Sulphur in equal parts, two gases will be formed, that is, nitrous acid
and sulphurous acid gas. These two gases are likewise purifiers, but,
as their base is not saturated with oxygen, they cannot compare with
the preceding gases. Therefore, I have said two gases, that is the
sulphurous and nitrous, and not the sulphuric and nitric.
Dr. Fodere does not lend much credit to these fumigants, because
we do not certainly know the nature of the contagious poison, besides,
the air has no need of purification, since the oxygen which it contains
suffices to destroy the contagious miasm. He does not altogether
reject the use of fumigants, at least, in the hands of experts, but adds
that the means most approved to cleanse walls and wooden furniture
and straw beds is boiling water in which they may all be washed.
The walls after having been washed should have a coat of whitewash
216
A TREATISE ON TYPHOID FEVER.
and the furniture should be rubbed with a sponge wet with vinegar.
But if one could succeed with the use of boiling water, upon the
small and low walls of a cottage, and, with the scanty furniture, how
could we quickly disinfect the large hospitals, churches, and large
apartments of a whole city and an infinitude of furniture of different
materials. It is much better then to use the fumigants, which are
more easy of application, while they are admitted by everybody to be
efficacious.
After fumigating, the ward should remain closed for some hours,
then all the apertures should be thrown open, so that a current of
fresh air may enter to dissipate the remains of the purifying gas, and,
after being open three days, they may be used without danger and
will be found perfectly purified.
III. HYGIENIC PRESERVATIVES.
The most certain and infallible preventive known, even to the
ancients, which never fails to produce a good effect, consists, not in
fumigations, washing, ventilations, etc., but in a simple resource and
that is, to get away from the infected place. It is necessary, however,
that this should be done in time and with the necessary precautions, so
that one should not carry the contagion with him and thus bring ruin
to others as has so often been done. This salutary counsel is con-
tained in the following distich :
Haec tria tabificam tollunt adverbia pestem;
Mox, longe, tarde, cede, recede, redi,
that is to say, Fly early, stay away a long while, and return slowly.
But, fortunately, it is not necessary for one to go very far, nor leave
his own dwelling, when an epidemic of Typhoid fever reigns; it is
sufficient, m rely, to isolate the patients and not approach their dwell-
ings, since the contagion of this fever is not very diffusible, slowly
propagated, easily restrained, for, by using proper isolation it is easy
to keep it where it originated and to strangle it there. But all can not
to
use this means, as many are constrained, by their occupations,
enter the dwellings of patients and approach their bed such as physi-
cians, surgeons, priests, who, in the time of danger, can not forsake
their posts without opprobrium; such also are notaries, public admin-
istrators, nurses, etc., etc. Those who wish to avoid the contagion or
suffer as little from it as possible should observe the following hygienic
precepts.
Live in spacious apartments open to the light and air; exercise in
the open air, in elevated places, but never to weariness; wear such
clothing as will protect against the dampness of the atmosphere and
TREATMENT OF TYPHOID FEVER.
217
the variations of temperature; keep the person scrupulously clean;
use soap or alkaline baths which cleanse the skin without weakening
the body; use succulent food and such as is restorative and easy of
digestion; drink good and pure wine, if you have been in the habit of
it; avoid every change of regimen which might be fatal; sleep suffi-
ciently; treat every rising indisposition upon its first appearance;
avoid every circumstance which might excite sadness, violent pas-
sions, anger, fear, disgust, terror, anguish, prolonged reflections, the
fear of being infected; keep in a happy mood and enjoy, in a word,
as much as is possible, tranquility of mind and calmness of spirit.
IV.
THERAPEUTIC PREVENTIVES.
Many remedies are recorded in medical works as capable of pre-
venting Typhoid fever, but, Homœopathic physicians, with all due
respect to the opinions of their colleagues, affirm that, as we never
can have general specifics for the treatment of a given disease, so we
can never have absolute preventives, which can preserve from contagion
every person who uses them.
Preventives, if, indeed, there are any, should be found among the
remedies most efficacious against the disease; but, as each individual,
when taken with a disease, will never present one particular form,
requiring this remedy, rather than that, so each individual should
have his own particular preventive, and this preventive should always
be the drug, which, if this person were taken with the disease, would
correspond most exactly with the particular form presented by the
individual symptoms. And, inasmuch as we cannot foretell what
would be the form of the affection which any one would present, on
being taken sick, so it is absolutely impossible to determine, before-
hand, which of the various pretended specifics would be the most
efficacious for him. And hence there is nothing more irrational and
nonsensical, if the expression may be allowed, than to make all persons
take, no matter what highly praised preventive, when they are in per-
fect health and present no positive indications for this remedy, rather
than for any other. All that is, many a time, attained by this mode
of action, is, by the abuse of preventives, to make those sick who
were really well, and to fail in preventing disease in those for whom
quite another preventive should have been used. Many times,
deplorable effects have been observed in consequence of these
wished-for preventives, given, without any positive indications of
their propriety, to persons in perfect health and continued for a long
time, and such persons are often seen, after using these pretended
D 13
218
A TREATISE ON TYPHOID FEVER.
universal preventives, taken with disease and have suffered in a
severer form than others and some indeed have died. Therefore, with
many learned and experienced physicians, I think that the most
rational thing, by way of preventives is, not to give medicines to all
persons in health, but rather to administer to each slight indisposition
which might arise, during the contagious epidemic, the drug most
fully corresponding with the characteristic symptoms of this indispo-
sition. If this drug is found amongst the so-called specifics against
this epidemic, all the better, if not, recourse must be had to some
other which may be in perfect rapport with the given indisposition.
Acting in this way, each physician would always be right in his own
practice and would really preserve his patients from the prevailing
epidemic.*
CURATIVE TREATMENT.
The most complete division reigns among Allopathists regarding
the treatment of this disease, although, in late years, the most
animated discussions have been held in regard to it; and numerous
medications have been zealously advanced and numerous facts have
been quoted, analyzed and interpreted in favor of the most diverse
views.
Among physicians, some have recourse to the antiphlogistic method
(general and local bleeding, cupping upon the abdomen, cooling
drinks, emollient clysters, poultices, baths, etc.,) others have pre-
scribed the purgative method (saline and oily purgatives administered
daily in every stage of the disease); others have recourse to the anti-
putrid, antiseptic treatment (Quinine, Camphor, Musk, aromatic plants,
wine, alcohol, etc.) Some praise the abortive method (Mercury inter-
nally and externally); while others extol the contra-stimulant; and
certain practitioners, refusing to acknowledge any system exclusively,
combine them in different ways. Thus they employ, in an inflamma-
tory form, blood-letting; in a bilious form, a purgative or an emeto-
cathartic; against adynamy, tonics; against ataxia, Opium and
revulsives.
To show the confusion which reigns in the views offered by authors,
*NOTE.- Perhaps a word may be allowed regarding the danger of contagion or
infection. What it may be in the hospitals of Europe or in the dense population
of many of their cities, I have no personal knowledge, but I have seen something
of Typhoid fever in Chicago, during the last thirty years, and do not hesitate to
say that the precautions recommended by our author, would be needless if not
injurious here, as tending to excite alarm and to encourage needless anxiety. The
superabundant ventilation, enjoyed by the dwellers on our Western prairies,
furnishes the best prevention of any wide-spread epidemic of this fever.-TRANS.
TREATMENT OF TYPHOID FEVER.
219
upon these various methods, it will suffice to mention that which is
laid down relative to the antiphlogistic.
"Let us examine," says M. Tardieu, "the different methods
employed in this disease; there is but a single one of them, which,
employed in the first period, following a precise formula, can certainly
modify the course of the disease, prevent the development of severe
ataxic or adynamic accident, make less rare the fuliginosity of the
mouth, the eschars, and even the eruption of the characteristic spots,
and, by necessary consequence, shorten the duration of the disease or
lessen its mortality, and that is the repeated and sufficient blood-let-
ting, such as is at present used by Prof. Bouillaud."
M. Valleix after having analyzed the facts relative to the antiphlo-
gistic method concludes as follows:
"It results, from what has just been said, that there is nothing to
prove the great efficacy, which some attribute to blood-letting, and
that a moderate bleeding has only a slight effect."
Some physicians, and especially M. Delaroque, have gone still
further and have affirmed that bleeding always produces a bad effect
in Typhoid fever.
Practitioners are not only at variance about the therapeutic method
which deserves the preference in Typhoid fever, but, even those who
adopt the same method are far from agreeing as to the agents which
should be employed. Thus, amongst the physicians who have adopted
the purgative method, some prefer Castor oil and Siedlitz powders,
while others, on the contrary, use Calomel. Prof. Grisolle, after
having mentioned the facts reported by partisans of Calomel, adds :
I am not of this opinion, because Calomel does not seem to me to
possess any specific virtue; it only acts as a purgative, and, in this
regard, it seems to me inferior to Castor oil and the neutral salts; it is
a purgative the most inconstant and the most faithless, of all others.
Its repeated use can not be other than injurious. Taufflieb himself
says, that, in the adynamic form, mercurials may be dangerous and it
is to be feared that they sometimes produced gangrene of the mouth."
We have spoken of the divisions which exist regarding the Typhoid
fever of adults and the same may be said touching that of children.
“We see,” says Monneret and Fleury," that the same disagreement
exists relative to the therapeutics of Typhoid fever of children as
regards that of adults."
"In view of the disorder prevailing among authors regarding a
disease, moreover, against which therapeutics has so little effect, that
we may say with good reason that it is the opprobrium of the art, a
great number of physicians depend upon expectancy, confessing their
impotence in the treatment of this disease.
"Laennec said that Typhoid fever was a disease against which art
220
A TREATISE ON TYPHOID FEVER.
offers the least resources, and where nature, the most displays its power.
It is certain that medicine does not possess any means, upon the
efficacy of which, we can depend in this formidable affection; neither
bleeding, nor tonics, nor revulsives, modify the course of this fever,
very much; it always pursues its own course, whatever is done.
"There is yet another circumstance, where expectation is proper,
and that is when the disease, though dangerous, has a fixed course,
which the physician can not arrest, in Typhoid fever, for example,
and variola, where nothing avails against the essence of the disease,
nothing can prevent Peyer's patches from tumefying or from observing
certain periods for ulceration and others for cicatrization. These are
the necessary states, which no therapeutics actually known, is capable
of remedying.
The number of ancient and modern physicians who have declared
in favor of expectation, according to Monneret and Fleury, is very
considerable," and after having quoted Sydenham, Baglivi and
Bordeau, they add : Laennec was convinced of the impotence of art
and of the admirable resources which the organism could oppose to
the progress of the disease. Cruveilhier professed the same doctrine.
Andral, after having tried every method of treatment, which has
been extolled, one after the other, has ended by submitting his patients
to a careful and wise expectation. He confines himself to the use of
diluents, till some special indications present themselves.
"To leave the disease to nature, with the expectant method chiefly,
because it may tend spontaneously to the resolution of the disease, is
not the same thing as to determine, by our drugs, a reaction entirely
artificial, which, though sometimes useful, is often also without any
profit or hurtful.”
One may gain an idea of the impotence of Allopathy against
Typhoid fever, by seeing how insufficient are the means, at its
disposal, against the ataxic symptoms, which represent a great part of
this affection.
66
Ataxy," says Tardieu, "requires revulsives; the coldness, anti-
spasmodics, which, however, have only a doubtful efficacy."
"We have very rarely," says Grisolle," obtained, in this case, some
advantageous results from Camphor in injections, and from Musk in
solution; at the same time, we give these remedies rather to quiet our
consciences than with the hope of modifying the cerebral accidents."
As regards revulsives, we must observe that blisters, although
recommended by a great number of authors, and used in practice,
may produce the most serious accidents.
It results," says Valleix," from the observations of Louis that,
without having any favorable action, blisters tend to produce eschars.”
In the medical dictionary we read of gangrenous ulcerations even,
being produced by blisters.
We must do justice to the progress of surgery, but we can not fail
TREATMENT OF TYPHOID FEVER.
221
to see that surgical means are too much used in Allopathy and there
are very many affections in which patients are tortured without being
cured, in which Homœopathy obtains a cure without violence and
without pain. The Allopathists, themselves, confess that they abuse
surgical means too much. In support of this assertion, I quote the
following passage taken from a paper of Dr. Bouvier, a physician of a
hospital for children, and member of the Academy of Medicine.
"I have been struck by one circumstance pitiful for the art and
especially for children; it is the abuse which is generally made of
cauterization in the treatment of affections of the osseous system.
The moxa, the calci-potassic cauteries, the use of concentrated min-
eral acids, the red-hot iron ploughing up the back, every day, or the
hips, or knees of those unhappily affected with spinal disease or cox-
algia or white swelling, the large deep wounds of horrid ulcers which
mutilate these parts of the body, leaving behind them, if the patient
can survive, both the disease and the treatment, deforming scars,
indelible signs of a barbarity which belong to other times. "It is the
part of the executioner," says Ambrose Pare, in his apology for the
ligature of the vessel, against Gourmelen, who defended the actual
cautery, "it is truly the part of the executioner to burn everything
with one blow, without using more mild measures." This is what is
done in the cases to which I have called attention, but the masters have
said it and the multitude follow routine blindly. Two very distinguished
surgeons, Malgaigne and Chassaignac, have already demonstrated the
defect of this method, in white swellings in particular, but the treat-
ment is none the less persisted in."
I should say, that, with this exposition of the Allopathic method,
used for the cure of Typhoid fever, I have not intended nor do I intend
to censure the labors of so many very respectable and learned practi-
tioners of this city and so many others, knowing full well their
immense love for medical science and their sincere labors made for its
perfection. I trust, however, that they will some day undertake the
serious examination of the principle established by Hahnemann for
the cure of diseases, by which, with their knowledge and their subse-
quent investigations, they could 'much more perfect and propagate it,
so that, following their example, it should be generally adopted, and
thus, all following a principle generally sanctioned, these manifold
medical differences would terminate, much to the benefit and advan-
tage of suffering humanity.
To whatever medical system, then, one belongs, it is always certain
that the true exercise of the medical art lies in finding a curative
method in such a manner as to obtain the greatest possible advantage
over the disease, and every good physician, if he wishes to succeed in
222
A TREATISE ON TYPHOID FEVER.
his purpose to find such a curative method, should make for himself a
representative index of all the hygienic, therapeutic, and surgical
means which may be had, not only so that no omission could occur by
reason of lack of care, but rather, that, after having concluded what
and how much it was necessary to use from all these means, to be
able, in prescribing, to make it correspond well with the disease, and,
as a general thing, to cure it.
I. HYGIENIC MEANS.
First of all the patient should lie down, where circumstances allow,
in a spacious chamber, and we should see that the order to renovate the
air, regularly, every day, is rigorously obeyed, whether by opening the
window or by means of ventilators, so that he may have plenty and
pure air, not vitiated by his own exhalations, or those of others;
otherwise, the patient had better be in a barn or some other place half
closed, except, of course, in the colder seasons of the year. Fresh
and pure air is an essential necessity for Typhoid fever patients and
they are not chilled so easily as the common people think. The tem-
perature of the room should be regulated by a thermometer and it
should be constantly kept where it is possible at from 53° to 57°, not
rising above this last figure, and every species of fumigation should be
forbidden. The walls of the room should not be painted in such a
manner as to excite delirium in an exalted imagination. When the
imagination of the patient is tormented by itself, on account of the
darkness which prevents his seeing objects about him, it is well to
make the room lighter, without, however, allowing the rays of the sun
to reach the bed.
If it is not possible to obtain for the patient a bed large enough, so
that he can move in any direction, let him have two beds, in one of
which he can pass the first part of the day, and, in the other, the
latter, which will afford him great relief. The linen ought to be
changed often; it should be fine and well laid, so as not to leave any
wrinkles, which may produce sores. The cover should not be too
heavy, while curtains are injurious on account of the obstacle which
they present to the indispensable renewal of the air. Urinals, adapted
to the form of the genitalia, should save the patient the trouble of
rising from the bed to urinate; the same may be said of the vessels
passed under the patient to receive the alvine discharges. It is desir-
able to remove excrements of every kind, at once, and all possible
cleanliness should be observed. Both the body and the bed-linen
should be changed as often as the patient sweats. We should not fail
TREATMENT OF TYPHOID FEVER.
223
to call the attention of the nurses, frequently, to the necessity of
seeing that the body of the patient should be kept scrupulously clean,
during the whole course of the disease. These measures are not
superfluous, even for the cleanliest persons, for some are often gov-
erned by prejudice or they fear to injure the patient by uncovering
him or from modesty they may fail to examine, attentively, the region
of the anus and the genital organs to remove from them any adherent
excrements. It often happens that we can not remedy the injury
arising from neglect in such matters. The most insignificant and
inconsiderable erythema of the nates which, at first, might have been
readily cured, in the latter part of the disease, may be the cause of
serious danger to the patient, being the beginning of an extensive
decubitus.
The same cleanliness should be observed in all other parts of the
body. Thus, when the patient becomes so weak that he is no longer
able to cleanse his mouth himself, it is necessary to wash it carefully
with a bit of fine cloth, wet with cold water. It is especially neces-
sary to remove the viscous collections which cover the teeth and gums
before they have become dry and decomposed. Even patients quite
stupefied, generally give tokens of pleasure and gratitude after this
service.
When the tongue and lips are dry and cracked, the teeth black, the
patients are very anxious to cool them. Clear spring water, cool and
pure is by unanimous consent, considered the best of all drinks.
Nowhere is it more proper, than in Typhoid fever, that the patient
should drink abundantly, but, on the contrary, he is apt to drink but
little, either on account of difficult deglutition, or because he asks for
but little, and the nurses have become discouraged, whereas they
should always recommend and insist upon it. Nothing is more cruel
than to leave these patients suffering with thirst. Asclepiades did
not permit, in the first three days of the fever, that the patients should
cool their mouths. The ancients did not generally allow it when the
weather was damp and the patient was sweating. When, afterwards,
they acknowledged the precept, Aut bibere, aut mori,* they tormented
the patient, forcing him to drink much, with the intent of dissolving
the humors and facilitating critical evacuations. Neither system
deserves the preference. Moderation is always necessary in every-
thing. Est modus in rebus, sunt certi denique fines. Thus, the drinks
* NOTE.-Drink or die.
224
A TREATISE ON TYPHOID FEVER.
should be moderate and not too cold; cold things produce, or, generally
increase, the cough; on the other hand, hot things do not sufficiently
revive the patient. A middle way is hence desirable. Water should
be given often, so as to keep the mouth and the tongue of the patient
always moist, as well as to repair the enormous loss of serum resulting
from the evaporation and the diarrhoea. If, in the later stages, the
patient does not ask for drink, being so stupefied that he does not
realize his need of it, it is necessary to put the water to his lips. Nurses,
not well informed, or, with too little conscience, often sin in this
regard.
Though nothing is more refreshing than cool and limpid water, yet
sometimes we may add a little raspberry syrup, or cherry, or mulberry
to render it more agreeable and uniform to the wishes of the patient.
Very seldom, in this disease, is it proper to acidulate the water with
citron, with lemon or vinegar for fear of paralyzing the effect of the
remedies. If the disease is tedious the patients soon become dis-
gusted with one drink, and it is prudent to change it often. One can
make a most pleasant beverage, varied according to the taste of the
patient, with small apples cut and boiled, orangeade made of sweet
oranges, the juice of the ripe grape recently pressed out, a decoction
of cherries and dried prunes, simple panada, milk of almonds, milk
and water, etc. If the diarrhoea is profuse, a mucilage of oatmeal or
barley is to be preferred. In the beginning of the third week, or,
towards the end of the second, when the patient begins to feel weak,
we may allow, every day, a small quantity of light wine. The fear
that the administration of alcoholic drinks may increase the fever, is
unfounded and it will be well not to wait for extreme exhaustion
before allowing a little wine. In all time, physicians, of extensive
practice, have recommended the use of wine in adynamic fevers and
chiefly in the following circumstances; extreme debility, lack of
moral energy, sadness, a sound of sad voices, softness and diffluence
of the pulse, abundant viscous sweats; coldness of the skin and,
finally, a desire for wine. It is injurious, on the other hand, when
the pulse beats violently, the face is inflamed, the heat of the skin
is excessive and, in case of violent hæmorrhage. Even when wine
is indicated it should be given with consideration of the habits and
the faculties of the patient. To those who are abstemious it is neces-
sary to administer it with much circumspection and, to topers, it may
be given even when there seems no necessity, considering only their
habits, which, as is said, are a second nature. The best wines in
TREATMENT OF TYPHOID FEVER.
225
Typhoid fever are those of Champagne, of the Rhine, of Moselle,
of Franconia, of Austria, in fine, those which contain a great deal
of carbonic acid or are of a nature slightly acid-these latter may
be diluted with water to which a little sugar may be added. When
wine is taken to restore the strength, those of Burgundy or Bor-
deaux deserve a special preference. The wines of Portugal, Spain,
Cyprus are seldom suitable, at least, unless the patients are old,
and it is always necessary to dilute them accurately with water and to
reserve them for the period of convalescence. Coffee has almost
always seemed injurious; the same may be said of tea, and hence it
is better to forbid them altogether, as well as aromatic decoctions and
all medicinal sudorific or diuretic substances.
As regards the question whether any nourishment ought to be
offered to the patient, and of what nature, or whether he should be
condemned to an absolute diet, the opinions of different physicians
differ very much.
The disciples of the doctrine of putridity prefer vegetable food,
because they say it is antiseptic. The followers of the asthenic
doctrine advise animal food because it is more reparative. Most
physicians wish their patients to observe a severe regimen and the
more severe, the greater the danger. A goodly number of German
and French practitioners consider the use of broth, of flesh, of eggs,
and of other nutritious substances in febrile diseases, in general, as
injurious, and for them the words fever diet and water soup are iden-
tical. Drs. Legroux and Barth say that food should not be given to
the patient till about the eighth day. Others, like Trousseau, Aran
and Behier think it necessary to nourish Typhoid fever patients from
the first. English physicians, therefore, especially reproach the
German, because their dietetic prescriptions take from Typhoid
fever patients those aliments which are essential to repair the loss of
the elements of the organism, and that therefore the mortality in
Germany is greater than in England, because the Germans, so to
speak, leave their Typhoid fever patients to die of hunger.
Medical observations and physiological experiments agree exactly
in establishing the impropriety of a rigorous diet, in fever of long
duration. In fact, Chossat has observed that a complete abstinence,
for twenty-four hours, makes the body lose 42-1000 of its original
weight. Now, in Typhoid fever, we see a considerable loss of flesh
taking place rapidly, and it, sometimes, reaches the last degree of
emaciation. It is not likely that death, when it happens, results less
226
A TREATISE ON TYPHOID FEVER.
from the progress of the disease itself than from the loss of that
without which life is impossible.
There is no doubt that, in every fever, the consumption of the
organic elements is notably increased and that no physical fatigue
consumes the body like fever. While corporeal fatigues are, for the
most part, borne with impunity, because the gain by the introduction
of food repairs the loss incurred, most fever patients die, at last,
because the increased waste is not made up by an increase of nutri-
tious material. Speaking more especially of Typhoid fever, we see
that, in this disease, the temperature of the body is increased for more
than a week and, correspondingly with this, it is thought that the
production of urea is considerable augmented; in the most favorable
cases we see the patients much debilitated; they often lose ten or
twenty pounds of their usual weight, and regain it very slowly and we
must grant that these considerations are not calculated to encourage
the use of water soup, but invite rather to the use of flesh, milk, and
eggs, as long as it is found that such a diet does not increase the
fever. On the other hand, however, it is very clear that patients can
derive no advantage from the introduction of these aliments, if they
are not assimilated; it is rather injurious, if we vainly fill the
stomach with food which can not be digested, but which will decom-
pose, and, in this manner, will irritate also the gastric mucous mem-
brane. Dyspepsia constantly accompanies all the morbid states
which follow this fever. If, in prescribing the diet for a Typhoid
fever patient this fact is kept in view, and, if we conclude that the
stomach has produced a quantity of gastric juice sufficient to digest a
great quantity of protean substances, we should certainly not bring
relief to the debilitated powers of the patient, but would rather pro-
voke a morbid complication which would yet more increase the danger
to life. Hence, from what has been said, this precept may be deduced,
and it has, at the same time, the warrant of practical experience, to
give to patients, who are continually losing their strength, from
Typhoid fever, a suitable diet.
I say, a suitable diet, for, if the absolute diet arose from the rule of
those deplorable doctrines, which prevailed in the beginning of this
century, if an abstinence, too far pressed, has its grave incon-
veniences, we should not fall into an opposite excess and imitate
those who, not knowing how to keep from extravagance, do not fear
to give solid food in the very first days of the fever. There is a great
difference between the broths, and the light soups and the tenuis victus,
TREATMENT OF TYPHOID FEVER.
227
as Hipprocrates called his famous barley broth, of which I assert the
indispensable utility, and the pounded meat which certain physicians
make their unhappy patients swallow.
"The suitable medication is the suitable giving of food," said
Celsus.. "In aliments are remedies," repeated Aretæus. This idea is
as old as medicine. From Hippocrates, who has devoted, as is well
known, a special book to this subject, to the present day, the great
physicians of times past have not ceased to insist upon the importance
of a regimen which they have considered as the most powerful and
active means of the healing art. "With the help of a well regulated
diet, and given from the beginning of the disease, I have seen," says
Mortone," fever cured by the mere powers of nature, without there
having been any need of the pompous arsenal of pharmacy, and, on
the contrary, I have seen, with profuse and repeated bleedings, with
emetics and cathartics, improperly administered, this disease, mild at
first, degenerating into a malignant form." Hence it is necessary,
when the patients do not oppose it, from the beginning of the disease,
to give the patients several times every day, a small quantity of milk
and beef-tea. The more the disease is protracted, the more, the
exhaustion of the patient increases, at the same time, the more
unwearied must be our endeavors, from time to time, to introduce
nutritive aliments, but in small quantities and always in liquid form,
such as beef-tea without fat, now simple, now mixed with rice or the
yolk of an egg. though none of these should be too rich.
"In a disease like fever," says the illustrious Dr. Graves, of Dub-
lin, "which may last fourteen days, twenty or twenty-one or more, the
question of diet is one of the greatest importance, and I am convinced
that, on this point, great errors are committed. I am convinced that
the system of inanition was often carried to a dangerous excess and
that a prolonged abstinence, in many cases, was the cause of the
death of patients affected with the fever. Let us study the results of
too long abstinence in a person perfectly healthy. Hunger appears
suddenly to cease very soon and to return, perhaps, from time to time.
After two or three days, this sensation assumes a morbid character,
and, instead of being a simple sense of emptiness, becomes an inordi-
nate want, accompanied by burning pains in the stomach, burning
thirst, and, after awhile, gastralgia, fever and delirium. Here then,
we have the results of inanition, a true gastric disease and a cerebral
irritation.
Read the account of the shipwreck of the Medusa and the Alcestes
and you will be shocked at the terrible effects of inanition. You will
see that the greater part of the victims of that catastrophe became
real maniacs and presented symptoms of a cerebral inflammation.
66
'Now, a patient suffering at the same time from fever and from
prolonged abstinence, whose sensibility has become dulled and whose
functions are profoundly disturbed, who, moreover, has perhaps
stupor and delirium, will not demand food even though he needs it;
and, if you do not constrain him to take food as a remedy, you will
228
A TREATISE ON TYPHOID FEVER.
see, supervening, the symptoms which inanition produces in a healthy
person, and you will have a gastric or cerebral inflammation as conse-
quence of being deprived of food. You will think, perhaps, that the
patient does not need food because he is without appetite and does not
ask for it. You will see the same person allow the urine to accumu-
late in the bladder of the patient, because he does not feel the need of
expelling it. Your duty is to interfere when the sensibility is changed
and when the sensation of need is benumbed, and you should not per-
mit the patient to run the risks of the terrible consequences of inani-
tion because he does not ask for food. I never pursue such a course.
After three or four days of fever, I always prescribe a light diet and
continue its use through the whole course of the disease.
"See how the symptoms of inanition, pushed to extremes, resemble
those of Typhoid fever! Pain in the stomach, epigastric sensibility,
thirst, vomiting, cerebral congestions, injection of the conjunctiva,
headache, insomnia, and finally, furious delirium; such are the phe-
nomena which follow a too prolonged abstinence. Add to all these,
the tendency to putrefaction of the tissues, manifested especially by
spontaneous gangrene of the lungs. Guislain, Physician of the
Insane Hospital, at Gand, has seen, in many cases, what confirmed
the existence of gangrene of the lungs, in the insane who died of hun-
ger. In thirteen patients who died in this manner, nine had pulmon-
ary gangrene. Is it not, perhaps, reasonable to suppose that analogous
accidents were observed in patients, who, in the course of a fever, had
been subjected to a too rigorous diet?"
Nothing better can be added to this teaching, so true, of Graves,
than what he said to his pupils, "If you are at a loss for an epitaph for
my tomb, here is one, 'He fed fevers." "
It is necessary, then, to feed patients with Typhoid fever; it is
necessary to attend to the state of their strength, so as to put them in
a condition to resist the fever which devours them; according to their
degree of weakness, and according to the presumed length of the dis-
ease, it is necessary for them to eat more or less, but always food in
small quantities and in a liquid form. The age, the sex, the tempera-
ment, and the habits of the subjects, should moreover be taken into
consideration. Children support abstinence with difficulty; being
obliged not only to repair their loss, but also to grow; and their diges-
tive organs, being full of activity, an absolute diet is for them insup-
portable. Old people, although they bear fasting much better, yet
need proper nourishment. Women are endued with less gastric activ-
ity than men; taking less exercise, and experiencing less loss, they
also feel the less need of nourishment; perhaps they may be considered
as more capable of sustaining abstinence. The same observations
should be made as regards temperament, idiosyncrasies, habits, etc.,
but I omit them for the sake of brevity.
TREATMENT OF TYPHOID Fever.
229
•
and
If, in the course of the fever, a regular nutrition is necessary,
we must gradually pass to a more substantial one, as the fever
declines, we must be none the less careful not to allow solid food;
and indeed, much more attention should be given to the food in con-
valescence, and it is indispensable to resist the desires of the patient,
whose appetite is then generally much increased.
Having taken care to sustain the strength during the whole course
of the disease, be it longer or shorter, we shall not have the hurtful
effects of abstinence and inanition to fear, and can more easily place
our patients beyond the reach of accidents which might be feared,
even at the moment when they thought that they were cured. At
this point, we must avoid indigestions above all things, which, if they
do not induce serious gastro-intestinal disturbances, and in some
cases, fatal peritonitis, may produce relapses; or at least, retard the
return of health. Hence, it is necessary, during convalescence, to
watch the diet of the patients, with the greatest possible circumspec-
tion, to prevent his committing any errors. The number of patients
who die in convalescence from Typhoid fever, because nothing was
said to them about what, or how much, they might eat, from lack
of care on the part of their physician, or from their own fault, not
having followed his directions, is very considerable. At the patient's
meals, which it is better to repeat often, we must allow but a very
small portion of food at each time, so that the small quantity of
gastric juice secreted by the stomach of the convalescent, may
suffice for its complete digestion. All food difficult of digestion,
which leaves much residuum, should be rigorously prohibited. An
indigestion, in itself considered, inconsiderable, a diarrhoea, mod-
erate even, a slight vomiting, etc., should always be held as dan-
gerous accidents, because they may induce the perforation of an
ulcer not yet cicatrized, and produce an unexpected death, just
when the disease seemed to be overcome.
We often have to meet the prejudice, especially in the lower
classes, that the bodies of patients should not be washed, and,
since cleanliness is indispensable, they ask a thousand questions
about whether the water used should be cold or hot.
In many
countries, the opinion is held that cold bathing is always benefi-
cial, and promotes, in the sick, a salutary reaction. With us, it is
very general, even among the lower classes, to combat the extreme
and distressing heat of Typhoid fever by bathing the whole body
with cold water alone, as this vivifies and soothes the nervous sys-
;
230
A TREATISE ON TYPHOID FEVER.
tem, favors reaction, renders the economy more sensitive to the
action of Homœopathic remedies, provokes a crisis by the urine,
and, above all, by perspiration, and adds powerfully to the action
of remedies administered to this end. It often happens, that,
towards the end of the second stage, the best indicated drugs do
not produce any favorable change, and even produce unpleasant
aggravations, and then we obtain, by the internal and external
use of cold water, critical salutary movements, and, under its influ-
ence, the medicinal aggravation gives place to curative effects.
•
Cold water has been used from the remotest times. It was fre-
quently used, externally, in Typhoid fever, by Hahn and Theden;
but G. Wright and J. Curie especially advocated it, and their
example was followed by Gregory, Hall, Giannini, Jackson, Fro-
lich, Rueg, Frank, and others, with great relief to their patients.
The aspersions and washings should be repeated every two or
three hours, until we have obtained, at least, a diminution of the
burning heat of the skin. Often, after the first or second washing
or aspersion, a slight sweat supervenes; then it is proper to cease.
It is necessary to say, that the washings should be repeated, many
times during the day, if need requires, and that they should be
done with the greatest possible care and delicacy, so that the sooth-
ing and tranquilizing effect, which they always have upon the
patient, may not be destroyed, by the discomforts inseparable from
their performance.
Patients, in this fever, from beginning to end, may quench their
thirst as often as they will, with a small quantity of cold water,
gargling their dry and burning mouth, covering with wet com-
presses the hot and aching head, and laying upon the distended
and painful abdomen cloths wet and well wrung out, and often
changed. In constipation and diarrhoea, patients may also use cold
injections, and when the heat is very great and dry, it is common
to use rapid frictions with a wet cloth, all over the body, and, if
that is not sufficient, to wrap the patient in a wet sheet.
To all physicians who see in the extreme increase in the tem-
perature of the body, a direct danger to the life of the patient,
the fact that this danger may be avoided by the energetic sub-
straction of caloric, is one of the most important therapeutic
resources, as it has been recognized as the best refrigerant and
soothing means for these patients in the violence and intensity of
the fever.
TREATMENT OF TYPHOID FEVER.
231
The aspersions are performed as follows: The patient should
be taken out of bed quite naked, and water should be poured
upon him from a height, and a little colder than the patient
is. This being done, he should be wrapped quickly, and put
into bed. The bathings are done with a sponge, dipped in
water. When the patient is very weak and cannot support him-
self, we may facilitate these baths by putting two beds near together;
spread on one a sheet wet in cold water, and then well wrung
out; then wrap the patient and cover him with blankets; after
ten or twenty minutes, he may be laid in the other bed, simi-
larly prepared; this process may be repeated from four to six
times a day.
Besides all this, it is of the greatest importance to keep up the
courage of the patient. The doctor should always have a cheer-
ful countenance, to inspire confidence. The patient should not see
distressing objects, nor hear of them. It is well to cheer up the
spirits by making the patient consider his recovery sure and cer-
tain, but it is proper to avoid every sudden and powerful emotion,
even those which are agreeable. There should be but a few per-
sons about the patient at a time, so as not to weary him with
long and tedious discourses, and care must be taken to avoid
touching upon disagreeable topics. To poor patients, far away
from their native land, we may promise, to relieve their mental
depression and their home sickness, a speedy return home. In fine,
nothing should be neglected, which can be done to relieve their
depressed moral condition, which, more than any other thing,
wastes the vital forces.
II. THERAPEUTIC MEANS.
The therapeutic means are as numerous as the various forms
which Typhoid fever can present. And as it happers that all
these forms differ, among themselves, according to those affected
by them, so it is impossible to indicate the different means which
correspond to each one. I shall indicate, however, the chief of these
which have seemed to me to be the most frequently successful,
but it should be mentioued, that all that is to be said will have
value only as an indication relative to the given power of the
fever, and to the particular state of the one affected by it.
We are permitted to foresee, up to a certain point, the various
combinations of symptoms which present themselves in every pos-
sible form in Typhoid fever, but this foresight is, after all, quite
232
A TREATISE ON TYPHOID FEVER.
limited, as observation will soon show, if the practical tact of the
physician does not come to the assistance of his lack of prevision.
Man is an inert machine, whose actions and disorders we may
measure and calculate with certainty. By his quality of being free
and spontaneous, he creates in and about himself, conditions of
existence ever new. If we live and enjoy an activity beyond all
that we ever knew, we never can attain the limit of the new
things which may be presented to our notice. In this respect, it
may be said that the science of the sick man is rather inexhaust-
ible than inaccessible.
However that may be, I will endeavor to indicate the remedies
which are most suitable in the various periods of Typhoid fever,
and which have been very efficacious in the treatment of those
cases entrusted to my care during the last ten years, leaving to the
diligence of my colleagues to select, according to the principle, sim-
ilia similibus curantur, that which shall be most fit to each particular
case presenting itself; for I must repeat, the conduct of practice
depends upon the individuality of the case, and the most efficacious
means are those which chiefly correspond to the predominant char-
acteristics.
BATH TREATMENT IN TYPHOID FEVER.
The following is from Prof. H. P. Gatchell, M. D. :
[Disease is not so tractable that it is well to neglect anything which
will mitigate suffering, or promote recovery. Hence, I can perceive
no reason why such bath treatment as may contribute to these ends,
should be neglected any more than the best dietetic method. That
the wet sheet pack does allay fever, and contribute to a favorable
issue, is the opinion of those who have given it a fair trial.
The special indication, is continued high temperature, with a dry
skin; and the higher the temperature, and the dryer the skin, the
more appropriate is the pack.
Usually, after the patient has been enveloped from half an hour to
an hour, (occasionally an hour and a half) the fever will be sufficiently
reduced. The pack is in most cases, very soothing, often inducing
sleep in restless and sleepless patients. It is not always advisable to
employ it for irritable children, impatient of restraint, and yet I have
seen such, after being enveloped, become quiet, often falling into a
slumber.
In case of adults, who are impatient of confinement, it is well to
have some one sit by them until they are taken out of the pack.
There are some points of difference in the minor details of the
packing. But they are unimportant. I will give the method I have
generally followed. Lay a comforter on the bed so that the upper bor-
TREATMENT OF TYPHOID FEVER.
233
Wet a
Lay this
der will reach the patient's neck. On this lay a blanket.
sheet in cold water, wring it so that it will not drip.
upon the blanket, folding the lower end so that it will not reach
below the ankles, unless the feet are very hot; in which case the feet
should be enveloped in the sheet. Place the patient on the back
along the middle of the sheet, with the arms in contact with the sides,
and the feet close together. Bring one side of the sheet over the
patient, tucking it carefully under the opposite side. Carry the other
side of the sheet over to its opposite, tucking in as before. Do the
same with the blanket, wrapping the feet carefully. Repeat the same
with the comforter. Care should be taken to fold the several envel-
opes carefully around the neck, so as to leave no room for air to
enter. After taking the patient out, wash off quickly, a portion
at a time, the rest being covered with a wet towel; after which, gentle
rubbing with a soft healthy hand may be practiced, unless the patient
is inclined to sleep.
Some physicians prefer to leave the patient in the pack for
several days, renewing the moistness of the sheet by sprinkling
water upon it. Never having tried this method, I have no opinion
to offer except on one point. I think it may be better to change
the sheet, for the reason that the cutaneous excretion often ren-
ders the sheet offensive. As to frequency of using the sheet, I
recognize no rule but that derived from high temperature and
dry skin, whether the demand is for one or a dozen packs in
twenty-four hours. One need not be particular as to the precise
temperature of the water with which the sheet is wet; since exposure
to the air will, through evaporation, bring it to nearly the same tem-
perature. The warmer the air of the room, the more rapid will be
the evaporation. Whether or not the pack (or any other bath) acts
Homœopathically, is of no more consequence than whether any par-
ticular method of diet or exercise thus acts. The vital question is:
Does it act beneficially?
Let any one give it a fair trial, and he will hardly fail to be grati-
fied with the result. He can then discuss the modus quo of its action
at his leisure.]
TREATMENT OF THE PREMONITORY STAGE.
In the premonitory stage of the disease, or in its period of incuba-
tion, Bryonia and Rhus toxicodendron are the most frequently indi-
cated, which, if they do not prevent the disease, at least, mitigate it
from the beginning. But it is rare that we succeed in arresting its
development, because the illy defined symptoms are not clearly
enough pronounced to make it possible to prescribe the remedy suita-
ble for this end. This is often to be attributed, also, to the negligence
of the patient, or his attendants, who fancy that a diseased state, so
faintly characterized, must be transient, and they do not attach
importance enough to it to call the physician in time. Thus some
D 14
or M
234
A TREATISE ON TYPHOID FEVER.
days are passed, and then, the fever begins with slight chills, which
appear on the first or second day, with loss of appetite, weariness of
the limbs, agitated sleep, to which succeeds increase of heat, which
soon becomes burning and biting, with much thirst; the pulse is full,
accelerated, a little hard, the urine rather scanty, symptoms which
denote a profound affection, and not likely to disappear, and which
ought to be sufficient also, to call the attention of the physician to the
danger which threatens.
If,
If, in this early stage, we notice a dry heat, the skin burning, red-
ness of the cheeks, alternating with pallor, great nervous excitement,
agitation, groans, anxiety, painful rush of blood to the head, vertigo,
and, above all, delirium, at night, we should begin the treatment by
giving Aconite, ( 3d dilution,) which should be repeated at longer or
shorter intervals, according to the intensity of the symptoms.
instead of these symptoms, we notice a moderate febrile action, loss of
appetite, a mucous state, and especially vomiting, and mucous diar-
rhoea, it will be proper to administer Ipecac, (1st or 3d dilution). If
we see that the fever is not quieted by the action of the remedy,
and other and graver symptoms supervene, we must suspend its
administration, and use some other remedy, according to the rules of
homoeopathic therapeutics.
TREATMENT OF THE FIRST PERIOD.
In the first period, called also the stage of increase, we find indi-
cated Pulsatilla, Nux vomica, Mercurius sol., Dulcamara, Bryonia alb.,
Rhus tox., Ipecac, Verat. alb., Digitalis purp., China off., etc.
Pulsatilla is a most useful drug in flaccid, languid, tender constitu-
tions, and in lymphatic temperaments, when we see chills predomi-
nent, with neither appetite nor thirst, a bad, pasty mouth, white
tongue, nausea, mucous vomiting and stools, and a peevish, sad,
complaining disposition. One drop of the sixth dilution, in distilled
water, may be given every two, three, or six hours.*
Nux vom. is suitable when bilious, gastric symptoms predominate,
*NOTE.-Perhaps here is as good a place as any to say that these directions,
as to doses and attenuations, should not be taken too literally. Those who
do not know that some remedies, at least, in the higher attenuations, act
well even in acute diseases, have something to learn, while perhaps it may
be claimed, with equal confidence, that there are occasions where the lower
attenuations are to be preferred. The question of the dose is yet an open
one, and likely to be for some time, and one in the solution of which, at
the bed-side, each practitioner must exercise his own judgment. My own
conviction is, that there is less fear of getting too high than too low.-TRANS.
TREATMENT OF TYPHOID FEVER.
235
presenting themselves with a bitter and pasty mouth, yellowish
tongue, nausea, greenish vomiting, and bilious diarrhoea, burning
in the belly, or simply pain in the stomach, with colic and fre-
quent desire to go to stool, without being able to accomplish
anything; urine scanty and red, with tenesmus or constipation.
May be given in 3d or 12th dilution, in globules, every two hours,
or in drops.
Mercurius solub. will be efficacious in persons of a very weak and
delicate constitution, and, at the same time, very irritable, of lym-
phatic, nervous temperament, and presenting the following symp-
toms: face pale, discolored, yellowish; putrid and insipid taste in
the mouth, with tongue loaded with a very thick and yellow
coating; lack of thirst, (or thirst not very intense*), painful sens-
ibility of the epigastrium, and of the hepatic region, copious, liquid,
flocculent evacuations, sometimes a little bloody, frequent desire to
urinate, agitation, anxiety, sleeplessness, and violent headache. A
grain of the first or second trit., may be given every two or three
hours. Dr. Bærtl gives much importance to this remedy in cases
which require it, and he thinks that it prevents intestinal ulceration.
Dulcamara shows its efficacy in the cases where there is a sudden
chill, or heat and cold have produced the beginning of the disease, and
where there is neither nausea, vomiting, nor gastric disturbance;
where the tongue is in a normal state, and the patient presents bor-
borygmi and gurgling in the belly, with twisting pain and pressure
in the intestines; abdomen sensitive to pressure, especially in the
umbilical region. Given in the 1st or 3d dilution, a drop every two,
three, or six hours, it soon causes the abdominal pains to cease, ren-
ders the alvine evacuations less frequent and more consistent, pro-
moting a general sweat, during which the fever ends.
Rhus is to be given when there is a dull feeling of the head, with
cerebral pains; dry, burning heat, excessive pain in the head, with
tension and rigidity of the nape of the neck, worse in the evening,
and upon motion. It is suitable also when there are wandering pains
in the nape of the neck, and in the kidneys, with weariness and lan-
guor of the limbs at the most acute stage of the first period, when the
nervous symptoms begin to manifest themselves; when the tongue is
coated with a fur, and there is diarrhoea with borborygmi; chills, ver-
tigo, with closing of the eyelids, altered color of the face, dryness of
*NOTE.-This symptom should be questioned. Intense thirst characterizes Mer-
curius.— TRANS.
JorM
:
236
A TREATISE ON TYPHOID FEVER.
the throat, vomiting of food, yawning, head dull and heavy, pres-
sure upon the eyes, painful sensitiveness to noise and light, som-
nolence, loss of memory, tendency to delirium, lower lip and tongue
blackish. May be given in 3d or 12th dilution, a drop every two
or three hours.
Bryonia is indicated when the disease threatens to pass into the
second stage, or if, from the beginning, ataxic, or nervous symp-
toms show themselves on the first day, as a lacerating, throbbing,
jerking headache; nausea and disgust, with whitish tongue,
bitter mouth, dryness of the throat, thirst, vesicular eruption on
the lips and in the mouth, crampy tension in the stomach, pain
in the epigastrium under pressure, abdomen painful, flatulence,
constipation, urine rare and turbid, voice weak or hoarse, cough
in the morning, sharp pain between the ribs on coughing, or taking
a deep breath, oppressive lassitude, cold sweat on the head, skin dry.
From the 3d to the 12th dilution, one drop every three hours.
Ipecac succeeds in cases which take on a very marked gastric char-
acter, with a choleriform state, a yellow tongue, with nausea, vomit-
ing, and bilious diarrhoea of a bright green, intense heat, especially in
the evening, general headache, or only semi-lateral, continual motion
of the head as if it were badly placed upon the pillow, sweat upon the
head, shaking in the limbs, which have a painful tremor. May be
given in the 1st or 3d dilution, one drop often repeated.
Veratrum alb. has always shown itself of great efficacy when the
disease begins with vomiting, and liquid stools, with coldness of the
limbs and cold sweat. In a case, in the second stage, in which the
arms, up to the elbows, and the legs to the knees, were as cold as
marble, and covered with petechiæ, the pulse scarcely sensible, the
abdomen extremely painful, with involuntary evacuations, and emis-
sions of urine, this remedy alone was sufficient. It may be given from
the 6th to the 12th, in globules, at first every two hours, then at inter-
vals of an hour or two.
Digitalis is useful in nervous, lymphatic constitutions, where there
is dilatation of the pupils, tongue perfectly clean, pulse slow and
regular, depression of the strength, pressure and fulness of the epigas-
trium, disgust, heartburn, and even vomiting. It may be given in the
1st or 3d dilution, a drop every three hours.
China is indicated when the disease takes on the appearance of a
slow fever, with pallor of the face, headache, alterations of the sight,
noises in the ears, dulness of hearing, coated tongue, dryness of the
TREATMENT OF TYPHOID FEVER.
237
mouth, with bad taste, thirst, nausea, pressure in the epigastrium,
which is also sensitive to pressure, swelling and pain of the bowels,
watery evacuations, lientery, scanty urine, oppression of the respira-
tion, pressure upon the chest; lancinating, lacerating pains in the
limbs; anxiety, sleeplessness, chills, coldness, especially of the hands
and feet. May be given from the tincture to the 3d dilution, giving
one drop every three hours.
TREATMENT OF THE SECOND STAGE.
If the remedies given during the first stage have not arrested the
course of the fever, and this has gone on to the second stage, (eight or
nine days after the invasion of the fever,) then we have recourse to
the following means: Pulsatilla, Merc. dulcis, Bryonia, Rhus, Phos-
phori acidum, Chamomilla, Belladonna, Agaricus muscarius, Coffea
cruda, Aconitum, Calcarea carbonica, Cocculus, Hyoscyamus, Sulphur,
Veratrum album, and the applications of the water cure treatment.
Pulsatilla.-In soft and relaxed constitutions, with little or no thirst,
gastric malaise, pale and yellow color, phlegmatic temperament,
unquiet mental disposition, ill-humored; bitter mouth, tongue cov-
ered with a whitish or greenish coating, loss of appetite, stringy
vomiting. To be given in the 3d or 6th dilution, three or four times
in twenty-four hours.
Merc. dulcis is suitable in illy defined gastric disturbances, painful
sensibility of all the abdomen, watery evacuations, as if colorless or
mixed with flocculent matters, or like the washing of flesh, occurring
most often at night. It is necessary to suspend this remedy when
the tongue becomes dry, and delirium manifests itself. May be given
in the 1st trituration, a grain every two or three hours. Under the
influence of this drug, the evacuations become bilious, more consis-
tent, less frequent, the painful sensibility of the abdomen disappears,
and, with it, all the other morbid symptoms.
Bryonia shows itself more efficacious when the fever takes on the
character of nervous versatile, or of cerebral typhus, in which a strong
delirium is accompanied with intense febrile heat, great thirst, with
dryness of the mouth, and vesicular eruption within; epigastrium
sensitive to pressure; bloated abdomen, loaded urine, pains in the
sides of the chest, when coughing or taking a deep breath; somnol-
ence during the day, agitation at night; pulse soft and small, clammy
sweat; tremors of the hands. From 3d to 12th dilution, a drop every
two or three hours.
Rhus tox. is suitable in every stage of the disease, and is especially
238
A TREATISE ON TYPHOID FEVER.
indicated when the symptomatic train takes on the character of a
nervous stupid fever, or when the alvine dejections are extremely
copious. It is one of the most potent drugs, renews the strength,
arresting or moderating the fatal colliquative diarrhoea, and dimin-
ishes the intensity of the cerebral congestion. It may be given as
Bryonia is, with which it has a very great analogy.
Phosphoric acid is especially useful for blondes, with delicate, white
skin, prostration of the strength, with consciousness almost' lost,
scurvy-like alteration of the mucous membrane of the mouth, extreme
slowness in answering or in moving, colliquative watery diarrhœa, a
great number of petechiæ, profuse sweats. From 1st to 3d dilution
one drop every two hours, in distilled water. It operates better some-
times when alternated with Rhus.
Chamomilla where there is redness, and febrile heat of the face in
the afternoon, with swelling of the parotids, redness and dryness of
the mucous membrane of the mouth, the tongue cracked and furred,
putrid and bitter taste, fœtid breath, violent thirst, with great desire
for fresh water; besides this, there is nausea, bitter vomiting, pres-
sure upon the stomach, colic, extreme sensitiveness of the abdomen
to pressure, greenish yellow, watery evacuations, urine with yellowish
flocculent deposits; also catarrhal hoarseness, mucous rales, tickling
in the trachea provoking cough, oppression, pressure upon the ster-
num, lancinations, burning in the chest; insomnia, soporous state”
with subsultus, lively dreams, mild delirium, dry febrile heat, anxiety,
nervous irritation, sighs, groans. (Sixth dilution, two or four times
in the twenty-four hours.)
Belladonna is indicated, in inflammatory cases, where the pulse is
full, hard; frequent, sensible pulsation of the carotids, animated face,
swollen, the skin hot and dry, thirst extreme, the belly meteorized, the
urine turbid and loaded. Also when the patient complains of intense
pain in the head, with lancinations in the back part or top of the
head, with sensation as if the forehead would burst; redness of the
face, alternating with pallor, the eyes brilliant and fixed; pupils
dilated; groans, agitation during sleep, frightful dreams, furious
delirium, or nocturnal delirium, consisting solely in the utterance of
a few incoherent words; tongue red, dry, trembling and cracked;
constipation or frequent diarrhoea, but in small quantities; urine sed-
imentous, or clear and very abundant; pulse large, full, varying in
quantity. To be given from the 3d to the 12th dilution. It is more
advantageous to alternate it with Aconite, (3d dilution,) each every two
TREATMENT OF TYPHOID FEVER.
239
or three hours, when the intense febrile heat persists, accompanied by
involuntary fluid evacuations. These drugs usually provoke a perspi-
ration, which is the prelude to a general improvement.
It may also be alternated with Bryonia, giving this during the day,
and the Bell. at night. The alternation of these two remedies is
specially appropriate in Typhoid fever with ataxic or cerebral
symptoms.
If, to the symptoms of Bell., just described, there is added a delir-
ium, shown merely by singing and by improvising, it is better to
suspend the use of Bell., and administer Agaricus muscarius in the
same dose and time as the Bell., if we wish to procure calm and repose
for the patient, if not a cure.
If now the disease has continued a fortnight in an individual of del-
icate complexion, with white skin and light hair, who is sad, cast-
down, silent, and without any delirium; his color suddenly becomes
lively, the eyes are brilliant, the face colored, and he either laughs or
speaks without interruption, and without any reason; if a dry cough
presents itself more and more, with great weakness, it is necessary
to give Coffea cruda, 6th, putting fifteen globules into some water, of
which a spoonful may be given from hour to hour, till the return of
the quiet which existed at first.
Bærtl employs Calcarea carb. at the end of the second period, or, at
the beginning of the third, when ulcers seem to form in the intes-
tines, and when the diarrhoea does not yield to the indicated Homo-
opathic remedies. This remedy is given sometimes alone, (the 30th
dilution, one drop two or four times in the twenty-four hours,) some-
times alternated with the remedy which the best corresponds with the
totality of the symptoms; the repetition is then more frequent, (six
or eight times a day.) The alternation with Bell. gives the best
results. We begin with the 30th dilution. If not better in twenty-
four hours, we give the 24th, 18th, 12th, and sometimes even the 6th.
The improvement which occurs manifests itself with a diminution of
the sensibility of the abdomen, of the meteorism, of the agitation
and anxiety; the evacuations become more consistent and more
seldom.
Phosphorus is used with success, towards the end of the second
period, where there is sanguineous engorgement of the lungs-hepa-
tization, with oppression and anxiety, pulse frequent, with loss of
force; watery diarrhoea, sweats and nose-bleed. In typhoid-pneu-
monia, when Aconite (3d), several times repeated, produces no
240
A TREATISE ON TYPHOID FEVER.
improvement, and the expectoration becomes purulent and fœtid,
Phosphorus is perfectly indicated, especially when the patient seems
to be of a vigorous temperament with blue eyes, and when nothing
seems to help him. The proper dose is the 6th or 12th dilution, half a
drop, five or six times a day.
Bært has often obtained, with Sulphur, prompt and very happy
results in cases where Rhus, Bryonia, Phosphoric acid were administered
without result. The indications for this remedy are a pallid aspect,
with dull eyes, pruriginous eruption, burning of the lips, dryness of
the mouth, watery evacuations, more frequent at night, dry cough,
more marked in the evening and at night, lancinating pains in the
chest, oppression, insomnia, inquiet agitated sleep, dry heat of the
skin, with tranquil pulse. A grain of the 2d trituration, once or
twice a day,
Pulsatilla, 12th dilution, and Cannabis from the 1st to the 3d, have
shown themselves efficacious in the retention of urine, or with diffi-
cult or painful passage of same.
Hyoscyamus puts an end to the frequent desire to urinate, with an
impossibility of doing it. It may be given from the 3d to the 9th.*
TREATMENT OF THE THIRD STAGE.
In the third stage of the disease, the following remedies are indi-
cated: Bryonia, Rhus tox., Phosphori acidum, Belladonna, Opium,
Calcarea carb., Nux vomica, Veratrum album, China, Arsenicum, Nitri
acidum.
Bryonia shows itself efficacious in violent delirium, great febrile
heat, extreme thirst, great dryness, little vesicles and ulcers in the
mouth, and on the lips, painful distension of the epigastrium,
abdomen sensitive to pressure, involuntary emission of urine and
fæcal matter, oppression, mental depression, somnolence without
dreams, complaints, murmurings, mild delirium, agitation, miliary
eruption. (From the 3d to the 12th dilution, one drop in distilled
water every two or three hours.)
Rhus is administered with Bryonia, and they are alternated every
other day. It is most suitable when the patient is in a state of
sopor and prostration, with extreme weariness, which prevents his
making the least motion, very abundant watery diarrhoea; evacua-
tions and urine involuntary. It is suitable, too, when the dissolution
*NOTE.-It is of use, also, when there is no desire; given in the 9th, every
hour, it seldom fails, nor does it have to be repeated often.— TRANS.
TREATMENT OF TYPHOID FEVER.
241
of the blood makes rapid progress, manifesting itself by nose-bleed
and petechiæ. It is given from the 3d to the 15th dilution.
Phosphoric acid is given alternately with Rhus, in a general stupor
of all the organs, when the tongue is dry and cracked, the teeth cov-
ered with a fur, the lips blackish, the cough frequent and dry; con-
stant decubitus, continued delirium or low muttering, picking the
bedclothes, fixed look, desire to run away, dry and burning skin,
abundant, involuntary, watery evacuations; pulse frequent, weak,
intermittent. The usual dose is a drop of the first dilution,
given eight or ten times in the twenty-four hours. In desperate
cases, where the prostration almost amounts to agony, Bærtl pre-
scribes concentrated Phosphoric acid, from two to six drops in a
few ounces of distilled water, a spoonful at a dose. This is also
given by way of injection, against intestinal hæmorrhages.
Belladonna has the special property of often giving a profound
modification to a disease, a different and favorable direction. It
is usually given in the 6th dilution, sometimes in the 12th, more
rarely in the 1st. This drug, finally, is indicated by the general
erethism, the violent delirium, a great internal and external heat,
redness and swelling of the face, dry tongue, lack of sleep; also,
when the patient is in a soporous state, without complaints, with-
out wants, except it be for something to drink; difficult and,
sometimes, impossible to swallow, eyes fixed, shining, the mouth
open, by reason of the relaxation of the muscles of the lower jaw;
tongue leathery, so that the patient cannot put it out of his mouth;
deafness, he drinks with avidity, and a little at a time, abdomen
tense, evacuations and urine involuntary, tendency to slide down
to the foot of the bed, to uncover himself, to thrust out the legs,
picking of the bedclothes, somnolence without sleep, intermittent
pulse. Belladonna always shows itself, in such cases, one of the
most potent medicinal agents.
Opium is given with much success, in profound coma, with a
slow, full, but depressible pulse; light mutterings, carphologia, fixed
look, skin wrinkled, tongue dry, evacuations fetid and involuntary.
(2d or 3d dilution,)*
Calcarea carb. is indicated at the beginning of this stage, during
the formation of the intestinal ulcers. It is often useful to alter-
* NOTE. Opium may also be given when the system fails to respond to the
remedy which seems indicated-a few doses, given two hours apart, prepare
the way for the more strictly Homœopathic remedy.-TRANS.
242
A TREATISE ON TYPHOID FEVER.
nate it with Rhus or Belladonna, according to the case. It is well
to begin with the 30th dilution, and to descend progressively to
the 6th.
Nux vomica is given where there are intestinal cramps, obstinate
constipation, which determines the blood to the head or the chest.
Where there is a supra-excitation of the arterial system, we
obtain the best effects from Aconite. It may be alternated
with Belladonna in parotitis, and Belladonna with Calcarea, when
the febrile reaction has ceased. Where there are pains in the side,
with fever, Aconite is to be alternated with Arnica, (3d dilution.)
Veratrum album is a heroic remedy when the patient has vomit-
ing, and frequent liquid alvine evacuations, with cold sweat;
pulse scarcely perceptible; abdomen very painful, and as if con-
tracted; the urine is discharged unconsciously, petechiæ on the
extremities, which present to the touch, an icy coldness. May be
given from the 6th to the 12th dilution, two drops in four ounces
of water, a spoonful to be given every hour, the intervals to be
lengthened as the improvement progresses.
Towards the end of the third stage, when the seat of the dis-
ease seems to be fixed in the chest, and there is pulmonary san-
guineous congestion, followed by hepatization, dyspnoea, pungent
pains in the sides, mucous rales, abundant expectoration of bloody
mucus, and, at the same time, of fetid sanies, Phosphorus shows
itself most efficacious, (and this is, with Bryonia, the best remedy
against typhoid pneumonia,) from the 4th to the 12th dilution, a
drop in distilled water, many times a day.
China, in the last stage, dissipates the nocturnal sweats, accom-
panied by a progressive loss of strength, obstinate constipation,
with clean tongue and sluggishness of the bowels.
Arsenicum is a powerful modifier which many practitioners have
extolled, in the treatment of Typhoid fever, and from which I
have derived great help, in the patients treated by me; it is, how-
ever, sometimes unsuccessful; a new proof that affections, united
under the same pathological denomination, are far from being
always identical; that insignificant gradations in the symptomatic
impression may indicate a profound difference in the nature of the
disease, as well as the employment of different remedies, from
which we conclude that it is necessary to take into account the
entire totality of symptoms. Dr. Bærtl says, regarding Arsenicum,
"The use of this substance, in cases which I have treated, has
TREATMENT OF TYPHOID FEVER.
243
not generally given me good results, although I have administered
it in different dilutions, and in repeated doses. Once, only, when
the fever became low, and was accompanied with copious liquid
evacuations, preceded by a sensation of extreme weakness, (this
phenomenon is a characteristic symptom of Arsenic.,) pains in
the belly, and violent thirst, Arsenicum (9th dilution,) alternated with
Chamomilla, (5th), produced a prompt, and salutary effect. Under its
influence, a swelling of the calves occurred, accompanied by acute
pains, which put an end to the typhoid affection. To an individual
who had suffered several times from scrofula, I gave, every day, a
drop of lodium, (2d dilution,) which made the hard swelling and the
pain disappear.
When Phosphoric acid does not produce an improvement in the
intestinal hæmorrhage, we must employ Nitric acid, alone, or alter-
nated with some other indicated Homœopathic remedy, in a dose
of a drop of the first dilution. If, however, the desired result is
not obtained with this dilution, it will be necessary to administer
the Nitric acid in injections. (Four or six drops in two or three
ounces of water.)
TREATMENT OF THE COMPLICATIONS.
Various morbid conditions may present themselves, during the
course, and after the cure, of the typhoid affection, requiring
special treatment. Epistaxis, intestinal hæmorrhage, peritonitis,
perforation of the intestines, subcutaneous petechial hæmorrhages,
contusion and ulceration of the skin, upon the back, and, espe-
cially upon the sacrum, in consequence of decubitus, mumps, deaf-
ness, boils, metastatic abscesses, miliaria, an eruption analogous
to itch, diarrhoea, cough, with expectoration or without, nocturnal
sweats, œdema of the inferior extremities, irrepressible vomiting,
enteritis, and finally, abdominal phthisis.
The remedies for these complications are, generally, Arnica,
Arsenic, Belladonna, Calcarea carb., Carbo veg., China, Hepar sulph.,
Ipecac, Ledum pal., Phosphori acid., Rhus tox., Silicia, Sulph.
The epistaxis* (nose-bleed,) which is very frequent in Typhoid
fever, and is observed from the very first, as has already been
noted, in speaking of the symptoms, requires Aconite, in the first stage,
then Mercurius solub., especially when occurring at night, preceded
*NOTE.— Ledum will be found a capital remedy for this trouble in Typhoid
fever, or out of it, as well as for hæmorrhages from any organ.-TRANS.
244
A TREATISE ON TYPHOID FEVER.
by violent congestions to the head. In the second stage, where
we have it with a frequent pulse, loss of strength, watery diar-
rhoea, sweats, and oppression, we must use Phosphorus as already
directed.
Pulsatilla, Rhus and Sulphur have been also employed with suc-
cess in epistaxis, each separately, or, alternately with the remedy
appropriate to the totality of the symptoms. Bærtl employs the
lower dilutions against the indications of dissolution of the blood.
In intestinal hæmorrhage, the chief remedies are Arsenicum,
Carbo veg., Ipecac, Phosphorus, Phosphoric acid, from which we should
select that one which seems most indicated by the symptoms,
which accompany this hæmorrhage. Phosphoric acid, however, is
the remedy which has produced the best results and may espec-
ially be reccommended to practitioners in severe cases.* *
The application of snow to the abdomen, is also an efficacious
means, and assists the action of the drug administered internally.
Peritonitis requires treatment according to the law of similars; but
Arsenic, Carbo veg. Ipecac, are the principal remedies wherewith to
meet this complication, although the minute examination of the
symptoms may require some other remedy.
Perforation of the intestine is promptly fatal, nor is there any
hope of cure, when an effusion of the substances contained in the
intestines passes into the abdominal cavity. In cases of a small
perforation, we should seek to promote adherences, which might
circumscribe the effusion; hence, it is necessary to demobilize the
patient and his intestines, then to limit the resulting peritonitis.
Opium, in doses rapidly narcotic, and elastic collodion spread upon
the abdomen, are the two means recommended by practitioners as
corresponding to these indications.
The subcutaneous haemorrhages may be dissipated under the
influence of a good regimen, and the re-establishment of the
strength, and it seldom requires any medicine. However, where
the absorption is slow, it may be aroused very much by the admin-
istration of a few doses of Arnica.
The inflammation of the skin of the sacrum, produced by long
decubitus, is quickly modified under the use of Belladonna, repeated
in low dilutions. If the part affected becomes gangrenous, we must
*NOTE.— Nitric acid, 3d centesimal dilution, two or three drops every hour
or two, generally suffices for this complication.
TREATMENT OF TYPHOID FEVER.
245
resort to Carbo veg., given internally, in a high dilution, at the
same time that the sore is covered with the first trituration.
China and Arsenic internally, are also suitable for the gangrene
when Carbo veg. does not suffice to arrest its progress. *
Sulphur and China favor the formation of healthy granulations and
cicatrization. Silicea in the 12th, is indicated when the alteration
extends to the bones, in which case the external parts may be washed
with a solution made by the 3d trituration of this same Silicea
-three drachms to a pound of water. Some practitioners recom-
mend to wash often, and to keep a compress wet with a solution
of the tincture of Arnica, from the first beginning of the redness
of the skin over the sacrum, or any other part of the body. Dr.
Teste recommends to take three drachms of tallow, melt it over
a slow fire, add to it fifteen drops tincture Arnica; mix it well
together, and use it for medicating the eschar on the sacrum, or
wherever it is. Covering the excoriation with a bit of gummed
silk often prevents its spread. It is necessary to unite, to the use
of these various remedies, frequent bathing, the renewal of the
air, and change of linen.
The parotitis (mumps,) is resolved by Aconite and Belladonna,
which act like a charm at the beginning of the fever, when inflamma-
tion of the parotid glands is present. Every time," says Bærtl,
"that I have had to treat inflammatory swelling of the parotids,
hard to resolve, I have cured it with Belladonna, (from the 12th to
the 6th dilution,) and in some refractory cases, with Belladonna
(12th) alternated with Calcarea carb. (12th or 30th.) The resolution
of the gland, followed by convalescence, has always been the
result of this treatment.‡
Tonsilitis, which sometimes appears in this disease, is resolved by
Aconite and Belladonna alone, or in alternation, when the inflamma-
tion is phlegmonous, and the redness is dark. When the redness is
rather pale, and the tonsils are covered with small white ulcers, Bry-
onia is more efficacious, as practitioners have confirmed by repeated
trials.
The boils which succeed one another in an interminable manner,
*NOTE.— And Secale.— TRANS.
✦ NOTE.— If this is not at hand a very good substitute may be had by chop-
ping hay finely, and steeping it in hot water-this water makes a capital wash
where the bones are ulcerated. See Grauvogl's Text Book, II, 366.—TRANS.
NOTE.- Mercurius vivus deserves notice in this connection.— TRANS.
246
A TREATISE ON TYPHOID FEVER.
and without interruption, disappear under the use of Belladonna
alternated according to the case, with Sulphur, Lycopodium or Silicea.*
The deafness, which in some cases persists till the end of the dis-
ease, requires Arnica, Phosphorus, Phosphoric acid, Veratrum.
The metastatic abscesses, which sometimes appear, require Belladonna
or Hepar sulphur.
The miliary eruption, which produces a troublesome and dis-
tressing itching, requires Rhus and Ledum pal. iu alternation.
It is necessary to avoid, on such an occasion, the use of even tepid
water, which often occasions fatal metastases.
In the eruption analogous to itch, the washings and tepid baths are,
on the contrary, favorable. We may administer, according to the
case, Sulphur, Mercurius, Carbo veg., Causticum, Rhus, Nitric acid,
Lycopodium.
The persistent diarrhoea, which usually follows the constipation,
and which does not depend upon a saburral state, nor upon a chill,
requires the use of China, often repeated, from the 1st to the 6th
dilution.
The persistent cough, accompanied or not with expectoration, ordi-
narily yields to Ipecac, 3d dilution, and, if it occurs during the night,
to Sulphur, 2d and 3d trituration, one or two grains per day. This
medicine, in the same dose, will also put an end to the night sweats, if
they persist, notwithstanding the fortifying regimen of convalescence.
The enteritis, which returns in convalescence, requires the use of
Muriatic acid, Phosphoric acid, Arsenic.
The obstinate vomiting of convalescence, with slowness of the pulse,
excessive weakness, coldness, and the discharge of a blueish sub-
stance, in the act of vomiting, requires the use of meat and wine. If,
even with such a regimen, the vomiting persists, we must give Nux
vomica and Graphites, just after the meal.
The oedema of the lower extremities often disappears with the
return of strength, and when the patient begins to walk about; if it
persists, however, Arsenicum alternately with Sulphur or Lycopodium
must be given.
The diarrhoea, occurring during convalescence, is often an indica-
tion of the worst augury. Patients, attacked with this formidable
affection, complain of periodic colics, and of a sensation of burning
*NOTE.-Arsenic is a prime remedy for these troublesome companions, and,
for an external dressing, nothing is like the tomato.-TRANS.
TREATMENT OF TYPHOID FEVER.
247
in the abdomen, especially in the course of the transverse colon. The
appetite is good, the tongue clean, with a reddish coat, the belly is
soft, rarely swollen; on pressing with the hand upon the region of the
cæcum, one perceives a sound like that of water shaken, and the
patient then experiences acute pain; there is much borborygmus or
gurgling in the belly, especially at night, like the glu-glu from a
bottle which has been emptied. In the outset, the diarrhoea only man-
ifests itself at night, and afterwards in the day, but it is always more
frequent at night; the evacuations are at first a bright brown; after-
wards they contain streaks of blood, and, at last, seem to be composed
of a purulent sanies, mixed with blackish and fetid blood; the urine
is scanty, red, and turbid; the fever is periodical with paroxysms in
the evening. Finally, nocturnal, colliquative sweats, excessive emaci-
ation, death.
•
Sometimes, we succeed in arresting the progress of this formidable
affection, by the use of Pulsatilla, then Belladonna and Calcarea carb.,
given alternately. Dr. Bærtl says that he obtained some success with
Arsenicum and Sulphur, in high dilutions and alternated. Carbo veg.,
in the 3d or 12th dilution, given in drop doses, in distilled water,
every three or six hours, has also showed itself very efficacious.
III. SURGICAL MEANS.
Surgery has nothing to do in Typhoid fever, only as regards reten-
tion of the urine in the bladder; when we cannot overcome this with
medicines given internally, we must resort to the catheter.
Blisters are not used by Homœopaths, and at the present day, it
seems very generally, even in Allopathic medicine, that they are not
prescribed in this disease, owing to the great tendency that the sores
have to gangrene, as physicians have often observed.
General bleeding, by unanimous consent of many experienced and
learned physicians, has been forbidden in the treatment of Typhoid
fever, as it produces injurious debility, the beneficial vital operations
are disturbed or hindered, and the nervous character of the disease is
much exalted. In the last epidemic which reigned in this city, a few
years ago, it was observed that patients who were bled, always died,
and even if death does not always follow blood.letting, yet, neverthe-
less, the crisis and the whole course of the disease is much retarded,
and convalescence is thus much protracted.
The same happens after local bleeding, and we no longer see a great
number of leeches prescribed, as was done a few years ago. They are
now seldom applied, or only in the more intense local inflammations,
248
A TREATISE ON TYPHOID FEVER.
in which the Homœopathist seldom uses them, because the proper
remedy, selected according to the law of similars, and given according
to Homœopathic laws, leaves no occasion, for them.
As regards the use of baths, and especially of cold water, it has
been abundantly treated of under hygienic means.
As regards the sores of decubitus, nothing more need be said, unless
we repeat, that, in medicine, we cannot establish general treatment,
and what is suitable in each case of a given disease; but the treat-
ment should be modified according to each individual case, and the
remedy should be selected in view of the totality of the symptoms, of
whatever nature they may be, as has been often said, so that we may
always have, with the help of God, a happy termination in the treat-
ment of our fever patients.
THE END.
CHAPTER IX.
SYMPTOMATIC INDICATIONS.*
66
Hering thinks the distinction between a so-called "Typhoid” and
Typhus" is entirely useless in the selection of the medicine. The
same is the case with localized and not localized forms. The only
advantage is, to be able to distinguish such forms as may be, or have
oftener been, contagious. The prognosis also depends not altogether
upon the symptoms, and the dietetic rules may be altered in certain
forms. Hence, we cannot do without pathology.
Beginners may be somewhat aided by knowing what, in certain
forms, described under peculiar names, has been given with success.
Exanthematic forms:- Apis, Arn., Ars., Bell., Bry., Calc. ostr., Carbo
veg., Lachesis, Mercur., Mur. ac., Nux mosch., Phos. ac., Phosphor., Rhus
tox., Secale, Stramon.
Pectoral forms.- Pneumo-typhus: Ant. tart., Bry., Carb. veg., Hyosc.,
Phosphor., Rhus tox.
Enteric forms.- Ileo-typhus, enteric typhus, typhus abdominalis:
Apis, Àrs., Bellad., Bry., Calc. ostr., Carb. veg., Cinchona, Colchic., Gin-
seng, Ipec., Lyc., Mur. ac., Nit. ac., Nux v., Phos. ac., Phos., Rhus tox.,
Secale, Sulphur, Verat. alb., Phosph. ac., seems to act chemically.
Grauvogl, II, 35. Oxal. ac. is to be placed next to it, after Apis, or
followed by it. H. Gross.
Bilious form.-Typhus icterodes, typhus biliosus: Bellad., Cham.,
Merc.; after anger, Cham.; with sensitiveness in region of liver:
Bellad.
Mucous form.— Typhus pituitosis: Mercur., Pulsat., Rhus tox.
Petechial form.-Hæmorrhagic, typhus putridus: Arnica, Arsenic,
Camphor, Carbo veg., Chinin., Chlorum, Mur. ac., Nitr. ac., Sulph. ac.,
Arsen.: when putrid, foul, cadaverously smelling stools; brown, dry,
leather-like tongue, extreme prostration.
Mur. ac.: fetid stools, intestinal hæmorrhage, sopor, so weak that
he settles down in bed into a heap.
Arnica.: foul breath, petechiæ, says there is nothing the matter
with him.
*NOTE.-This excellent analysis of symptoms is taken from Hering's "Specimen
of Analytical Therapeutics”—a most valuable work, which we hope will soon be
completed. The first volume only is as yet published. This should be in the hands
of every physician.
D 15
250
A TREATISE ON TYPHOID FEVER.
Putrid decomposition of all the fluids, tongue parched, dry, brown;
bloody, cadaverous, fetid stools, Rhus tox. Phosphor.
Cerebral forms.-Typhus cerebralis, typhus encephalicus: Arnica,
Bapt., Bellad., Bry., Hyosc., Lachesis, Nux mosch., Opium, Phosphor.,
Rhus tox., Stramon., Veratr. alb.
Versatile forms.-Typhus versatilis: Bell., Bryon., Chamom., Cina,
Digit., Hyosc., Ignat., Lycop., Mur. ac., Natr. mur., Nux vom., Opium,
Phosph. ac., Pulsat., Rhus tox., Stramon., Zincum.
Stupid forms.-Typhus stupidus: Arnica, Arsen., Bellad., Bry.,
Carb. veg., Cinchona, Cocc., Helleb., Hyosc., Lachesis, Mur. ac., Nitr.
spir. dul., Nux vom., Opium, Phosphorus, Phosphoric acid, Rhus
tox., Secale, Stram., Veratr. alb.; with torpor intermitting, Phosphor.
ac.; with complete stupor, Opium; depression of nervous system,
without any other affection, except enlarged spleen, Coccul.
Apoplectic forms.—(Congestive fever.) It is absurd to expect any-
thing from large doses of Bellad.; it is murderous to bleed, and fool-
ish to apply ice instead of clothes dipped in cold water, changed every
few seconds. If it were not, or could not be prevented, Glon., Gel-
sem., Laches., Sanguin., or Veratr. vir., may help if their indications
are not overlooked.
Impending paralysis of brain, Lycop., Opium, Phosph., Zincum;
impending paralysis of lungs, Arsen., Carb. veg., Phosphor.
Moschus.-Cannot get the phlegm up, breathing and pulse weaker
and weaker, fluids roll audibly down the throat, stools and urine pass
unconsciously.
Carbo veg.- Paralytic condition, stupor, collapse, dissolution of
blood.
In the beginning of Typhoid fevers, almost any medicine may be
given, particularly such as are indicated by the genius epidemicus, or
prevailing character of complaints. One third of such patients as
come under our treatment, from the first, ought to be able to sit up
and go out again within a week or two; over another third may last
from two to three weeks; hardly one third will run to the full time of
six weeks, excepting such cases as have been spoiled by wrong treat-
ment, or have, after feeling unwell, taken Ricinus oil or Citrate of
Magnesia.
At the beginning, or in the early stages, the following remedies
have been given; with sudden tumultuous symptoms, especially con-
gestive headache, Bellad.; with nosebleed, Rhus tox.; gums bleed,
Mercur.; (in yellow fever, Carbo veg.), lassitude and heavy limbs, with
headache, white covered-tongue, loss of appetite, belching, Bryon.;
furred tongue, Coccul.; mouth and tip of tongue dry, Nux vom.; gas-
tric symptoms, with acute shooting pain, in different parts of body,
Bryon.; the same, but with sour, bitter belching and vertigo, Nux
vom.; in case of looseness, Bryon., Rhus tox.; with sour bitter belch-
•
SYMPTOMATIC INDICATIONS.
251
ing, Puls.; or with flatulence, Phosph.; suspended catamenia and
gastric symptoms, Puls.; vomiting, and copious watery diarrhoea,
Ipecac.; copious, thin, watery stools, after pain in bowels, with rapid
sinking, Veratrum alb.; chilliness on the slightest motion, Nux vom.;
drowsy, but not able to sleep, Bellad.; erethrism, Rhus tox.; stiffness.
Bryon.; wants to lie down on one spot, Rhus tox.; trembling with
weary limbs, Bellad.; heat unbearable, but uncovering makes chilly,
Pulsat.; in the beginning of typhus versatilis, Bry.; later, Mur. ac.;
if the so-called nervous symptoms are predominating, Baptisia or Gel-
semin. is better than any of the others.
Not only the duration of the fever ought to be a great deal shorter,
but the mortality ought to be considerably less. The latter ought to
be restricted to patients with such organic diseases as are developed
by the fever, or such relapses as are brought on by neglecting the
rules during convalescence.
Most peo-
The stage of convalescence is of the highest importance.
ple who get well within a week, suppose nothing serious has been the
matter with them (compare Mr. Kidd's remarks, British Quarterly,
1847, VI, 97), and do not follow the positive rules, to avoid for the
full time of six weeks, all excesses in eating or drinking. The least
indulgence may bring on a dangerous relapse. The more appetite
they have, the more carefully they ought to limit the quantity as well
as the quality. All exertions of mind or body are a great risk; coi-
tion very often proves fatal.
During convalescence, the following have been given with success:
in the most complete despair of recovery, Psorin.; loss of memory,
Anacard.; hemicrania, Ignat.; rheumatic toothache, Rhodod.; appetite
will not return, Psorin., Sulphur; ravenous appetite, Arsen., Pulsat.;
cannot eat, everything tastes bitter, Pulsat.; unconquerable bilious
vomiting, Cinchon.; obstinate vomiting, Kreosot.; slow recovery, with
diarrhœa, Cinchon.; sour diarrhoea, Rheum; from using sour things,
with cutting, Ipecac.; great sexual desire, Aloes, Phosph., Psorin.; ten-
dency to tuberculous deposit, Calc. ostr.; periostitis of sacrum, Silic.;
constant, painless, ædematous swelling of lower limbs, Aur. mur.;
after it failed (right side) Bellad.; lower limbs as if paralyzed, Selen.;
obstinate rheumatism, Colchic.; strength alone wanting, Veratr.; great
prostration, Psorin.; marasmus, Cinchon.; relapse, after over exertion
of body, Rhus tox.; of mind and body, Cuprum; of mind alone, Nux
vom.; after a fright, Ignat.; angry passion, Nux vom.; continual chilli-
ness and sensitiveness to the slightest draught, Selen.; weakening
sweats day and night, Psorin.; convalescence too slow, Cinchon.;
unpleasant sensations running downwards, Guaco; upwards, Fluor.
ac., Selen.; threatens to assume a lingering form, Arnica; feverish
feeling, appetite delayed, Coccul.; slow protracted cases, with mild
delirium, restlessness, anxiety, Arsen.
The sick room ought to be moderately warm, but aired freely, partic-
ularly during the time when the sun shines into it, and always after
252
A TREATISE ON TYPHOID FEVER.
sunrise. A grapery would be the best place to keep the patient in.
Rubbing daily with a towel dipped in cold water, is advisable, and if
the patient is used to washings, it may be done all over.
Towels are
better than sponges.
To disinfect a room, or destroy all kinds of bad odor, roast three
or four beans of coffee on the stove or a hot plate; all other disinfec-
tants are injurious and useless. Tubs of water under the bed will, in
most cases, prevent bed sores. In changing the bed-clothes or shirts
put the clean ones in the sun for one hour, shirts inside out, or rub
with the hand what will touch the skin, to take off the peculiar sphere
of the laundry. Never interrupt sleep.
Pure cold water is to be allowed as much as the sick person wants,
in summer cooled by ice around the outside of the vessel, as melted
ice is injurious; stale bread well toasted, but only brown, and while
hot put into boiling water, cooled afterwards in an earthen vessel, not
in metallic; apples boiled in much water and a few small raisins;
some raspberry syrup, not made up artificially; or good rice-water,
not seasoned, nor flavored; no vinegar nor lemon may be offered to
the sick, unless there is a great desire; barley or oatmeal gruel
according to taste; the so-called Essence of Beef is one of the most
injurious things, only does harm, and is not nourishing; beef soup
only is advisable in convalescence, and always with some solid food;
never allow young animals, or unripe fruit or vegetables. Pure
American or Hungarian wine in small doses, but no port wine.
Scraped beef made into a flat lump, salted and fried, or a roasted
potato, is the best when beginning to eat. Too much hunger should
be moderated by the medicine, and very light and plain food given
often, and but a little at a time. For complaints after each morsel
of food, Pepsin may be given; for total want of appetite, give the
indicated medicine, and offer such food as the patient used to eat
when a child.
PRINCIPAL REMEDIES.
The principal remedies are here arranged in the order of their
value. The special indications will enable one to select the remedy
in each case:
Apis, Arnica, Arsen., Bapt., Bryon., Calc. ostr., Hyosc., Laches,
Lyco., Mur. ac., Nitr. ac., Nitr. s. dul.,* Opium, Phosph., Rhus t.,
Sulph., Cinchon., Coccul., Pulsat., Alum. p. s., Bellad., Camphor, Can-
thar., Carbo veg., Cham., Colchic., Helleb., Hydro. ac., Nux mosch.,
Nux v., Phos. ac., Psorin., Secale. Sepia, Silic., Stram., Tarax., Verat.,
Alumin., Coff., Crocus, Cupr., Digit., Dulc., Ferr., Hepar s. c., Ignat.,
Kali c., Merc., Merc. sub., Sulph. ac., Amm. carb., Anac., Ant. tart.,
Arg. nit., Astac., Borax, Carb. an., Chin. sul., Con., Crotal., Ferr. mur.,
*NOTE.- Sweet Spirits of Nitre ought to be prepared in the usual manner,
by mixing one part of Nitrous Ether with eight parts of pure absolute alco-
hol; it ought to be kept in small bottles, and should not redden the cork.
SYMPTOMATIC INDICATIONS.
253
Flu. ac., Ginseng, Glon., Guac., Ipec., Iris v., Jod., Kreos., Lachn.,
Lauroc., Mosch., Nat.mur., Nitrum, Oxal. ac., Selen., Spong., Staph.,
Zinc.
MIND SYMPTOMS.
FEELINGS.
even to the most loved child, Phos.; to
to everything, Sec.;
forehead, Verat.;
Indifference, Arn., Cinch.;
the most loved objects, Merc.;
insensibility, impelling to rub
with a pale face, Cinch.
Apathy, Verat. a.;
extreme dullness of senses, Nitr. sp. d.
with a kind of
and insensibility,
with indifference, Cinch., Phos. ac.; and
Does not complain at all, Op.; no complaint of anything, Hyos.;
unless questioned, he says nothing of his condition, which does not
seem dangerous to him, Colch.; says he feels well, nothing the matter
with him, Arn.; thinks he is well, Ars.; utters no desire, Helle.; does
not ask for anything, has hardly any of the usual wants, Nitr. sp. d.;
no action by will, Helle. Compare stupefaction, stupor.
Anxiety, Ars., Bry.; with nausea and cold sweat on the forehead
while standing, Verat.; -with pressure in the heart and tearing pains
in the loins, sinking of all the forces, but restless, more after than
before midnight, Rhus t.; and weakness, Ars.; and frightful
dreams, Ars.; or waking from them, Chinch.
Does not know what to do with himself, mostly in the third hour of
the night, Ars., Kali c.
Inexpressible sense of illness in mind and body, Merc.; dejected,
debilitated, with aversion to thought, Bry.; either sorrowful, depressed
or violently delirious, Bell.; depression of spirits, with timidity, Sec.;
sadness, Op.; hopeless of recovery, Psorin., and certain of death, Bap.;
uneasiness, with sense of illness, Op.; uneasiness of mind and body,
Op.; fear of being left alone, Hyos., Lyc.; believes he is always alone,
Stram.; timid and fearful, Bell., Bry.; faint hearted, timid, inclined to
weep, fears death, Acon., Ars., Cocc., Rhus t., Verat.
Wants to go from one bed into another, Ars., Bell., Calc. os., Cina,
Cham., Hyos., Mez., Rhus t., Sepia, Verat.
Desire to run away, in later stages, Bell.; and much excited, Stram.
Compare desires.
Frightful objects constantly before the imagination, while his
expression is that of fear and terror; believes he sees dogs, cats, rab-
bits, approaching from all sides, and that he sees ghosts, Stram.
Fear of death, Acon., Ars., Bry., Cocc., Rhus t., Verat.
CONATION, WITH FEELING OF PAIN.
Embarrassed, Hyos., Sulph.; does not know whether he will take
what is offerred or not, whether to take this or that, Hyos.; suspicious,
Bell.; great impatience and despair about pains, and bad feelings
which he cannot describe, Ign.
254
A TREATISE ON TYPHOID FEVER.
Bad humor, Rhus tox.; vexed, irritated, wants to quarrel, Bry.;
chagrined, Nux vom.; quarrelsome, Bell.; angry disposition, Bry.,
Cinch.
Irritable, Cocc., too sensitive, vexed from questions, or gives short
answers, easily offended, Bry.; nervous, with depression of spirits,
and intolerance of all impressions on the senses, especially of noises,
Cinch.; - after muttering for awhile, can endure neither noise or con-
tradiction, speaks hastily, Cocc.; - peevish, easily offended, Bry.
DESIRES.
Desires to get out of bed, Bry.; to change beds, Ars., Cal.; to escape
from bed, Bell., Bry., Hyos., Stram.; to go home, Bry.; to run away,
Bell., Bryon., Hyos., Stram.; to escape, Bell., Op.; to jump out of bed,
Hyos.; restrained and calmed with difficulty, Zinc.; springs up from
bed suddenly, Bell., Nux vom.
Wishes to die, with indifference to the most loved objects, Mercur.;
inclined to weep, with fear, Acon., Bry., Cocc., Rhus t., Verat.
ACTIONS.
Loquacity, afterwards stupid and irritable, Lachnan.; talks all the
time or not at all, Stram.; of the business of the day, or the last
few weeks, Bry.; to himself, Rhus t.; constant muttering, Hyos.,
Stram., Tarax.; Compare delirium.
―
____
Murmuring, Laches.; which cannot be understood, Hyos., Lyc.;
slow Phos. ac.; with picking clothes, Hyos.; loquacity, Hyos.,
Laches.; with an insensible apathy, hardness of hearing, and a pleas-
ant, happy expression, which looks strange, Apis.
Talks incoherently, without any seeming connection of ideas, Lach.,
Rhus t.;
indistinctly, Hyos.; nonsense, with eyes open, Hyos.;
of dogs, wolves, cattle, soldiers, battles, Bell.;
like a drunken man,
Lyc.
Sings and laughs loudly in his delirium, Bell.; laughs, whistles,
recites verses, sings opera pieces, Stram.; whines, and don't know
why, Hyos., moans loudly, Mur. ac.; cries out suddenly, Hyos., Lyc.,
Stram.; from time to time, Ars.
Staring constantly at surrounding objects, with apparent entire self-
forgetfulness, Hyos.
Picking the bedclothes,, Arn., Ars., Colch., Hyos., lyc., Op., Psorin,
Stram., Zinc.; with muttering, Hyos.; in delirium, Rhus t.; catching,
grasping at flocks, Lyc., Phos. ac., Zinc.; playing with his own hands,
(not picking with them), Hyos.; motion of hands as if they would get
things, Phos. ac.; groping about with hands, Op.; waving hands, as if
getting things out of the air, Stram.; reaching after objects in the
air, Psor., Sulph.
Does foolish things, behaves like a madman, Hyos.; acute mania,
Bell., Stram.; beats and scratches others, the milder others talk to
them, the worse they get, Hyos.; abuses those about him, Hyos.;
strikes, bites or spits at his attendants, Bell.; strikes his attendants,
SYMPTOMATIC INDICATIONS.
255
with fearful outcries; great disposition to bite and tear every thing
with his teeth, even his own limbs, Stram.; raving, with pain in the
head, Ars.; never awkward, but wondrously dextrous, Stram.
Answers hastily, Bry., Hepar, Rhus t.; - rightly, but in a quick, vio-
lent manner, as if angry, Rhus t.; with indignation, Puls.; hasty
speech, Bry., Cocc., Hepar.; if he talks at all, it is quick and hasty,
Ars.
AVERSIONS.
Silence, Verat.; as if averse to everything, Nux v.; sits absorbed in
silence, Op.; with an unconquerable inclination to sleep, Cocc.; obsti-
nate silence, will answer nothing, Cinch.; taciturnity, China; don't
want to talk, Phos. ac.; averse to speaking, Rhus t.; with confusion
of head, Merc.; reluctant to answer questions, Phos. ac., Rhus t.; to
speak, Bell.; answers short, Bry.; with "yes" or "no," Phos.; short
and incorrectly, Phos. ac.; declines to answers question, Arn.; answers
no questions, Ars. Hyos.
Averse to speaking, thought is difficult, Rhus tox.; scarcely answers,
in spite of what is done to induce him to do so, appears to hear with-
out understanding what is said, or without allowing it to make any
impression on him, Nitr. sp. d.; permits no one to speak to him, Verat.
Refuses things offered, Bell.; and remains lying indolent, without
sleeping or speaking, Nitr. sp. d.
Indolence, sits in silence, Cocc.; of mind and body; through the
day averse to employment or movement; in the evening averse to
work, pleasure, speech or movement; extremely uncomfortable;
knows not what the matter is with him, Sulph.
Quiet and then suddenly restless, Chlorum; avoids moving about,
is dull in his senses, stupid and embarrassed, Sulph; averse to all
efforts of mind and body, Cinchon.
COGNITIONS.-REPRODUCTION.
C
Unconsciousness, Arn., Ars., Bell., Colch., Hyos., Laches., Lpcop.,
Mur. ac., Op., Phos., Rhus t., Stram., Zinc; and insensibility, mus-
cles relaxed, Op.; with loss of the function of senses, Hyos.; like
a deep sleep, Merc.; with imbecility, Stram.; he knows neither
where he is or what he does, Puls.; lies with both arms stretched
along the sides of the body, ; suddden starts, Canthar.; perceptions
entirely lost, picking at the bedclothes, Colchic.
Insensibility, Ars., Cinchon.; with indifference, Verat.; with
stupor, feels neither pain nor pleasure, Op.; and loss of conscious-
ness, Helleb., Rhus t.; with loss of speech, pulselessness and cadav-
erous aspect, while the natural heat of the body is retained, and he is
in a sleep-like state, from which he emerges with consciousness and
speech, Merc.; stupidity and embarassment, avoids moving about,
Sulph.
Stupor, Apis, Laches., Phos. ac., Rhus t.; with murmuring delir-
ium, Apis; with profuse sweat, Kali carb.; sinks into a state of
apathy or stupefaction, remains perfectly unconscious when spoken
256
A TREATISE ON TYPHOID FEVER.
to or called, cannot be shaken or roused from his lethargy, Hyos.;
apathy, unconsciousness and stupor, with murmuring delirium, Apis;
takes no notice of what occurs, neither sees, hears, nor recognizes his
relatives, insensible to external impressions, Stram.; (compare senses.)
with brown, parched tongue as hard as a board, teeth and gums
covered with a brown mucus, and the usual mucus dried up to hard
crusts, Rhus t.; feeling of drunkenness, with desire to lie down, or
with rush of blood to the head, Bry.; is conscious of no want except
thirst, Hyos.; silly stupidity, sadness, and weakened memory, Op.; loss
of thought for the moment; insensibility so that he knows not where
he is, Merc.; sensibility entirely benumbed, Op.; insensibility; is com-
pelled to rub the forehead, Verat.; giddiness, vanishing of thoughts,
Nux mos.; loss of speech, Hyos.; utter insensibility, Psorin., Sulph.;
cannot be brought to himself, Nitr. sp. d.; when spoken to, answers
properly, but unconsciousness and delirium immediately return, Arn.,
Bell., Hyos.; stupor soon returns, Hyos.
Loss of Memory, Anacard., Hyos.; memory weakened, Op.; forgets
the word while speaking, Arn.; forgets time and place, Merc.; and
what he has said, Mur. ac.; cannot remember the most recent occur-
rences, Rhus t.; remembers events only as dreams; almost entire loss
of mind, Verat.; dullness, like a want of memory, Puls.
Recollection; mind occupied with things past and present, Mur. ac.;
does not know those about him, relatives or friends, Hyos.; does not
comprehend what occurs, knows neither relatives, nor the most famil-
iar objects, Op.; now he knows his friends, and again he does not,
Bellad.
Slowness of comprehension when asked a question, Sulph.; cannot
find the right expression for his ideas, does not remember what has
passed, Cocc.; thinks rightly, but uses wrong words for the correct
ideas he intends to express, Arn., Graph., Lyc.; great difficulty in
speaking, to use the right expressions, Puls.; talks slowly, answers do
not correspond, Carb. veg.; either does not understand the questions,
or does understand and cannot speak, Hyos.; makes irrelevant
answers, Hyos., Phos. ac.; does not understand questions, does not
answer, Sec.; when spoken to, is as if awakened from a dream,
appears silly, and can only comprehend and answer after a great
effort, Sulph.; recognizes what is said to him, but as if after a dream,
Op.; sits absorbed in silence, Op.; sits as if in thought, yet thinks of
nothing; like a waking dream, Arn.
Absent mindedness, with staggering, Ars.; cannot fix his attention
on present objects, or manage his affairs, Sulph.; as if absorbed in
thoughts, and yet a want of ideas, Rhus t.; with insensibility as if
intoxicated, Nux mos.; absence of ideas, Sulph.; entire self-forgetful-
ness, Hyos.
PRODUCTION.
Intellect; difficult thinking and speech, Secal.; — clouded, though he
gives correct answers; unless questioned, he says nothing of his con-
SYMPTOMATIC INDICATIONS.
257
•
dition, it does not seem dangerous to him, Colch.; internal dullness,
as if sleepy or drunk, Op.; obtuse mental operations, with great incli-
nation to sleep, Merc.; mind sluggish, with inability to think, Carb v.
Slow movement of ideas, Phosph., Rhus t.; and also of the power of
comprehension, Cinchon.; answers correctly, but slowly, Nux mos.,
Rhus t.; and reluctantly, Phos. ac.; mental operations slow and diffi-
cult, Rhus t.; ideas move slowly and constantly around one subject,
· Petrol.; with confusion of head as if bound, Carb v.; dwells long on
his answer before giving it, often does not answer at all, Nux mos.;
averse to thinking, debility of mind, vanishing of thought like faint-
ing, Bry.; difficulty of thinking, great forgetfulness, and dullness in
head, Bry.; cannot bring two ideas into connection, weak in his
intellect, Sulph.; inability to think, thoughts cannot be directed or
controlled, Hyos.; slow comprehension of ideas, Op.; confusion of
ideas, Bapt.; stupefied condition; sits as if in thought, like a waking
dream, Arn.; dullness, stupidity, Op., Rhus t.; and sopor, Carb. v.;
lethargy and stupidity, Nitrum.; lethargy of the sensorium, a kind of
half paralysis of the mental organ, Nitr. sp. d.; imbecility, Up.,
Stram.; idiotic state, Helleb.; stupid and disconcerted for many days,
Phos.; with dullness of intellect and all the senses, Op.; does not
think, with confused heaviness in forehead, Arn.; stupidity, with dila-
ted pupils, Sec.; cannot comprehend an idea, with headache, painful
on waking in the morning, Phosph.
Fixed ideas, when he has once grasped a thought, it cleaves to him,
and will not vanish, Pulsat., Petrol.; some one idea haunting him,
monomania, Stram.; the same disagreeable idea arouses him as soon
as he falls into a slight slumber, Calc. os.; great crowd of changing
ideas, Laches., Puls.
Illusions, as if his body were cut in two, in the middle, as if all sur-
rounding objects were very small, while he himself is very large,
Platin.; very long and tall, Pallad.; believes he sees a large com-
pany of people about him, and grasps at them, Stram.; delirious
phantasies, in slumber and waking, as if she was on a distant island,
had great occupation, was a lady of rank, etc., Phos.; speaks to the
absent as if they were present, and calls inanimate objects by the
names of persons, while he takes no notice of his attendants, Stram.;
does not believe to be in his own house, Op.; thinks he is in the
wrong place, Hyos.; wants to go home, Bry.; believes he is always
alone, Stram.; thinks he is dead; muttering stupor, Apis, Lach.; says
there is nothing the matter with him, Arn.; thinks he is well, Ars.;
illusions of the senses, and imagination, Hyos.; has visions of beauty
or terror, Bell.; sees people standing at the foot of the bed, Bry.
Terrible visions, sees animals which he fears, Bell.; with fear, and
desire to hide or run away, Puls.; hides under bed-covers, Stram.;
frightful visions, Carb v.; the 14th day, Calc. ostr., Stram.; frightful
phantasies, in the evening in bed, with frightened starts on closing
the eyes to sleep, Cinchon.; sees things all the time, Bell., Calc. ostr.;
vivid hallucinations, Mur. ac.; of sight, hearing and smell, Stram.;
D 16
258
A TREATISE ON TYPHOID FEVER.
with frequent changes of vision, (in T. versat.), Hyos.; absent persons
talk to him, Stramon.
When closing the eyes, sees persons and events before him, that are
neither fearful nor anxious, mostly strange faces, Ars., Calc. ostr.,
Carb. v., Samb.
DELIRIUM.
Mild, Ars., Op., Phos.; changing, with loud talking, Bell., Hyos.,
Stram.; talks about business matters, Bry.; with coldness, Ver.; with
attempts to run away, Bry.; in the beginning, only in sleep or on
awaking, Bry.; — in early stages, Bell.; second stage, Hyos.; after two
weeks, Calc. os.; and makes no complaint, in second stage, with gen-
eral heat, Hyos.; continued when awake; sees persons who are not,
and have not been present, Hyos.
Constant, Bap.; with congestion to head and face, Op.; allowing no
rest or sleep, Mur. ac.
Low, Rhus t.; murmuring, Arn., Hyos., Lyc., Rhus t., Stram.; slow
murmuring, Phos. ac.; muttering, Bell., Op., Ver.
After Calc. os., if the patient is harrassed by muttering delirium, a
tearing and stinging headache, lies in a state of quiet sopor, some-
times interrupted by screaming and scolding, with distended abdo-
men, Lyc. Jahr.
Soliloquizes much, Rhus t.; constant talking, thinks he is roaming
over fields, swimming, lying in the water for hours, Rhus t.; of old
occurrences, with open eyes, and recognizes what is said to him only
as if after a dream, Op.; with talking of religious things, of fulfill-
ing vows, prayers, Ver.; indistinct loquacity, Apis, Hyos.: loquacity,
mild or terrified, Stram.; about his avocations, Bry.; very
loquaciously, with brilliant eyes and circumscribed redness of the
cheeks, afterwards stupid and irritable, Lachn.; loquaciously, or
violently and loudly, Bell.; with singing, laughing and whistling; con-
stant involuntary odd motions, objects appear oblique, Stram.: talks
of ghosts devils and spirits, which he says surround his bed and afflict
him, Op. (Compare Actions.)
Imagines to be under the control of strangers, and desires to go
home, Bry.; goes out of bed, does not feel as if he were at home,
Op.; impression that he is elsewhere than at home, Ver.; talks of
going home, Bell., Bry.; talks of starting on a journey, wants to be
dressed, is ready to go, Op.; attempts to get out of bed, Bell., Hyos.,
Op., Stram., Zinc.; attempts to escape, Bell., Hyos., Op.; inclination to
run away, compare desires.
With Visions, Stram.; changing images from the past or present,
keep him active and irritated, Mur. ac.; frightful objects, Stram.
(Compare Frightful Visions, under Painful Feelings.)
Furious, Bell., Colch., Fuls., Zinc.; at the height of the disease,
Strum.; amounting to roaring madness, Zinc.; furibund, with loud
talking, laughing and attempts to escape, Op.; raving, restless,
obstinate, objects to sleep, redness and prominence of eyes, with intol-
erance of light, Bell.; violent, with staring eyes; strikes, bites, or
SYMPTOMATIC INDICATIONS.
259
—
spits at his attendants, Bell.; cries, strikes at all around, Canth.;
cries even to hoarseness, and complete loss of voice, Stram.; with
desire to escape from bed, Bell., Hyos., Stram.; maniacal, gets up,
tries to run away, screams, roars with sunken features, cold feet,
quick pulse, Zinc.; violent, followed by vomiting and deep sleep,
Sec.; violent, constant talkativeness, with subsultus tendinum, and
other movements, Valer.; - during the hot stage, Ars., Bell., Hyos.,
Op., Rhust.; with pain in limbs, Rhus t.
P
Delirium, with stupidity, Nux mos.; with stupor, Bap.; - with loss
of consciousness, Puls.; after still greater vertigo, like intoxication,
with sense of lassitude and weakness, Sec.; quiet, with great stupe-
faction and dullness of head, Phos. ac.; anxiety, headache, noises
before the ears, great restlessness, loss of speech, trembling and
anxious sweating, Ars.; violent pain in forehead, Bell.; heat of head,
Camph.; with open eyes, Bell., Hyos., Stram.; on closing eyes, all
sorts of frightful phantoms, Calc. os.; with sunken features, Zinc.;
with vomiting, and after it, deep sleep, Sec.; wild, alternating
with stupor and stertorous breathing, with open mouth and depres-
sion of the lower jaw, Laches., Op.; with hoarseness, Stram.;
with floccilegium, Phos.; with subsultus, Valer.; (See Actions.) on
going to sleep, Cinchon., Ginseng.; as soon as he falls to sleep,
Gels., Spong.; with sleeplessness, Bell.; with deep sleep after-
wards, Sec.; with sopor, Lyc.; with cold feet, Zinc.; with cold,
clammy skin, Camph.
Times of the day; in the evening, with hasty speech, Bry.; especially
at night, about business or previous affairs, Bry.; after midnight,
Kali carb.; in the morning, upon business, with disposition to run
away, Bry.
Agitation, restlessness, jumping out of bed, attempts to run away,
Hyos.; drunkenness, with staggering or indolence; frantic drunken-
ness, Nux mos.
Prostration, with depression of spirits; weakness, with inability to
do any work; marked sinking of strength, with inability to move;
want of tone in the solids of the body, Op.; - of the mind, he cannot
bring two thoughts together, as if quite stupid, Rhus t., and depression
of spirits, Merc., Nuph.; with torpor, Arn.; mentally restless, but too
lifeless to move, Bapt.
Fright; is frightened easily, Ign.; with nervousness, Kali carb.; ter-
rified, Stram.
MENTAL STATES AS CONDITIONS.
Mental exertions cause bodily symptoms; on endeavoring to fix
the attention on an object, throbbing in the vertex, Nux v.; great
anxiety and worriment of mind, Calc. os., Cupr.; long grief, Ign., Op.;
violent passions, Cham.
SENSES.
Increased sensibility, of all the senses, Bell., Mur. ac.; especially of
hearing and smell, Phos.; especially to noises, Chin.; sounds, talk-
260
A TREATISE ON TYPHOID FEVER.
ing, odors and light are insupportable, Nux rom.; increased perception
of the usual pains, Bry.;- followed by dullness, Rhus tox.; percep-
tion slow, or not comprehended, Helleb.; dullness of all the senses,
Stram., Sulph.; with apathy, Nit. sp. d.; as if the senses had ceased to
act, Helleb.; with heavy eyes and extreme weakness, Opium; senso-
rial action sunken, Carb. veg.; is completely insensible, as if in a
dream, he neither sees nor hears, Bell.; perception entirely lost,
Colch.; loss of senses, Apis, Verat.; no complaints, has no pains when
pinched, Phos.; stupefaction, Stram., with watery eyes, Opium; hal-
lucinations of sight, smell and hearing, Stram.
SENSORIUM.
Stupefaction; of the head, with dullness of vision, Stram.; — drunk-
enness, and beclouding of the head, Nux vom.; —and dullness, Rhus
tox.
Confusion; of the head, Arnica, Rhus tox.; cannot read, nor perform
the least labor, Merc.; as if bound, with slow ideas, Carb. veg.;·
and stupefaction of mind Secale; —with vertigo, Puls.
Dullnes; difficult to think, Strum.; and heavy feeling, Gels., Puls.:-
and vacuity, Sulph.;- like a want of memory, Puls..;- and heat of
head, Camphor; -with bruised pain in the forehead, Puls.;-with
cold sweat on the forehead and hands, Coccul.; and giddiness,
when getting awake and sitting up, has to lie down, Opium.
Weakness in the head; if he turns it, he loses his consciousness for
the moment, and after stooping he cannot rise, Rhus tox.; - and stu-
pidity, Khus tox.; and lightness, Stram.
Vertigo; like drunkenness, Hyos., Puls.;-increasing after delirium,
Secale.;
as if he would fall, after rising from the bed, Bhus tox.;
with dullness in the forehead, as if a board were before it, Coccul.;
with staggering, and inability to stand erect, Secale.;-the whole day;
whirling, while moving, especially the head, Carb. veg.; — increased
by raising the head, Arnica, Cinchona; when rising up in bed,
Bry., with nausea, compelling to lie down again Coccul.; as though
he were swung to and fro in a cradle, or in a swing, Ignatia; — while
lying on the back, like a whirling, with qualmishness; better when
lying on the side, Merc.; when standing, Lachesis, Secale; when sit-
ting up, Bry., Phos ac., Tarax.; falls when trying to sit up, Phos. ac.;
—while raising or moving the head, Arnica ; on rising from lying
on the back, with obscure vision, Nux vom.; - when moving, especially
after motions, Bell.;
the head, Arnica, Carbo veq., Puls.;
rising, Coccul., Nux vom., Rhus tox.; compelling to lie down, Bry.,
Coccul.; — in the morning on awaking, with weakness of the limbs,
Cinchona; - so that he cannot rightly comprehend an idea, Puls.;
with confusion and stupidity of the head, as if he would lose his
senses, Phos.; with anxiety and glimmering before the eyes, Bell.;
- and headache, Bry.; with heaviness, Cinchona;
on
with obscured
vision and ringing in the ears, as if there was a whirling in a circle in
the brain, with momentary loss of consciousness, Nux vom.; — with
with muscular restless-
nausea and subsequent heat, Cinchona;
SYMPTOMATIC INDICATIONS.
261
ness, Nux mosch.; and fainting while leaving the bed, Opium ;
and sleepiness, as if drunk; he does not know where he is, and walks
with eyes shut, Nux mosch.
INTERNAL HEAD.
Heaviness of the head, Nux mosch., Opium; - and all things seem to
whirl in a circle, Verat.; - with sense of empty confusion, and severe
pain, Hyos.; — and dulness, Gels., Puls.; and muddledness, Merc.;
like lead in the forehead, with dull pain, Carbo veg.; — with pressure
in the brain, and desire to lie down, Bry.; - has difficulty in raising
it, Puls.; —of occiput, like lead, so that the head constantly falls
backwards, Opium; — with intolerance of light, Puls.; —in the morn-
ing, with drunken vertigo, Nux vom.;
- in the vertex, Sulph.;
with sensation of fullness, Sulph.
Humming and buzzing in the head almost the whole day, Phos.; she
cannot go to sleep, because she cannot get herself together; her head
feels as though scattered about, and she tosses about the bed to get
the pieces together, Bapt.
-
Headache, dull, stupefying, with confusion of ideas, Bapt.; heavi-
ness and confusion in the head, Bell.; at the base of the brain, in
the forehead, and especially in the membranes of the brain, Hyos.;
the brain seems to be the only organ affected, Helleb.
Congestion, to the head, Bell., Opium, Stram.; during the early stage,
especially in tumultuous cases, with great drowsiness, but inability to
go to sleep, and frequent starting during sleep, Bell.; - to the head,
with moderate delirium, Apis; venous —, with dark red face, Opium.
Throbbing, of the carotid and temporal arteries, and also in the fore-
head, Bell.; in the top of head, left side; in the back of the head, or
in the temples, frequently for half an hour, Phos.; - in the forehead
and occiput, worse when moving, Bry.; from every movement,
with heat in the head, Lach.; - sensation as if the head were bound
with a band, with pressure, Merc.
C
Stupefying pain, Bapt.; pressing in the forehead, and great heavi-
ness, with rushing sounds in the ears, Ars.; heavy, stupid headache
in the frontal region, Bry.; -pressure in the forehead, which changes
into shootings or tearings (on the left side), Hyos.; pressing, contract-
ing, stinging headache, Bell.
Pressing outwards in the temples, Merc., Rhus tox.;-the sides
together, Rhus tox.; —in the occiput outward- in the forehead, with
pain in the supra-orbital bone, mostly when touched, Merc.; dull or
stitching pains, worse from motion, and opening the eyes, Bry.; pain
in forehead and temples, Apis, Bell., Glon., Hyos., Stram.
Tearing pain in the occiput, Tarax.; on left side, Hyos.; as if the
brain were torn, Rhus tox.; in the morning on awaking, and after,
Puls.
Bruised pain, as if compressed, Nux vom.; in the forehead, Puls.; in
the occiput, as if the cerebellum were bruised, Rhus tox.; pain first in
the forehead, then in the occiput, Nux mosch,
262
A TREATISE ON TYPHOID FEVER.
Headache with the delirium, Ars., Colch.; violent pain in the fore-
head, Bell.; increased by moving the eyes; eyes red, prominent,
staring, sparkling, brilliant, distorted, or affected by spasmodic
motion, Bell.; worse from opening and moving the eyes, Bry.,
Rhus tox.;—in the forehead and eyes, Bapt.; does not allow opening
of the eyes, followed by attacks of yawning and stretching, Ignatia;
when waking from sleep, Rhus tox.; in the evening, Bry.; with las-
situde, Bry.
Heat, and burning in brain, Calc. ostr., Phosphor.; — in head, Cam-
phor; and fullness, Sulphur; sensation of mostly in head, Bry.,
Rhus tox.; —and chilliness in body, Coccul.; cerebral irritation pre-
dominant, Apis, Bell., Bry., Cuprum., Hyos., Lach. Opium, Stram.,
Zinc.; again the 14th day, Calc. ostr.; inflammatory cerebral irritation;
power of the senses and mental faculties impaired, speech heavy and
embarrassed, they no longer recognize their own relatives, or are car-
ried away by a furious delirium, and make attempts to escape out of
their beds, Bell.
EXTERNAL HEAD.
Throbbing of arteries, Bell., Opium; turns the head from side to
side, Arsen.; frequently raises or jerks the head from the pillow,
Stram.; movement of occiput, grasping it with hands, Carb. veg.,
Opium; raises up the head, but it constantly falls backwards, and the
mouth opens to the widest extent, Colchicum; inability to hold up the
head; congestion (see Eyes), Opium; he can hardly hold the head
erect, and falls asleep, Cinchona.
Forehead covered with cold sweat, Colchicum, Mercury, Veratrum ;
head and extremities cold, body hot, Phos.; great sensibility of scalp
to the touch, like a boil, Rhus tox.; impelled to rub the forehead, with
a kind of insensibility, Verat.
SIGHT AND EYES.
Sight, intolerance of light, Bell., Puls.; sensibility to it, Lachesis;
shuns the light, Mur. ac.; hallucination of sight, all objects appear
oblique or double, or smaller and further off, Stram.; obscured vision
with vertigo, Nux vom.; diminished sight and hearing, or entire loss
of these senses, Secale; apparent loss of sight, Psorin, Sulphur; blind-
ness, Gels., Stram., Zincum; loss of sight, hearing, and speech,
Stram.
Pupils much dilated, little sensitive to the light, Carb. veg.; and
immovable, Colchicum; — dilated and immovable, Stram.; - oftener
large than small; no reaction to light; either contracted, or greatly
dilated and immovable, Bell.; immovable, but sees and talks,
Stram.;-immovable, and but slightly dilated, Colchicum; dilated,
Merc., Helleb.; with restlessness, Nux vom.; contracted, dilated, or
immovable, insensible to light, Opium; much contracted or dilated,
and insensible to light, Cinchona; first contracted, then dilated,
Puls.; the left pupil contracted, while the right is dilated, Colchicum;
- contracted, or dilated, with slow respiration, Coccul., Hyos., Nux
SYMPTOMATIC INDICATIONS.
263
vom., Secale, Verat.; contracted, Arsen., Mur, ac., Stram., Sulphur,
with cloudiness of the head, Arnica.
Eyes; bright and injected, Glon., Helleb., Hyos., Stram.; — glisten-
ing, Ars., Stram.; with contracted pupils, Mur. ac.; brilliant, with
delirium, Lachnan.; unusually bright, Op.; red and sparkling,
staring, Bell.; rolling about in their orbits, Hyos.; glassy, Bell.,
Opium; and tearful, Bryonia; dull, Gels., and weak, Merc., Lach.,
Stram.; — without lustre, Ars., Hyos., Merc.; and pupils without reac-
tion to light, Carb. veg.; without expression, Bell.; vacant look,
with dilated pupils, Helleb.; expressionless, like the of a dying
man, Opium; -watery, Bry.; and stupid senses, Opium; and sunken,
Ars.;-beavy, Baptisia; - Opium, dim and sleepy, Phos. ac.;- promi-
nent and turned upwards, Ars., Opium; turned awry, Nit. sp. d.;
have a wild expression, Ars.; hollow, sunken - Colch.; dull and
sleepy, Phos. uc., Stram.;-dull and heavy, Rhus tox.;
turned up
and lying on back, Psorin, Sulphur ; wild and wandering, Secale;-
convulsed, Bell.; and prominent, Hyos.; and immovable, Opium; -
turned upwards and looking over the forehead, Opium; rolling of the
eyes, Bell., Hryos., Secale.; austere look, Bell.; distorted, Lach.;
and staring, Hyos.; squinting, Bell., Hyos., Lyc., Stram.
Staring; Hyos., Opium, Phos. ac., Secale, Zincum; — with open eyes,
at one point, Bell.; at surrounding objects, Hyos.; with watery
eyes, without comprehending what occurs, or recognizing his rela-
tives, Opium; -with slow comprehension, and slow answers, Helleb.
Eyelids; trembling and jerking, Coccul; open, Bell., Hyos., Lyc.,
Opium, Stram.; with sopor, Lyc.; — open, and lies speechless, Opium;
open, in delirium, Ars., Opium., Stram., Verat.;- half open, Colch.;
half covering the dull eyes, Phos.; —paralyzed, sunken down, either
cannot or will not open them, Coccul.. Lach., Zincum; heavy and full,
closed as if paralyzed, drowsiness increases to coma, Coccul.; drop,
Ars., Gels.;-contracted, Bell.; difficult raising of the -, Opium; on
closing the frightened starts, Cinch.; frightful phantasies, Stram.;
visions, Bry., Calc. ostr.; injected, Baptisia, Opium; - red, Hyos.;
chronic soreness and inflammation of- Sulph.; catarrhal ophthal-
mia, Euph.; covered with pus, suppurating, Hyos., Zincum; closed
with sticky matter, Ars.; pale watery, swelling like a little bag over
the eyes, Kali carb.
Eyes sunken, Ars., Colch., Lyc., Phos., and heavy with blue circles,
Phos.; and hollow, Colch., Phos.; hollow, with dark circles, Cinchon.
HEARING AND EARS.
Hearing; over sensitiveness, Bell., Bry., Lyc., Mur. ac., Phos.; to
music, Bry.; every sound annoys him, Sulph.; noise is intolerable,
Cinchon., Coccul.
Ringing; Ars. Coccul.; in the head, Ars.; and rushing sounds in the
ear, Opium; buzzing, singing, rushing sounds, Hyos.
Rushing sounds: Hyos., Merc.; like noise, Ars.; like wind, Puls.,
and humming, Secale; and thundering, Lach.
264
A TREATISE ON TYPHOID FEVER.
Illusions, hallucinations, Stram.; like rain or music, Mur. ac.;
with vertigo, Nux. vom.
Hardnsss of heariny: Apis, Ars., Bry., Phos.; — commencing with
buzzing, Hyos.;—in fever, Bell., Chlorum, Carb. v., Hyos., Nitr. sp. d.,
Phos. ac.
Deafness: Bell., Carb. v., Chlorum, Hycs., Lachnan., Lach., Merc.,
Nit. sp. d., Phos. ac., Psor., Stram., Sulph.; as if the ears were stopped,
one or both, Verat.; with a rushing sound, Merc.; like the wind,
Puls.;—with humming and rushing sounds in the ears, Secale; - with
ringing in ears and head, Ars.
Great dryness in the ears, disappears rapidly after a dose of Sulph.
Parotid glands swollen, Merc.
SMELL AND NOSE.
Nose. Can endure no odors, Sulph.; smell and taste very acute,
Mur. ac.; frequent bad smell, Ars.; hallucinations of smell, Stram.
Dryness; in the nose, Bry., Nux vom., Phos.; in the nostrils, Puls.;
of the nose, lips and tongue, Mur. ac.; coming from the mouth,
Bell.; from the mouth and throat, Bell.
Nasal mucus dried to hard crusts, Rhus tox.; acrid ichorous dis-
charge, excoriating the alæ nasi and upper lips, rendering them raw
and sore, Arum triph.
Bleeding: Arn., Hyos., Lach., Phos. ac., Sec., Sulph. ac.; only from
right side, at night, in sleep, Verat.; - from the mouth and gums,
Carbo veg.;-from the teeth and gums, Sulph.; for seven days,
Sulph.; continued - Nux vom.;- frequent and copious, mostly in the
evening, Phos; hæmorrhage, Carbo. veg.; at night, Rhus tox.; - in
sleep, Bry., Merc.; -mostly after midnight or in the morning, Rhus
tox.; -mostly at 3 o'clock A. M., or after rising;-daily, for many
days, Bry.; —at the commencement of the disease, Rhus tox.; —with
salivation, Hyos. (do not give Merc.); —relieves, Rhus. tox.; does not
relieve, Phos, ac.
Nostrils; distended, Opium; fan-like motion of -, Lyc.; dry, Puls.;
and black, Colch.; sooty, smoked, Ars., Chlorum, Helleb., Hyos.;-
look smoked with dry tongue and mouth, Chlorum.
Nose pointed, Verat.; and cold, Camphor; and cold mouth, Verat.,
(Cina.)
FACE.
Face: cold sweat on the forehead; cool, pale, moist, thin, death-like
features; at the height of disease, Verat.; cold, covered with cold
sweat, Carb. veg.; — hot, mostly in the evening, Bry.; - sweats on the
right side, Puls.; - covered with sweat, Colch.; wears a happy and
strange expression, Apis; stupid expression, Colch., Stram.; listless
expression, Rhus tox.; besotted expression, apathic and indifferent
mind, Phos. ac.; stupid expression without collapse, Helleb.; stupid
aspect, with relaxed and hanging facial muscles and lower lip,
Opium; relaxation of the facial muscles, Opium, Zincum; trembling
SYMPTOMATIC INDICATIONS.
265
and jerking, Coccul.; convulsive trembling of lips and tongue,
Opium; spasmodic distensions, Stram.; distorted, Hyos.; spasmodic
action, Coccul.; as if from pain, Stram.; stupid expression, Hyos.;
sunken features, Zincum; anxious, hippocratic-, Ars.; expression
of fear and terror, Stram.; wild expression of features, with fullness
and redness of face, Bell.
Cheeks, yellow, with central deep flush, Bapt.;- reddened, Bell.,
Hyos., Mur.ac., Stram., and hot, Bell., Rhus tox.;- red and burning,
Bry.;-burning hot, with circumscribed redness, Ars., Mur. ac., in
afternoon, Lyc., with delirium, Lachnanth.; one red, the other
pale, Cham.; alternately red and pale, Verat.;-red, even blue, Bell.;
Face, dark red with snoring, Opium; with a besotted expression,
Bapt.;-red, with heat, Verat.; -red and cracked, Zincum ; —red
and bloated, Opium; blue, Carb. veg. Lach., Verat.; — bluish red,
with feeble, intermitting pulse, Verat.; - brown, bluish, black, Ars.;
- black and cracked, Lach.; — shining and puffed up, Bell.; -red
and bloated, Opium; pale, waxy complexion, Zincum ;— sunken and
pale, with pointed nose, Coccul.; waxy white or yellow, Silicea,
Zincum ; — yellow, Lyc., and dirty color, Merc.; — yellow and pale,
Bry.;— suddenly yellow and pale, after the first week (generally fatal),
Lyc.; — pale, sickly aspect, Kali carb., as after long illness; with
great uneasiness, and sunken eyes, with blue circles around them,
Sulph.; sick look, mostly in the evening; hollow, sunken eyes, with
blue circles, Phos.; - pale, ashy, Phos.; ashy color, with wild delir-
ium, alternating with restlessness, wants to be somewhere else; dry
tongue, smoky nose, diarrhoea, prostration, subsultus tendinum and
deafness, Chlorum; pale, dingy, or earth-colored, and sunken,
Ars., Phos., and cold, Carb. v.; — collapsed, Camph. ; — sunken Colch.,
Lach., Merc., Zinc.; — pale and expression dull, Sec.; nose pointed, eyes
sunken, Coccul. Phos, ac.: yellowish and sunken, Lyc., with sharp
nose and hollow eyes, with dark circles around them, with insensi-
bility and indifference, Cinchona ; and eyes sunken, Cinchona,
Merc. Phos. ac., Phos. Sulph.; -- pale, cold, cadaverous, sharpened nose
and sunken cheeks, blue circles around the eyes, Verat. alb.; deathly
appearance of -, Merc; hippocratic Ars., Carb. veg., Cinchona,
Colch., Phos., Secale, Zincum; cadaverous aspect, and extreme pros-
tration, Colch., Verat., while heat of body is retained, Merc.; petechiæ
Bell.
on --,
-
"
Jaw, rigidity of the muscles, Bapt.; pain in joint of lower Bapt.
-falling, Ars.; - dropping, Bapt., Lach.; hanging down, Lach.,
Lyc., Mur. ac.,Opium ; -- hanging during the coma, Lach.; sunken,
Secale; lower lips hanging, Opium; trembling, Arn.
OUTER MOUTH SYMPTOMS.
Mouth open, Merc. Phos.; to the widest extent, Colch., distortions
Bell., Camphor, Opium.
Lips, trembling, Stram., Sulph;--and tongue pale, Phos. ac.;
bright red, Sulph.; — dark red and dry, Bell.;- bluish red, black or
266
A TREATISE ON TYPHOID FEVER.
brown, Ars.; — dry an´l brown Nit. sp. d.; —covered with
slime, Colch. Ars.; crusts on the-, Ars.;— blue, Carb. veg. Cinchona;
dry and blackish, Ars., Bell., Bry. Lach., Phos. ac., Rhus t., Verat.;
- covered with black slime, Ars., Cinch., Phos.; as if parched by
thirst, Arn., with dryness of the palate, Phos., and brown or black,
Rhus tox.; crusts on- and tongue, Ars., gums and teeth covered
with brown or black slime, Ars.; -- teeth and tongue covered with
a thick brown coating, Colch.; dry, parched, and covered with
brown or black crusts, Ars., Rhus tox.; dry, Mur. ac., and
cracked, Ars., Bell., and brown, Bry., and hard, China; — cracked,
Colch., Puls., Sulph., and sore, Stram.; dry and black, Verat., and
bleeding, Lach.
—
A
Corners of mouth sore, Ars., Arum triph.; pain as if cut, excoriation
and cracks, ulceration, with pains as of excoriation, Merc.; —and
upper lip raw and sore from acrid, ichorous discharge from nose,
Arum triph.; eruption around lips, Phos. uc.
Teeth, grinding, Ars., Colch., grating. Hyos.,— covered with brown.
or black slime, Ars.; sordes on —, Bapt.; and lips Stram., covered
with a thick brown coating, Colch., brown slime, Hyos.; covered with
a dark mass, Hyos.; brown mucous, deposited on—, Sulph.
Gums, at the beginning, swollen and bleeding, Merc.; -- spongy,
separating and bleeding on the slightest touch, Carb. veg., Merc.,
Phos.; — and teeth covered with brown or black slime, Ars.; — covered
with brown mucus, Rhus tox.
Taste, and smell very acute, Mur. ac.; insipid, pappy and slimy,
Merc.; pappy-in the mouth, Coccul.; bad, Bapt., foul, nauseous,
viscous, flabby, soap-like, Merc., food is without taste, Nux vom.;
tastes neither food nor drink, Rhus tox., food tastes like straw,
Stram., like nothing, Ars.; bitter, Bry., Lach.; of things eaten,
Puls.
Speech, stammering, Ars., Bell., Carb. veg., Lyc., Secale., Stram;—as
if the tongue were too heavy, stuttering, Verat., unintelligible—,
Ars., -lisping and stammering, Bell., Opium, Stram., Verat.; - mut-
tering and mumbling; it costs him great effort to speak the words
plainly, Coccul.; impeded -, Phos. ac., from a dry, hard, glazed
tongue, Ars., falters and hesitates in speaking, aversion to the
effort, Sulph.; only answers with indignation, Puls., difficult, weak,
indistinct, Secale., indistinct —, Hyos.,
Hyos., nasal Lach., from dryness
in the throat, Bry.; speaks slow and weak, as if the organs had an
impediment to overcome, Secale, as if they could not move the
tongue, Carb. veg.; reluctant speech, Bell.;— difficult, Phos. ac.; with
heaviness of the tongue, Lach.; — from difficult respiration, and great
debility, Bell.; can only speak loud with great effort, Opium ; inability
to speak loud, Nux vom., lisping, Ars., Bell., Stram.; loss of — Colch.,
Hyos., Verat., and of consciousness, Merc.; with subsultus, Secale;
organs as if paralyzed, with lisping and stammering, Stram.; complete
aphasia, Bell.; inability to talk and to put out the tongue, which is
cracked, sore and ulcerated, Apis; hasty, (see Mind.)
SYMPTOMATIC INDICATIONS.
267
:
Tongue, trembling, and hard to put out, Gels., Lach.;-trembles when
put out, Bell., Lach., Secale; - trembling, Ars., Bell., Gels., Lach.,
Lyc. Secale; when protruding, Lach., Stram,, and dry and cracked,
Ars.;-sometimes spasmodically thrust to and fro between the teeth,
Lyc.;- comes out dry and black, with a snapping noise, and goes like a
pendulum, Lyc.;- trembling in the attempt of protruding, Secale; or
the tip remains under the lower teeth, or lip, and does not come out,
Lach.; can hardly put the-out, it trembles, Gels.; cannot put the
--out, Gels., Hyos., Lach., or if he does it trembles, Lyc.; after the-
is put out with difficulty, can hardly draw it in, Hyos.; -- protruded
with difficulty, Colch., Lach.; does not move rightly, Bell.; cannot
move the-at will, even if conscious, Mur. ac.;-stiff, like a piece of
wood, Ars.;- heavy, stiff and numb, Colch.; as if stiff, difficult
motion while swallowing, Lach,;- immovable from dry, black crusts,
Phos.; sensation as if-was too thick, while speaking, Nux vom.;
heavy, with stammering, as if drunk, Bell.; Lach., and immobility,
with difficult speech, scarcely movable, Carb. veg.; paralytic weakness
of — Bell.; — paralyzed, Baryta c., Hyos., Lach., Mur. ac., Opium,
Stram.; - paralyzed on the right side (turns to the left,) Bell.,-as if
burnt, and insensible, coated, Puls.
•
Tongue, dry, Bell., Chlor.; Gins., Hyos. Lachn., Laches, Mur. ac., Nat.
mur., Nux mosch., Op., Phos., Phos. ac., Stram., Verat.; and lips dry,
Phos. ac. See Lips. Very dry nose and lips, Phos.; burning-and
lips; looks like burnt leather, Hyos.; --rattles like leather, Mur. ac.;
dry and hard, Merc., and glazed, Ars., and stiff as a piece of board,
Ars.,and cracked, Bell., Hyos., and red, Laches., and trembling, Ars.;
great sensation of dryness of, with excessive thirst, drinks but little
at a time, Ars., and great thirst, drinks much, Bry.; not coated, with
desire for drink, Rhus tox., dryness of-- without thirst, Opium, Pal-
lad.; as if burnt, and yet no thirst, Magn. mur., Puls.; - dry, with
diarrhœa, Phos., and debility, Nat. mur., in the morning, Sulph.;
red, Hyos., Lachnanth., Rhus tox.; -- bright red, Colch.; covered all
over with raised papillæ, Ant. tart., Bell., and dry, Ars., Baptisia, Bell.
Laches,, Lyc., Rhus tox.; dry and cracked, Ars., Hyos., and hard,
Hyos., Rhus t., and hot, Bell., and glistening, Laches., Kali bich.;
dry and dark red, Bapt.; - raw, painful, inflamed in middle, Gels.
Tongue clean, or only lightly coated, Gels., Mur. ac., with gastric
and other derangements, Cina, Dig.; clean and dry, Stram.; -dry,
with thirst, Rhus t.; dry, red, and hard, Bry., Hyos.;
almost clean,
(
with hard, bright red edges, and cracked lips, Op.
Tongue smooth, not very dry, Phos. ac., and white, Bell., and glossy
as if deprived of its papillæ, Terebinth.
Tongue rough and dry, Stram., and cracked, and dark brown, Bry.;
brown or blackish, Merc.; - sticks to the roof of the mouth, Nux
covered with a thick, tenacious paste, like a layer of putty
spread over it, Bry.
mos.;
Tongue brown, Bap., Hyos.; colored brown and black, Sec., and
•
268
A TREATISE ON TYPHOID FEVER.
-
and lips, Ars. See Lips.
lead-colored, Ars., Carbo v.;
dry, Hyos., and hard, Rhus t., and parched, as hard as a board, with
diarrhoea, Rhus t.; crusts on
brownish,
Nux v.; pale, Carbo v.;
bluish or
pale, Carbo v., and small, Mur. ac.; blue, pale or sticky, Carbo v.; dark
colored, Bry., Staph.; blackish -, Merc., Ver.; black, Ars., Lach.,
Op, Rhus t., Sec., and cracked, Cinchon., Ver., with deep edges, Nux v.;
raw and burned, Cinchon., and dry, Ars., Laches., Lyc., Op., Phos.,
Rhus t.; -furred very lightly, Mur. ac.; and mouth covered with a
muddy paste, Carbo v.; hard thick phlegm on Rhus t.;-dry, brown,
as if burned, Ars., Lyc.; full of thick dirt, or hardened phlegm, Rhus
tox.; thick and gray coating on Merc.; grayish-white slime on
as if coated with a skin, Phos.; sticky and dirty, Lyc.,
and yellow, Puls.; thick white, or dirty white
furred in the beginning, Cocc.; thick, dirty-
Merc., and stools of greenish mucus, Nitr. ac.;
Nitr. ac.; has a red margin
Phos. ac.;
and moist, Carb. v.,
coating on - Bry.;
white coating on —,
white coating, with sore spots on
and white centre, Bell., Gels., Sulph.; furred in the middle and
behind, not on edges, Bry.; dry, with a brown streak in the middle,
Arn., Bapt.; two white stripes on a red ground, Bell.; yellowish-
brown, dry in centre, Stram.; white coating on sides of —, Caust., in
centre, Bell., Bry., Gels., Phos., Sulph.; sore spots on
Nitr. ac.,
Tarax.; mapped —, Ars., Lyc., Nat. mur., Tarax.; yellow, Bry., and
sticky, Puls., and rough, or dry, with whitish-yellow coating, Bap.,Coc.;
- yellow and red, Puls., yellowish, later, brown and dry, Bry.; gray
coating and cracked, Puls.; brown, Hyos., and dry, mostly in the
centre, Bap.; - grayish-white, Phos. ac.; thickly covered, Colch.,
and cracked, Bry.; brownish, cracked crusts on -, Phos. ac.;
ered with dark brown sordes of an offensive odor; foul
with a thick layer of yellowish or brownish fur, Bry.; remaining after
Bryonia, Nux v.
Tongue cracked, Apis, and parched, Carbo v.;
M
COV-
covered
as if scalded, Ver-
atr. v.;
as if burned, Ars., and rough, dry, and dark brown, Bry.;
thick, Nux v., and too red, dry and swollen, Verut a.; - swollen and
dry, Stram.; small, atrophied -; substance altered, Mur. ac.;
indented from the teeth, Ant tart.; soft with imprints of the teeth,
Kali hydr., Merc., Rhus t.,. Stram.; shooting in the -, Bry.; — red,
raw, painful and inflamed in the middle, Gels.; sore, red, with ele-
vated papillæ, Arum t.; painful, as if chapped and burning, Merc.;
- covered with black crusts, Phos., with vesicles, Apis; white-coated
with sore spots, Nitr. ac.; - has a coating, which on removal,
leaves sore spots, Tarax.; cracked, sore and ulcerated, Apis, Bap.,
fissured, dry, Carb. v.
Tip of tongue remains under lower teeth, or lip, when attempting to
put it out, Lach.; clean and pointed —, Kali carb.; heat and dryness of
—, Carb v.;
dry, Nux v., and red, Bell. (Rhus t.); undefined redness
of —, and redness of the borders, Ant. t., Bell., Rhus t., Sulph.; — red,
in the shape of a triangle, Rhus t.; a whitish coating on one side,
Rhus t., on both sides, Caust.; red and cracked, or cracked and
SYMPTOMATIC INDICATIONS.
269
bleeding, Laches.; as if burnt and rough, Phosph:. fissures on the
一​,
Laches.
Dryness; of mouth, Chlorum, and tongue, Mur. ac., and food tastes
like straw, Stram.;
in early stage, Nux v.;
in fore part of mouth, and on tip of the tongue
fauces into the nose, Bell.;
of mouth and fauces, Phos. ac.; from the
of mouth and throat, Magn. mur., Nux
Mosch., Nux vom., Phos. ac,; Puls., at night, Cocc., in the morning, as
if from the use of spirituous drinks the evening before, Nux v.; sense
of or actual
afternoons and after midnight, Rhus t.; and
thirst, Arn., Bapt., Bry., Lach., Rhus t., Sec., Verat.; severe —, and
not relieved by drinking, Phosph., Rhus t., drinks large quantities at a
time, Arn., Bry.; — without thirst, Bry., Magn. mur., Nux mos., Puls.;
but not much thirst, water does not relieve, Phos.; feeling of —,
or actual without thirst, Bry., but has to moisten the mouth,
Stram.; of mouth and throat, Magn. mur., Puls.; in the evening,
so great, that the tongue sticks to roof of the mouth, yet without
thirst, Nux mos.
2
Mouth; sticky, no thirst nor appetite, Gels.; intolerably sticky,
Phos.,
filled with a slimy mucus, Merc.; accumulation of frothy
soap-like saliva in — and throat almost choking, Bry.; full of thick
viscid saliva, Bapt.; salivation, Hyos.; buccal cavity raw and sore,
Arum tri.; hæmorrhage from nose and Carb. veg.; raw and
throat, Arum tri.; the whole inside as if raw, Strum.; aphthæ, Bapt.;
small and bluish, with putrid acid stench, Mur. ac.; putrid, Nitr. ac.;
sour, Sulph. ac.; noma, Camph., Helleb.
-
Smell offensive morning and evening, Hyos.; and tongue very
dry in the morning, Sulph.; metallic odor, Merc.; fœtid breath, Ars.,
Arn., Bapt., Merc.; putrid odor, Arn., Arum tri.; morning and night;
foul smelling slime covers the tongue, in the morning on waking,
with dryness of mouth and throat, Puls.; putrid, like carrion, Nux v.
cadaverous Hyos.
THROAT SYMPTOMS.
Gurgling when drinking; the fluid rolls audibly down into the
stomach, Ars.; the drink rolls audibly down the throat, as though it
were poured into an empty barrel, Hydr. ac., (Coccul.); the fluid
rolls audibly down the throat, and stools and urine pass off involun-
tarily, Mosch.; spasms of the pharynx, Bell.; choking sensation from
the stomach up into the throat, with oppression in the chest, better
from belching, Ignat.; chokes even with half a teaspoonful of water;
inability to swallow, Bapt.; difficulty in swallowing liquids, Bell.; dif-
ficulty in swallowing, Apis; swallowing very slow, Helleb.; complete
inability to swallow, Stram.; intense burning in throat, Verat vir.
Dryness; Bry, Nux mosch., Sec.; hardly permits swallowing,
Phosphor.; in throat and on tongue, without thirst, Pallad.;
palate, Phosph.; only of the palate, Stram. For Mucus and Phlegm
see Larynx.
Sore throat; Bapt.;
of
with deafness, Laches.; chewing or swallowing
food, or drinking causes suffering from the raw mouth, Arum tri.;
270
A TREATISE ON TYPHOID FEVER.
efforts to swallow produce violent pain, tonsils enlarged, uvula
inflamed and elongated, Bapt.; swollen glands of throat and neck,
Arum tri.; angina faucium, Merc.
Appetite; too great during re-convalescence, Puls.; hunger in conval-
escence, commences to eat, but does not enjoy it, everything is so
bitter, Puls.; when the will not return in convalescence, Sulph.
Psorin.; loss of —, Bry., Nux mosch.; with fullness of the stomach,
Nux mosch.; loss of and prostration, Rhus t.; would not eat nor
drink, but without any nausea, Iris vers.; repugnance to all ingesta,
tastes neither food nor drink, Rhus t.; in a hasty way they push
back the food they wanted, Bell.; asks for food, but refuses it when
offered, Phosph.
-
Carbo v.,
Thirst; Bell., Hyos., Merc.; much-, Hydroc. ac.; great
Mur. ac., Stram.; unquenchable Nat. mur.; inextinguishable
Colch.; with a red, dry tongue, Camph.; does not want anything but-
drink. Op.; with a dry tongue, Bry., Rhus t.; not relieved by
drink, Rhus t.; constant for water, Phosph.; day and night, for
cold drinks, especially for water, Merc.; for cold water, Ars.; — for
cold drinks, Bry.; with dry lips, and a bright red tongue, Bell.;
afternoon and evening, with cold sweat, Verat.; continual -, wherein
the patient only wets his lips, and cannot drink much, Ars.; water
molests the stomach, Sulph.; water does not taste well, Nat. mur.; is
not pleasant, Cal., Sambuc.; burning but does not drink much,
Betl.; spitting out of liquids put into the mouth, Bap.; continual
- but only wets lips, cannot drink much, every swallow becomes dis
gusting, Ars., Lyc.; violent day and night, does not drink often,
but much at a time, Bry.; large quantities, Hyos.; does not ask for
water, but when offered, takes it hastily, Op.; hasty drinking, Hepar
S. C.;
with nausea or vomiting, Ars.; continual with nausea,
Natr. mur.; - mostly in the evening, with aversion to water, Nux v.;
water does not taste well, Natr. mur.; with heat, from 3 to 6 P. M.,
Phos.; inextinguishable trunk hot and extremities cold, Colch.;
burning in head, and coldness of trunk, Arn.
Thirstlessness; with dry tongue, Magn. mur., Op., Pallad., Puls.;
with dry mouth, Nux mos.; no desire to drink, yet much burning heat,
Phos.
Wants acids, Ars., Bry.; alcoholic drink, Ars.; wine Bry., Coff.;
desire for refreshing acid things, fruit, wine, white-beer, Merc.
ร
Eating; after sour taste, Nux vom.; diarrhoea immediately after
Phosph.; great chilliness after taking anything to eat or drink,
Tarax.; after chilliness, Ars., Arum tri., Calc. os., Carb. veg.,
Caust., Ipec., Kali carb., Nux vom., Tarax., Zincum.
9
Drinking; hurts in the throat, Hydr. ac.; water molests stomach,
Ars., Phosph., Sulph.; after the fluid makes a rumbling noise in
the abdomen, as in an empty barrel, Hydr. ac.; after —, immediately
distension and pain in bowels, Nux v.; after rumbling, Merc.;
with haste, rumbling in bowels, Ars.; after water, abdomen bloated
and sensitive, Mancin.; after cold fingers, Taraz.
SYMPTOMATIC INDICATIONS.
271
1
GASTRIC SYMPTOMS.
Hiccough, Ars., Nux mos.; with sighing, Sec.
Belching, Coccul.; empty -, Bry.
Struggles, with frequent squeamishness, Ars., Bry., Calc. os., Lyc.,
Phosph.
Nausea, Coccul.; retching, Bry.;
sibility of epigastrium, Bry.
and vomiting, with painful sen-
—
Vomiting, Bry.; - and retching, Ars.; lessened by swallowing
water, but when it gets warm in the stomach, it comes up again,
Phos.; water with sour taste, Phos.; - food and other things, Calc.
os.; -phlegm and food, Verat.; water and green, slimy fluid, not
that which was eaten, Ars.; watery, bilious and slimy masses, with
great pain, Phos.; thick, black bile, mixed with tenacious, bilious
mucus, as if decomposed; a quart at a time, Sec.; after bile and
mucus, black bile and blood, Verat.; when moving, Bry., Sulph.;
and watery diarrhoea, Verat.; with burning heat, Cham.; after
delirium, Sec.; with headache, Kali c.
Scrobiculus; sinking, weak feeling in -, Ignat.; great soreness to
touch, or in motion, Bry.; bloated, Carbo v.
Stomach; illness and discomfort, Phos.; fullness in
-; Nux mos.;
full feeling in -, Bapt.; from - to hip, sharp pain, Bry.; — sensitive,
Phos.; and burning, Ars.; sensitive to external pressure, Ars., Sec.;
to touch, Merc.; even the bed-covering causes pain, Laches., Sulph.;
sensitive to pressure, Ars., Carb. v., Colch., Nux v.; pains, Op.;
the least pressure is insupportable; excoriating pain in the epigas-
trium from touch and cough, Bry.
Epigastrium, throbbing, pulsating, Puls.; painful sensibility, Sec.;
of — to pressure, Bry., Colch., Laches., Nux v., to touch, Merc., ten-
derness and pain in —, remaining after touch, Bry., Nux v.; fullness
in with tension, and embarassed respiration, Merc.; distension with
painful sensitiveness to touch, Nux v.
Liver; region of
ABDOMINAL SYMPTOMS.
sensitive, Phos.; to touch, Sulph.; pain in
Merc.; painful sensibility, Bell.; region of puffed and engorged,
Merc.; in hepatitis, after Bryonia, Laches., or Lycop., then Merc.
Spleen; rumbling in the region of
enlarged, Cinch., Cocc., Phos ac., Rhus t.;
pressure, Ars.; hardness of Cinch.
--
after Calcarea, Lyc.;
swollen, and painful to
Abdomen; heaviness in upper part, Natr. c., Nux mos.; pain as if
diarrhoea would set in, Bry., Cinch., Verat.; sensation in as if all
were raw; distension immediately after drinking, Nux v.; pinching,
grasping in Puls.; colicky pains, with looseness, Verat.; frequent
liquid stools, Ars.; violent colic, with gagging, Nitr. sp. d.; colic worse
in the morning, Bry., Pod., Sulph.; burning in Ars.; great soreness
and bloatedness of -, Apis; very sensitive and painful to touch,
Phos.; and distension with hardness; rumbling in as if there
would be diarrhoea, Verat.; sensitiveness in —, aggravated after
7
272
A TREATISE ON TYPHOID FEVER.
drinking water, Mancin.; incipient or fully developed intestinal affec-
tion; indicated in the inflammatory stage, if diarrhoea has already set
in, or Bryonia was not sufficient, Rhus t.; ileo-cæcal region very pain-
ful to touch, Ars., Merc., Phos. ac.; left iliac region, Bapt.; pain, as
from excoriation, or as if inflamed in the hypogastrium, especially
when touched, with weakness, Phos.; intestinal ulceration and hæm-
orrhage, Nitr. ac.; sensation of heat in Lachn.; surface of — hotter
than the rest of the body, Colch.; cœcal and peritoneal inflamma-
tion, Bell.; the whole compressed, Rhus t.; drawn in, Plumb.;
sunken in towards spine, Bell.; hardness of Arn.; with much
flatulence, Phos.; and painful if pressed, Op., Sec.; and swelling as if
from pent-up flatus. Sulph.
9
Soreness to touch; in abdomen, Apis, Cham., Hamam., Laches.,
Nitr. ac., Phos., Phos. ac.;
liver, Ars., Merc., Rhust.;
Phos.
in precordia, Merc.; in region of
below the navel if pressed on, Merc.,
Flatulence; fermentation in the bowels, with subsequent diarrhoea,
and discharge of putrid flatus, Carbo v.; loud, gurgling noise in the
ileo-cœcal tract, dry tongue, heat, delirium on going to sleep, Ginseng;
rumbling in the bowels, especially in the upper part, Cinch.; rolling
and gurgling as if from much Ars., Carbo v., Phos.; rolling and
grumbling, Nux mos., Sulph.
Rumbling, Cocc., Hyos., Nux v.:
—
during, and after drinking, Phos.;
– each time after drinking, or before every stool, Merc.; before
stool, Phos., Phos. ac.; mostly in the evening in
Bry.;
—
as if diarrhoea would set in, Phos., Verat.;
bed, or at night,
before diarrhoea
Laches.; painful; very offensive flatus, Phos.; with diarrhoea,
and pinching and grasping pains, Puls.; with painless diarrhoea,
Phos.; with diarrhoea of decomposed blood, smelling horribly,
Carb v.
Tension; Cinch., Colch., Op., Sec.; from accumulated gas, though
much is discharged, Phos.; with restless sleep, or heaviness in the
upper part of abdomen, Nux mos.; very full and hard abdomen,
Phos.
as if
Distention, with hardness, Arn., Bry., Cinch., Cocc., Colch., Laches.
Op., Sulph., Verat.; and painful sensibility to touch, Merc.;
from flatulence, Carbo v., Nux mos.; with diarrhoea, Cinch.; and
rumbling, Cocc.; before diarrhoea, Laches.; and constipation,
Lyc.; mostly in the afternoon, Carbo v.; - with pain, as if bruised,
and in the loins, when touched, Phos-; with pain on pressure,
Hyos.; in the region of the navel, with severe pinchings, painful,
as if from pent up gas; very offensive flatus, Rhus t.
Blouted, Apis, Cinch.; not painful, Helleb.; swelling excessive, Ars.
Meteoristic Distention; Ars., Lyc.; with rumbling, gurgling and pain-
less, watery, greyish diarrhoea, Phos. ac.; with loud rumbling and
gurgling in the intestines, Carbo v.
Tympanitic distention, Hyos.
Tympanitis, Op.;
in the morning, Cinch.; and sensitiveness of
SYMPTOMATIC INDICATIONS.
273
abdomen, aggravated by drinking water, Mancin.;
the back, Colch.
with pain in
Eruptions, on abdomen, roseola spots, Arn., Hyos.; white, miliary
●ruption, Apis; petechiæ, Bell.
Loins pain, as if bruised, Phos.; tearing, Rhus tox.
Groin sore, with involuntary diarrhoea, Cham.
During the time of the crisis, when papescent stools afford relief,
Ars., Carbo v., Mur. ac., Rhus tox.
STOOL SYMPTOMS.
Diarrhea; occasional -, Bapt.; watery, Ars., Colch., Hyos.. Lept.,
Merc., Mur. ac., Op.; more at night, Puls.; every half hour, each
time after grumbling in the bowels, without pain, Sulph.; continues
after the eruption, Chlorum; painless abdomen bloated, hæmor-
rhages, and slowly progressing reconvalescence, Cinch.; painless
with much rumbling noise, Phos.; profuse -, stools streaked with
blood, like flesh water, and the tongue dry, Phos.; colliquative
frequent and frothy, with tenesmus even at night, Sulph.;
sive, sour stools, Calc os.
Stools, whitish-gray, Bell., Phos. ac.; — grayish, Carb. veg.;
Phosphor.
Sec.;
exces-
gray,
Yellow, watery and slimy, Phos. ac.; watery or yellowish-brown
bloody, and cadaverous odor; tongue brown, parched and hard, Rhus
tox.; yellow, Bell.; watery and small, Ars.; and slimy, Cinchon., Phos.
ac.; liquid yellow, fœtid, twelve to fifteen in twenty-four hours,
Nuphar; thin, yellowish, badly-smelling, with rumbling in bowels,
Phos. ac.; sudden, thin, yellow, frothy, almost without fetor, Rhus tox.
Greenish, watery, with mixed flocks, Verat.; greenish mucus, Nit.
ac.; dark green and frothy, Merc.; green, slimy, acrid, with great
tenesmus, sensitive abdomen, Nit. ac.; greenish-yellow, Merc.
Brownish, Carbo veg.; soft, Ars.; floating on the water, Merc.; brown
r white, Arn.; blackish-brown, Verat.
Blackish, Cinch.; every hour, Stram.; black, from decomposed blood,
Phos.; like coffee-dregs, Ars.; only in the morning, Pod.; blackish,
offensive stools, with severe pain, Colch.
Bloody, Apis., Ars., Carb. veg.; dark, Phos.; pitch-like, sticky, Merc.;
Offensive, fluid, with white flakes, Colch.; like rotten cheese, Bry.
(Hepar s. c.); whether formed or loose, Lachesis.; of decomposed blood,
form and appearance of charred wheat straw, in larger or shorter
flat pieces, together with portions more or less ground up, with
hæmorrhage and nose-bleed, Lachesis; thin, and extremely offensive,
Lachesis, Opium, Psorin, Secale, Sulphur; thin, very offensive, with
glairy slime, sometimes great urging, Merc.; fetid, Bapt.; dark, tarry-
ing, mixed with bloody mucus, jaundiced condition, Leptand.; hæmor-
rhage, with fetid stools, followed by great prostration, Kreosote.
Putrid, Carbo veg., Secale; black, burning, excoriating, with restless-
ness and colic, Ars.; colliquative, Nux mosch.; putrid, watery, with
D 17
274
A TREATISE ON TYPHOID FEVER.
cutting and drawing pains in the abdomen and loins, extending to the
thighs, Nux vom.; greenish, dark brown, odor like foul ulcers, Ars.
Gangrenous, and bloody, Phosphor.
Foul, Apis, Ars.; like carrion, Stram.; cadaverous smell, involun-
tary, brownish, grayish or bloody, Carbo veg., Rhus tox.
Involuntary stools, almost sudden, black-brown, every three hours,
Bry.; unnoticed, Arnica, Ars., Bapt., Bry., Carbo. veg., Cinchona, Colch.
Hyos., Kali c., Mur. ac., Opium, Phos., Phos. ac., Psorin; Puls., Rhus
tox., Secale, Sulphur, Zincum; frequent — after meals, with rolling and
rumbling in bowels, Camphor; and urine, Arnica, Bell., Mur. ac.,
Psorin, Rhus tox., Sulphur; when flatus escapes, Nux mosch.; thin,
Verat.; painful, foul, bloody, Apis; - frequent, Zincum; and pain-
ful, Apis ; after constipation or hard stool, Nux mosch.; offensive,
Colch.; like carrion, Carbo veg.; black, brown, Bryon.; thin,
yellow, Cinchon.; yellowish, mixed with phlegm, Phos. ac.;
watery, Colch., Mur. ac., Nux mosch.; with white flakes, Colch.;
pieces of epithelium, Zincum; at night, in sleep, Puls., Rhus tox.; -
with stupefaction, Arnica.
Paralysis of sphincter ani, Hyos.
Diarrhoea, at night, Khus tox.,
Verat.; - with pressure in the abdo-
men, as if from gas, Arnica; after midnight, Ars.; early in the
morning, Sulph.; during cholera epidemics, Verat.; and belly-
ache, morning and evening, Kali carb.; with great epigastric
oppression, black, Dulc., Merc.; - with headache, and pain in all the
limbs, Rhus tox.; with bitter, sour belching, Bapt., Puls., Phos.;
with empty belching, Rhus tox.; painful —, with great sinking of the
forces, Cul. ostr.
Before the stool, pain in the abdomen, Bry., Lach., Rhus tox.; rum-
bling, Merc., Phos uc.; distension, Arnica; weakness in abdomen, like
fainting, Verat.
With the stool, colic pains, Ars., Colch.; cutting; after sour things,
Ipecac; pinching pains, worse at night, Puls.; pain during and after
stool, Verat.; painless stool, Phos., Sulph.; meteorism and loud rum-
bling, Phos.; tense abdomen, Verat., Verbasc.; rumbling, Arn.; ten-
esmus, Nit. ac., Sulph.
Frequent, small stools, excoriating the external parts, Nux vom.
Tearing pains in the limbs, during rest, Rhus tox.
Great weakness, Ars.; weakness, which compels to lie down,
especially in the morning, or at night, Bry.; weakness, pale face, cold
sweat on forehead, Verat.; feeble, stupid, insensible state, taciturn
mood, Phos. ac.
After the stool, much exhausted, with griping in abdomen, Merc.;
colic is gone, Rhus tox.; great weakness, Phos.; prostration, Sulph.
He has six discharges like diarrhoea, then he faints, first he had
heat and warm sweat, then cold on the face and feet, with white
tongue, Sulph.; with chill, Verat.; if the diarrhoea does not cease when
the rash comes out, Calc.
Flatus, putrid, offensive, Ars., Rhus tox., Sulph.; fetid, Nux mosch.;
1
SYMPTOMATIC INDICATIONS.
275
copious escape of
Sulph.; discharges of
Blood, in streaks, Phos.; bleeding from anus; Arn.; bright, and does
not clot, Nit. ac.; clotting and black, Alum p. s.; hæmorrhage from
intestinal ulceration, Ars., Mur. ac., Nit. ac., Phos. ac.; fluid, bright
red from the rectum by the pound, fourteenth day, after a diar-
rhoea, and sensitiveness of regio iliaca dextra, seventh day, faintness
with the slightest motion, Nit. ac.; reduced by hæmorrhages to the
verge of the grave, Carbo veg.; black, Mur. ac.; · of a tar-like con-
sistency, in large quantities, Hamam.; and pus, meteorism, somno-
with constant distension, Carbo veg.; much
without relief of tension, Phos.
lency, Carbo veg.
Slimy discharges, Cinch., Merc., Nit. ac., Phos. ac., Rhus tox.
Bilious discharges, Merc.; yellow or green discharges.
Constipation, alternating with looseness of bowels, Ars.; or offensive
watery diarrhoea, Opium; no diarrhoea, Helleb.; no stools for a long
time, Apis; costive, Bapt., Bry., Hyos., Lyc.; "dog stools," Phos.; six
days, Puls.; and vertigo, sour or bitter eructations, Nux vom.
If constipation still exists, and hence the intestinal ulceration has
not yet commenced, and if the sudamina and petechiæ have already
broken out during the inflammatory stages, Bry. If not costive, do
not give Carbo vey. Jahr.*
URINARY SYMPTOMS.
Bladder, violent pain and sensitiveness to the touch in region of
passing of water, urine yellow, without sediment, Lyc.
Urine, frequent urination in small quantities, Coccul; copious
Colch.; Mur. ac., Stram.; diminished -, and burning, Ars.; difficult
urination, with constant desire, Secale; dark, Nux vom.; saturated,
Bell., Glonoine, Hyos., Stram.; scanty; small quantities of dark brown
Puls., Sulph., Verat.; pains when urinating, Canth.; pains in blad-
der, has red sediment, Lyc.; suppressed, Canth., Colch., Secale,
Stram.; or retained, Ars., Hyos., Stram.; as if from a closing of the
bladder, or loss of its power, Opium; — passes involuntarily, is turbid,
like horse urine, Apis; unconscious flow of -, Apis; involuntary,
Ars., Colch., Helleb., Hyos., Lyc., Opium, Phos.; is passed uncon-
sciously in bed, Merc.; involuntary all night, Arnica, Ars., Bell., Hyos.,
Rhus tox.; copious, involuntary, Stram., Verat.; paralysis of sphincter
vescia and ani, Hyos.; involuntary stool and—, Bell.
While urinating, stool escapes, Mur. ac.
Watery, Mur. ac.; clear, transparent, and acid reaction, Mur. ac.,
Phos. ac.; alkaline and offensive, Bapt.; clear, very high colored, Nux
mosch.
Dark red, without sediment, brownish red, brown, with burning,
Puls,
*I have not lost a single patient in whom the bowels remained costive up to the
time of the crisis, when papescent stools afford relief.-Jahr.
I said the same more than twenty years ago, and can repeat it now: hardly in
the third week, the non-appearance of a stool is to be regarded with concern. The
same applies in child-bed. — C. Hering.
4
276
A TREATISE ON TYPHOID FEVER.
Brown, Ars., Puls., Ars., Sulph., Verat.
Dark, Carbo veg., Merc., Nux rom.
First clear, then white, as if mixed with chalk, Merc.
Turbid, Carbo veg., Ars.; like horse urine, Apis; after standing,
Sulph.; and white sediment, Phos.; and reddish, dark colored,
Carbo veg.; greenish, or dark brown when passed, and does not become
clear on standing, Ars.; after depositing a sediment, not clear, Phos.
Urine, more albumen in Rhus tox.; coagulates, like milk, Phos.
ac.; white sediment in Merc., Phos.; - colors linen slightly red,
Bell.; - leaves, if voided in bed, a red, sandy stain, like brick dust,
Lyc.; leaves a whitish sediment on the parts, legs and sheets, Merc.;
has a gray sediment, Puls.; - first clear, then white, as if mixed with
chalk, Merc.
Smell, like violet roots, Phos.; strong --, Carbo veg.; like horse urine,
Apis; sharp, disgusting, Phos.; very offensive, Bapt., Sulph.; strong,
ammoniacal —, turbid, deposits white sediment, Phos.; fetid - Bapt.;
intolerable stench, and involuntary, Ars.
me m
Genitals, great excitement, nymphomania threatens, Phos.; bleeding
from with no relief, Rhus tox.; threatened miscarriage. Sabin,
Secale.
CHEST SYMPTOMS.}
-
Speech, nasal, indistinct, Lach.; the few words he says, he whispers,
but not irrelevant, Nit. sp. d.; unintelligible, lisping, stammering,
as though the tongue were too heavy, Ars.; voice light and weak,
Verat.; weak and trembling, or hoarse, coarse or crowing, Ars.; cries
until the is lost, or he becomes hoarse, Stram.; voice hoarse and
hollow, Secale, Spongia; laryngotyphus, Kali hyd.; catarrhal affection
of larynx, with rough voice, Hepar s. c.
M
Sighing, Bry., Opium, Secale; inclined to sigh, expands whole chest
in with chill, Ipecac.
Breathing audible and accelerated, Colch.; more frequent, Mur.
ac.; rapid and labored, Merc.; interrupted, Phos.; intermittent,
with moaning, Opium; irregular and intermittent, Colch.; slow, Helle.;
deep drawn and sighing, Opium; sighing, groaning and moaning, and
a peculiar sour smell of the body, with or without sweat, Bry.;
short and anxious, oppressed rattling, Ars.; short, with anxiety
and vertigo, Phos.; short cough, cold hands and feet, wants fire in
the room, Carbo veg.; short after each cough, Phos.; rattling –
Hyos., and moaning sounds in chest, and loud sounds through the
nose, Chinchona; and loud Opium; and hard, Phos.; and cough,
Nit. ac.; deep, Nux mosch., Opium; mucous rale during stupor, or
furious delirium, Hyos.; the more snoring, the darker the face
becomes, Opium; stertorous, Lach., Opium ; loose, rattling, loud
and difficult, Opium; gray phlegm comes up, Nit. sp. d.; cold, Carbo
reg.; breath is hot to back of hand, Phos.; offensive, putrid breath,
Arnica; very offensive breath, Bapt.; oppression of chest, and dif-
ficulty of with pleuritic stitches in chest, and harassing cough,
with thick yellowish or reddish sputa, Phos.; anxious respiration, with
?
SYMPTOMATIC INDICATIONS.
277
strong heaving of the chest, Opium; want of breath, anguish in chest
as if pressed together, Phos.; embarrassed - from tension in stomach,
Merc.; dyspnoea, Lach.; difficult, anxious with sighing and hic-
cough, Secale; oppressed with extreme prostration, Ars.; gasping
could not draw a full breath, Bapt.; sudden spells of suffocation,
mostly in evening, lying down, with or without cough, Ars., Phos.;
Puls.
Impending paralysis of lungs, Nit. ac.; cough ceases, the collected
mucus cannot be expectorated, Moschus; rattling phlegm in wind-
pipe, Ars., Phos.; cough ceases, the collecting secretions cause loud
rattling breathing, Carbo veg.
Cough, suddenly changes from a loose one to a dry and hoarse one,
with anxiousness and dyspnoea, Spongia; - hard, with stitching pain
in chest, Bry.; a dry and difficult breathing, Lach.; dry, short,
hacking —, evening in bed, as if from roughness, or dryness in the
larynx, Bry.; harassing — all night, no expectoration in the day-time,
Rhus tox.; dry Ars.; and sore throat from bronchial irritation,
Bell.; with very little expectoration, makes them worse, Rhus tox.;
hard with tightness in the chest, Phos.; with pain in the head as
if it would burst, Phos.; troublesome - which causes pain in the fore-
part of the chest, and wakes from sleep, Phos.; severe —,
with pres-
sing headache the whole day, Phos.
Phlegm, mucus in throat, neither able to swallow, nor to expecto-
rate, Bapt.; rattling of on chest, Carbo veg.; moist rales in bronchial
tubes, audible at a distance, from infiltration of lungs, Ant. tart.;
loose, rattling cough and breathing, Nit. ac.; in typhus with children,
Bell., Bry.; loose cough, Lyc. Phos.; without expectoration, with pain
and sense of excoriation in the chest, so that he fears to cough, Phos.;
tenacious mucus from the throat, troublesome, Apis.
Sputa, tough, like gelatine, Bry.; - first transparent, then yellow-
colored, with or without impeded breathing, Ant. tart.; transparent
or thick, yellowish, or reddish, Phos.; mucus yellow, red and trans-
parent, hangs on the tongue, Phos.; viscous, hangs on the lips,
Phos.;
- hard to expectorate, with cough, in reconvalescence, Ars.,
Seneq.; catarrhal and pulmonary difficulties in the inflammatory stage,
Bry., Phos.; copious in morning, Bry.; streaked with blood,
Lach.; frothy, bloody mucus, with violent, almost constant cough,
Kali carb.; brownish, bloody, with irregular pulse, Nit. ac.;
bloody, with severe cough, Rhus tox.; — slimy, bloody, Lach.; bloody
froth with the —, cough excites bilious vomiting, Carbo veg.
Cough, in the evening, in bed, Bry.; worse from evening till mid-
night, Phos.
With cough, painful shocks in the head, Calc. ost.; pressing headache
all day, Phos.; bursting pain in head, Phos.; sore throat, Bell.; pain in
epigastrium, Bry.; stitching pain in liver, Bry.; roughness and dry-
ness in larynx, Bry.; dry cough, with difficult breathing, Lach; after
each cough, short breath, Phos.; tightness in chest, Phos.; pain in
forepart of chest, Phos.; pleuritic stitches in side of chest, restless
and anxious, Bry.; wakes from sleep, Phos.
278
A TREATISE ON TYPHOID FEVER.
Fever is increased by the cough, Calc. ost.
Chest, pressure in the lower part of —, l'hos.; stitches in the left
side, Acon., Bry.; in lungs or pleura, with a dry cough, Bry.; pleuritic
stitches when inhaling, Arn.; when coughing, Bry.; shooting pains in
left side, worse in the evening and on motion, Bry.; constant tickling
under the middle of the sternum, causing a hacking cough, worse
from talking or moving, Calc. ost.; aggravation of thoracic pains by
the least motion, or from breathing, Spigelia; inflammatory affection
of lungs, with rattling cough and breathing, Nit. ac.; effused fluid in
pleura after pleuritis, Sulph.; inflammation of lungs, or catarrh,
especially during the commencement of infiltration, recognizable by
the crepitation sound, Sulph.; infiltration of lower lobes, Rhus tox.;
hepatization, Phos.
Bronchitis, Bry., Merc., Rhus tox.; whole process falls on the lungs,
Phos.; if it does not succeed, Bry., Tart. em. or Nit. ac. (Jahr.)
Pneumonia, Phos.; tuberculosis of lungs, Kali carb.
Pneumonic symptoms throw all the others into the shade; next to
Bry. and Rhus tox., Phos.; if the patient is tormented by a violent,
racking cough, either dry, or with thick, yellow, tenacious sputa, spits
as in pneumonia, Lach.; lungs filled with blood, Nit. ac.
In pneumo-typhus Apis, Bell., Bry., Merc., Phos., Puls., Rhus tox.,
Sulph., with great rattling, dyspnoea, cedema pulmonis, Ant. tart.
Edema of lungs threatens during the mucous rale, Ant. tart., Carbo
Phos.
veg.,
Paralysis of lungs threatened, Ant. tart., Nit. ac.
Heart, pressure and anxiety, Rhus tox.; palpitates, Ign; during
the aggravations preceding the miliary rash, fourteenth day, tremu-
lous pulse, anxiety, restlessness, redness of the face, delirium, jerk-
ings, especially in children; short, hacking cough; excessive diarrhoea,
Calc. ost.; excited beating of; anxiety, with tossing in bed; says
but little, only complains of anxiety; says nothing, from weakness of
body and mind; excess of sensibility to sounds, to talking and light;
great indifference to all things, even to life; dull and weak in the
head, Ars.
Paralysis beginning, face and limbs grow cold, become covered with
cold sweat; a picture of complete torpor of all vital functions (thus
differing entirely from that of Ars., which is always associated with
erethism), Carbo veg.
Slow action of heart, Helleb.; frequent and small beats, Coccul.
Circulation without energy; blood stagnates in the capillaries,
causing cyanotic blueness of face lips and tongue, Carbo veg.
Pulse, very low, Helleb.; weak, feeble, Apis., Ars., Carbo veg.,
Hyos., Lach., Merc., Phos., Phos. ac., Psorin., Puls., Verat.; and inter-
mitting, Apis, Verat.; and quick, Ars.
Weak and irregular, Hyos.; - and frequent (sixth week), moving of
limbs causes drawing pains along the spine, Ferr. carb.; — and very
frequent, irritated, without energy, 120 to 130, Mur. ac.; - and rapid,
Merc.
SYMPTOMATIC INDICATIONS.
279
Small, Ars., Carbo veg., Colch.. Hyos., Lach., Phos., Phos. ac., Psorin,
Puls., Rhus tox., Secale, Sulph., Zincum; and frequent, Colch.;
weak and trembling, Ars.; weak and intermitting, Ars., Zincum ;
weak, and scarcely perceptible, Zincum; weak and quick, Phos.,
Rhus tox.; weak and contracted, Colch., Secale; weak, slow and
intermitting, Secale; - and irregular, Ars.; - and thread-like, Hyos.;
and hardly perceptible, Hyos., Zincum.
Weak and small, Ars., Carbo veg., Hyos., Lach., Phos., Phos. ac.,
Psorin, Puls., Rhus tox.; small and frequent. Lach.; and intermit-
ting, Phos. ac.; scarcely perceptible, Carbo veg.; small and quick
(130); Psorin, Sulph.; almost suppressed, Puls.; and rapid, Ars.; and
trembling, Ars.; and miserable, Nuphar.
Thread-like, stringy, wiry, Ars., Carbo veg., Colch. Hyos., Rhus tox.;
and variable, Bapt.; and quick, Colch., Phos.
Scarcely perceptible, Carbo veg., Hyos., Zincum, and quick, Colch.;
and small, Hyos.; and frequent, Zincum; very frequent, Camphor.
Pulseless, Ars., Carbo veg., Colch., Jodium; and unconscious, Merc.
Frequent, Ars., Bell., Carbo veg., Colch., Glonoine, Hyos., Jodium,
Lach., Stram., Zincum; and empty, Ars.; large and hard,
Jodium; and small, Ars., Coccul., Colch., Zincum; irritated, but
without energy, Mur. ac.; small and trembling, Ars.; and intermit-
ting, Zincum ; small and weak, Lach.; and sunken, Arnica, and
intermitting, Phos. ac.; scarcely perceptible, Zincum.
Accelerated and full, Phos.;
to 130, without energy, Mur. ac.;
carb., Lach., Puls., Sulph.
Quick, Ars., Colch., Psorin,
weak and intermitting, Ars.;
and small, Psorin, Puls., Sulph.;
bling, Ars., Phos.
over 100, Ars., Bapt., Phos. ac.; 110
120 to 140 in the minute, Bell., Kali
Puls., Khus tox., Sulph., Zincum,
and small, Phos., Rhus tox.; —, weak
and thread-like, Colch.; and trem-
Rapid, Hyos., Merc.; and intermitting, Hyos.; and weak, Merc.;
weak and small, Ars.
Intermitting, Apis, Ars., Hyos., Kali carb., Mur ac., Phos. ac., Secale,
Verat., Zincum; and weak, Apis, Ars.; Verat.; small and fre-
quent, Zincum ; and weak, Phos. ac.; omitting every third beat,
Mur. ac.
Slow, Opium, Secale; only 80, Helleb.; and full, Bapt.
Contracted, Colch., Secale.
Hard, large, and frequent, Jodium; and full, 98, Bapt.; carotids
beat violently, Bell., Glonoine, Hyos., Stram.
Full, Opium, Phos.; and accelerated, Phos.; 120, Gels.;
Bapt.; and slow, Bapt., Opium; and hard, Bapt.
Empty, Ars. See Imperceptible.
Changing frequently, Apis, Bapt.
Increasing by least motion, Jodium.
and quick,
Outer chest, eruption of a pinkish-blue red color, extending over
whole left side, Stram.; roseola spots, Ars., Hyos.; petechiæ, Bell.
Rash, red, Stram.; white, Valer.; miliary eruption from neck to
chest, then all over, Phos. ac.
280
A TREATISE ON TYPHOID FEVER.
Throbbing in the arteries of the throat, Phos.
Neck, stiff, Bry.; with pain in the bones after taking cold in a copi-
ous sweat, with pressing to forehead, Nux mosch.
Back, spine sensitive when fever is coming on, Nux vom.; pain in
Colch.; rending along spine from moving either hands or feet. Fer-
rum; loins and legs, as if bruised, and weak, after the slightest exer-
tion, weakness, with inclination to lie down, Nux mosch.
Great heat of the trunk, with cold sweat on head and limbs, Phos.
Red rash, Stram.; miliary rash, beginning on the neck, Phos, ac.:
petechiae on neck, Bell.
LIMBS.
Upper limbs, arm gets livid, and goes to sleep, Kali carb.
Hands, trembling, automatic motion of, with coldness of the
limbs, Zincum ; tremble violently when trying to lift, or move
them, Gels.; weak, Ars.; one hot, the other cold, Puls.; cold
――
sweat on -, Carbo veg.; on- and upper limbs, Zincum.
Fingers cold after drinking, Tarax.
Lower limbs, thighs, weariness, Phos.; weary, even while rising
from long continued sitting, Puls.; feel weak, Ars.; especially in
tremble when
recovery, they think they will have paralysis, Selem.;
trying to walk, Gels.; tearing in -, most unbearable when at rest,
relieved by moving them (Rhus tox. did no good,) Tarax; weak.
evening or morning, sluggish, disposed to sweat, and trembles, Carbo
veg.; attacks of jerking in - Coccul; aching and sense of deafness in
—, Bry.; heaviness in in the morning, with nausea, sinking and
drowsiness, Merc.
Knees, weak, Ars.; while sitting, or in quick motion, Phos.
Q
Feet, great heaviness of Coccul.; weak, Ars.; cold
Coccul.; weak, Ars.; cold — Lyc., Zincum ;
all night, Jodium; cold sweat on
Carbo veg.
Toes, sores between, Baryta, Sil.
All the limbs, muscles, refuse to obey the will, Gels.;
jerking, Coccul.
trembling or
Vanishing of power, like fainting, near losing his consciousness,
Sulph.; numbness, Secale.; sluggish, more in the forenoon, with heavi-
ness, Phos.; weak, Secale, Verat.; inclination to lie down, Verat.;
heaviness, Opium; and weariness, Bell.; with numbness, Secale,
especially of thighs, Cinchona; and of the whole body, with chilliness,
Puls.; as if from extreme fatigue, Arn.; and peculiar lassitude, with
headache, white-coated tongue, loss of appetite, restless sleep, Bry.;
and weak from morning to evening, Sulph.; and weariness, especially
in the legs, on rising from sitting, Bry.
Great weariness, weakness in the evening, with depression of
spirits, Merc.
Painfulness, extending from the elbows and knees, Lach.; severe
pain in the limbs, Rhus tox.; severe rheumatic pains, worse in rest,
somewhat ameliorated by moving and changing position, Rhus t.;
bruised feeling, Bry.. Rhus t.; coldness of the limbs, Zincum; hands
and feet, Ars., Colch., Lyc.; one hand and foot hot, the other side cold
SYMPTOMATIC INDICATIONS.
281
d red, evening and morning, Puls.; one foot hot, and the other cold
Lyc.; limbs cold, covered with cold sweat, Carb. veg.
Motion, desire for frequent and constant movement, which gives
temporary relief to the patient, pain better in motion, Rhus tox.;
fidgety feet, Zincum; averse to effort, Sulphur; to all efforts of body
and mind, Cinchon.; and dullness, Ars.; wants to lie quiet, Bry.; on
rising from lying, vertigo, Arn., Nux v.; on raising head, vertigo,
Cinchona; (see Head,) on rising from sitting, loss of strength, the
same at the beginning of walking, weary legs, Bry.; on moving, sore-
ness in stomach, Bry.; on moving quickly, weakness of knees, Phos.
Walking, inordinate weariness from a short walk, can walk but a
few minutes on account of weakness, Puls.; even the least walk pro-
duces great fatigue and headache, Phos.
Pain in all the limbs, Bry.; aggravated, darting-tearing pains, Bry.
General aggravation of pains from motion, Bell., Bry.
In the suffering parts, shooting, or jerking, tearing pains, in the
head, throat, chest, abdomen, etc., Bry.
From the least labor, weakness and exhaustion, with heat, rush of
blood, and trembling, Merc.; on the least exertion, loss of strength,
Bry.; after the slightest movement, immediately great weariness,
Nux vom.; great weakness, Merc.; exhaustion, Lach.; he must sit
down, Coccul; fainting, Coccul, Nit. ac.; chilliness (in the early stage),
Nux vom.; in the morning, Calc. carb.
Overestimates his strength, ventures to get up, and then sinks
down on to the floor, Apis, Ars., Lyc., Nat. mur.; can only walk a few
steps without support, Stram.; unable to walk, sinks down after a few
steps, Ars.
Every motion during the fever makes the patient feel sick, Fluor.
uc.; causes swelling, Cinchona.
After over-exertion of the body, Rhus t.; of body and mind,
Cuprum.
Restlessness, anxious to go from one bed to another, Ars., Bell., Calc.
ost., Cham., Cin., Hyos., Merc., Sepia, Rhus tox., Verat.; turns from
one place to another, Ars., Hyos., Rhus tox.; lying on back, suddenly
sits up, then lies down again, Hyos.: restless tossing about, Apis,
Bell., Canth., Rhus tox.; continually changing position, Ars., Bry.,
Cinchona, Rhus tox.; she has no rest, day or night, Sulph.; great,
Hyos., Rhus tox.; and anxiety, manifesting itself in constantly moving
head and limbs, whilst the trunk lies still, on account of too great
weakness, Ars.
General restlessness, in the muscles, with vertigo, Nux mosch.; with
dilated pupils, Nux vom.; all night, puts out hands, Phos.; in the
evening, tosses hands about, Phos. ac.; constant inclination to stretch
limbs, or change their position, Cinchona; can't lie long anywhere,
Bapt.; wants to rise up, Puls.; great nervous restlessness, Bapt.; of
body and limbs, Camphor; every position feels too hard, Arn.; feels
better when lying down, Bry.; rest relieves colic, Ars.; weakness of
D 19
282
A TREATISE ON TYPHOID FEVER.
the whole body, which compels lying down, Arn., Merc., Puls.; giddi-
ness compels lying down, Phos. ac.
Standing, he can hardly stand erect, on account of great weakness;
great weariness at nine o'clock, A. M., with heaviness in all the limbs,
and almost an unconquerable inclination to sleep, Coccul.; he cannot
stand up, but only lie or sit; if he stands he has the greatest anxiety,
with nausea and cold sweat on the forehead, Verat. alb.
After stooping, cannot rise, Rhus t.
Sitting, on sitting up he has nausea, Puls.;
knees weak, Phos.
stupid, as if drunk, on rising, dizzy, as if he would fall forwards or
backwards, Rhus t.; giddiness, Phos. ac.
Lying, wants to lie down, Coccul; in one spot (in the beginning,)
Rhus tox.; strong desire to lie down, and considerable relief on doing
so, Nux vom.; sluggish, with constant desire to lie down or to sit, Nux
vom., Pulṣ.; must lie down, sitting does not suffice, Puls.; strong incli-
nation to lie down, Stram.; painful to lie on the left side, Stram.
Shooting pains, worse during rest, Rhus tox.
During rest, intolerable, tearing pains, only in the lower limbs,
Tarax.; in all the limbs, Rhus tox.
Positions, lies quiet, without any complaint, Arn.; lying with head
thrown back, Bapt.; lying on back, Ars., Lach., Phosph., Zincum;
limbs drawn up, Helleb., Puls.; knees drawn up, Ars., Puls.; legs bent
to belly, forearm stiffly bent on arms, Bell.; eyes half open, abdomen
sunk in, Colch.
Sliding down in bed, Apis, Bapt., Helleb., Zincum; slips down to
the bottom of the bed, Ars.; into one heap, with moaning, Mur. ac.
Debility, quickly following the erethic stage, Rhus tox.
Weariness, Cinchon., Coccul; of limbs, Stram.;
all over, feel as
if they had overdone themselves, Ars.; in the whole body. Puls.;
most in thighs, Phos.; painful in the limbs, as if after a long walk,
Cinchon.; as if after exertion, Colch.; unconquerable -- like intoxi-
cation, Opium; as if after sickness, Sulph.; always fatigued and
weak, Sulph.
—
ready
Weakness, Camphor, Coccul, Opium, Rhus tox., Secale, Stram.;
suddenly, in midst of the disease, Chlorum, Nit. sp. d.; frequent, sud-
den attacks of — l'hos.; - sometimes more in the upper, sometimes in
the lower limbs, Secale; - intolerable, with giving way of the knees,
Merc.; in attempting to move, too weak to control his movements,
Gels.; — of limbs, with trembling after every effort, Sulph.;
to fall, with heat, rush of blood, and trembling, Merc.; on getting up,
sinks down to the floor, Ars., Apis, Nat. mur.; the greatest espe-
cially in the legs, knees, feet and hands, which tremble, with inability
to walk more than a few steps without sinking down, Ars.; universal
– and anxious-
in the morning, as if after too little sleep, Verat.;
ness, with staggering, Ars.; with relaxation of body and mind, with
insensibility, Cinchona; with aversion to all external objects, per-
sons and things, with drowsiness, Opium ; ready to fall, with inex-
pressible sense of illness in body and mind, which compels him to lie
SYMPTOMATIC INDICATIONS.
283
down, Merc.;
and exhaustion, with heat, rush of blood, trembling
from the least labor, Merc.; with strong disposition to sweat during
movements and in sleep, Cinch.; and sweat after fever, Psorin,
with inclination to sleep, Lach.; weariness and bruised soreness,
which compels to lie down, and yet every position feels too hard,
Arn.; - with sensibility of the surface, Colch.; — and great lassitude,
Bry.; with the vertigo, Secale.
Lassitude, the whole day, Sulph.; the whole body sluggish, Arn.;
general relaxation, with great nervous weakness, Phos.
Debility, Carbo veg., Phos. ac.; as if after severe sickness, Nat.
mur.; and nervous prostration, Bapt.; greatest debility, Nit. sp. d.;
with sliding down in bed, Mur. ac.; with trembling of the whole body,
and coldness of the limbs, Hyos.; and weakness, with sleepiness in
the afternoon, Bell.
Prostration. Chlorum, Colch., Gels., Merc., Rhus tox., Stram., Verat.,
very great, Arn.; uttermost and overwhelming — Ars.; lying in a
state of stupid apathy, senses inactive, very taciturn, and insensible
to every external impression, abdomen much distended, many gastric
ailments, and stools involuntary, Phos. ac.; - with inability to leave
the bed, falling of the lower jaw and eyelids, Ars.; exhaustion, Rhus
tox.; averse to every effort, even to speak, Sulph.; and anorexia,
and emaciation, Merc.; rapid, Ars.
Rhus tox.;
Sense of internal illness, as of impending disease Cinchona; attacks
as if body and mind were unstrung, Merc.
Sinking of strength, Arn., Hyos.; loss of all strength, Phos. ac.; rap-
idly, Phos.
Sinking of all the forces, Cinchona, Rhus tox.; general and rapid,
Ars., Phos., Secule; sudden, Colch., Nux vom., Verat.; in ten hours, he
can hardly speak or walk, Colch.; with muttering delirium, apathy,
loss of sense, bluish redness of the face, and a feeble, intermittent
pulse, Verat. alb.; paralytic, even in sitting, but mostly when moving,
Nux vom., Opium; with disposition to sleep, Verat.; rapid sinking,
dry tongue and skin, after bloody stools, Ars.; withered, bluish skin,
Carbo veg.; sinking down exhausted, Verat.
Inexpressible sense of illness in body and mind, Merc.
Fainting, Secale, sudden, Bry., Camphor, Coccul, Tarax; and
vertigo with every attempt to leave the bed, Opium; from bodily
movement, with spasmodic distortion of the facial muscles, Coc-
cul.; sense of illness and discomfort in the whole body, especially in
the stomach, even in the open air, Phos.; faintness and fever and
trembling, Lach.
Heaviness and dullness of body and mind, loathsome sensation of
the whole body, with weakness of the joints, especially of the knees,
while sitting, and in quick motion, Phos.
Weakness and weariness develop themselves, mostly as heaviness,
Puls.
Lies speechless, with open eyes and stiff limbs, Opium.
Appears to feel almost nothing, to be almost immovable, and yet
not quite paralyzed, Nit. sp. d.
284
A TREATISE ON TYPHOID FEVER.
All strength gone, settles down in the bed, paralysis threatens, Ars.,
Carbo veg., Mur. ac., Rhus tox., Nit. ac., Moschus; nearly at the verge
of the grave, Nux mosch. 200.
Debility as if the parts would be paralyzed. Rhus tox.
Paralysis of one or more parts, Caust.
Protracted reconvalescence, Psorin.
If the strength alone is still wanting, Verat.
Anxiety in the body, with disposition to tremble, Nux mosch.
Nervous tingling, lameness, Acon
Cow walk (gressus vaccinus) Luch.
Staggering gait, with difficulty in walking direct to a given point,
and anxious weakness, Ars.
Trembling, Ars., Bell., Hyos., Ignatia, Lyc.; of limbs, Ars.; and
internal with fever and faintness, evenings, Lach.; weakness,
Puls.;
with sense of
weariness in the limbs (in the early stage,) Bell.; of the whole body,
or one or more of the limbs, Stram.; -after every effort, Sulph.; - of
the part moved, in every effort, even of the protruded tongue, Bell.,
Lach., Secale; and jerking of the limbs, Apis; - in attacks, and
jerking of eyelids, muscles of face and limbs, fits of fainting from
bodily movement, with spasmodic distortion of the facial muscles,
Coccul; in the morning, with jerking of the limbs, Phos.
of the body, with prostration, Carbo veg.;
My
of hands
Rhus
Motions, automatic of muscles, Camphor, Khus tox.;
and feet, Coccul, Rhus tox.; involuntary - Bell., Colch., Hyos.,
tox.; Stram.; constant odd - of limbs and body, Stram.; sudden start-
ings, Canth.; twitchings, the fourteenth day; Colch.; frequently raises
or jerks the head from the pillow, Stram.
Jerking and turning of hands, Opium, violent
of the limbs, shak-
ing whole body, awake or asleep, Lyc.; of the limbs and tendons,
debility and weariness of the whole body, Hyos.; of the tendons,
Ignatia; with pale face and cold hands, and small, hard, rapid pulse,
Bell.
Subsultus tendinum, Chlorum, Lyc., Psorin, Rhus tcx., Secale, Sulph.,
Zincum; violent, Hyos.
Clonic spasms, Canth.
Spasmodic motions, convulsions, Hyos., Ignatia; convulsive motions
of mouth or face, Bell.; intermittent convulsions every two or three
hours, recur at the same hour, Moschus.
Clonic spasms of upper and lower limbs, with paralytic weakness,
Lauroc clonic spasms, from spinal marrow, Stram.
No loss of consciousness with spasms, Lauroc.
SLEEP.
Sleeplessness, with desire to sleep, Bell.; extreme prostration and
sleepiness, but unable to sleep, Merc.; impossibility to sleep, though
feeling very sleepy, Opium; great desire to sleep, but cannot, Mur. ac.
Sleepiness, unconquerable inclination to sleep, Coccul., Hyos.; with
weakness, Cinchona; he cannot prevent sleep when seated at work in
the day-time, Sulph.; while answering a question, falls into a deep
T
SYMPTOMATIC INDICATIONS.
285
sleep before finishing, Arn.. Bapt., Hyos.; like coma, Phos., Puls.,
Secale; and stupid, Gels.; in afternoon, Bell.; sudden in the even-
ing, cannot rouse herself from it, Rhus tox.; through the whole day,
Bry.; very weak and sleepy the whole day, Sulph.; often through the
day compelled to sleep whole hours, Puls.; he must sleep all the time,
Bry.; he sleeps on his chair, in a half-conscious state, Verat.; falls
asleep while sitting, Merc.; if left alone, he sinks into slumber, Helleb.;
the whole day, with anxiety, restlessness, sadness, dry lips, and a
constant desire to lie down, Rhus tox.
Great drowsiness, Bell.; slumbering all day,Phos. ac.
Slumber, with frightful dreams, changing into delirium, Bell.
Frightful, or imaginary visions, on closing the eyes, Ars., Bell.,
Calc. ost., Sambuc.; on going to sleep, delirium, Ginseng.
Uncommon sleepiness, as if from stupefaction of the head, Nux vom.
Great sleepiness, with giddiness, walks with the eyes shut, Nux
mosch.
Sleepiness, with weakness in all the limbs, Lach.
Easily roused out of sleep, and soon is conscious, Phos. ac.
Gentle sleep, Hyos.
Constant slumbering. Phos. ac.
Too great disposition to sleep, which is too profound, slept twelve
hours, and would longer, if not wakened, Merc.
Cannot go to sleep because she cannot get herself together, head
feels scattered about, tosses about to get the pieces together, Bapt.
Uninterrupted sleep for three days, Verat.; like in a deep sleep,
Merc.; deep sleep after delirium, Secale.
He cannot be roused, or only with great difficulty, Opium; continued
profound sleep, Verat.
Sleep, with loose, rattling respiration, Opium;
breathing, Opium, Stram.
with stertorous
Stupefying slumber the whole day, Secale; also at night, with
increased thirst, Opium; deep and long continued sleep, Secale.
In stupefying sleep, stertor, especially during expiration, Opium;
stupid sleep, with unconsciousness, Opium.
Restless, stupefying, dull sleep, with constant tossing about, Puls.
Lethargic slumbering, with murmurs and snoring, Rhus tox.
Comatose sleep, Bapt., Colch.; comatose slumbering, full of troubled
and intermittent dreams, Rhus tox.; -with anxious delirium, Bry.
The night seems long and tedious, with comatose slumbering, and
dreams full of bustle and hurry, Nux vom.
Unconquerable coma vigil, Coccul, Hyos.; with indistinct muttering,
Opium; alternating at night with coma somnolentum, delirium, hot
skin, and stupidity, Opium; with frequent starts, as if from fright,
and one eye open, and the other closed, or half open, Verat.
Constant somnolence, may be roused, but not to full consciousness,
Helleb.
Slumbers day and night, with murmuring delirium, Phos. ac.
Coma, Coccul., Verat. alb.; constant, profound Psorin; profound,
286
A TREATISE ON TYPHOID FEVER.
comatose sleep, with snoring (see Opium,) sometimes opening the eyes
without moving, with wild look, Bell.; profoundest —, lying silent,
immovable, insensible, a dreamy state. with drowsiness, and falling of
the eyelids, restless sleep at night, Nux mosch.; irresistible sleep and
complete -,
with insensibility, heat, pulse and respiration as in
health, Opium.
When spoken to, answers correctly, but soon relapses into stupor
again, Hyos..
Sopor, Ars., Lach., Lyc., Opium, Phos., Rhus tox.; deep, Coccul;
could not be awakened, Opium - and delirium, Lyc.; — and stupe-
faction, Phos.; stupid, soporous, comatose state, Arnica; with staring
eyes, Opium; febris soporosa of children, heat, chewing motions,
turning the occiput, or putting their hands there, Carbo veg. 200,
Opium; with open eyes, Lyc.; fevers, with soporous condition, dry,
black lips and tongue, and open mouth, Phos.; — lying on the back,
tongue heavy, face sunken, lower jaw hanging down, pulse small,
weak, and frequent, Lach.; threatens to terminate in paralysis of
the brain, Opium.
Lies at night in bed without consciousness, with groans, cold sweat
on the forehead, followed by weakness, Bry.
Great dullness of mind, with bodily weakness, Lach.
Complete insensibility, Lach.
Great anxiety and fearfulness drives from the bed, springs out and
calls for help on account of indescribable feeling of distress, Rhus tox.
He springs out of bed delirious, in evening slumber, Nux vom.
Delirious phantasies on lying down, Nux vom.
Muttering and phantasies in sleep, Nit. sp. d.
Much muttering during the evening fever, Lach.; unintelligible
muttering, Puls.; whimpering at three o'clock, Bry.; moaning and
whimpering, Nux vom.
Sleep with outcries, Bry., Hyos., Lyc., Phos.; wakening Stram.
Delirium at night, Bry., Lach., Puls.
Insensibility of the organs of touch, sight and smell, Opium.
Heaviness of the head, with dullness like lead in the occiput, with
vertigo, Lachesis.
Distorted, open eyes, Opium; half open, Opium, Sulphur.
Nosebleed at night, Bry., Merc., Rhus tox., Verat.; after midnight,
Rhus tox.
Jerkings of the face, Bry.
Face red, swollen, with injected conjunctiva, Bell.; with dark
brown face, Stram.
Distortion of the mouth, or movements like chewing, Bry.
Open mouth, Rhus tox.; half open mouth, red, puffy face, Opium;
hanging of lower jaw, Opium.
Thirst, with frequent drinking, Bry.
Involuntary stools, Bry.
Involuntary evacuations of fæces and urine, Arn.
Suffocating night mare, Opium.
SYMPTOMATIC INDICATIONS.
287
Blowing, whistling expiration through the nose, Nux vom.; with
very deep drawn respiration, Stram.; loud blowing, with in- and exha-
lation, Arn.
Respiration slow, heavy, and even intermittent, Opium.
Very short breath, Rhus tox.; with rapid pulse, oppressed and anx-
ious respiration, Opium.
Snoring inspiration, as if the posterior nares were contracted, before
midnight, Nux vơm.
Suffocating snoring with the inspiration, Bry.
Snoring in sleep, Sulph.; and murmuring and picking at the bed-
clothes, Rhus tox.
Whimpering, sighing, and moaning, Opium; whimpering, loud
talking, loud blowing, in- and expiration, Arn.
Pulse slow, suppressed, Opium; first rapid and strong, then weak
and intermitting, Opium.
Pulse, very small, rapid, and intermittent, weak, irregular, often
intermitting, small, rapid, or hardly perceptible, Stram; rapid and
weak, Opium.
Paralytic sensation in all the limbs, Rhus tox.
Constant sliding down in bed, with groaning and moaning in sleep,
and muttering and unconsciousness whilst awake, Mur. ac. See
Positions.
Sighing and jerks in sleep, which awake the patient. Bell.
Jerking of limbs, muscles of the face, and corners of mouth, Opium.
Constant slumber, with picking, Hyos.; touching surrounding
objects, with half-open eyes, Opium.
Shuddering from the slightest current of air, Bell., Selen.
Throwing off the bed-covering, because of heat, most in the palms
of the hands, Puls.; he casts off the clothes because they are too tight,
or too warm, yet he shivers as soon as he is uncovered, Puls.
Dry heat, Bry.; with pain in the part on which he has lain, as if the
place had been too hard, Phos,; with dryness of the mouth, which
impels him to drink, Phos.
Burning, both internal and external, Hyos.; on palms of hands,
Puls.
Sweat, quiet, sleep, with profuse sweat, Hyos.; night sweats, Hyos.;
greasy, stiffens the linen, stains it yellow, Lachesis; or is offensive,
Merc.; copious-, with itching of a miliary eruption, Opium.
Ma
Dreams, troublesome, Bapt., Ign.; full of phantasies and dreams in
long continuing slumber, Puls.; extravagant Nux vom.; delirious,
anxious, Arn., Hyos.; and heaviness from the evening into the
night, which much affect the body, Arn.; wakes from, - with fright
and outcries, Bry.; frightful Ars., Bell.; is kept awake for fear of
horrible visions, Bry.; angry, as if bitten by a dog, and he cannot
escape, as if he were hunted, of robbers, with frightened awakening
and a fixed idea that the dream is true, Verat.; frightful, Arn.; as
if he fell from a height, or as if he were not in his own home, and
talking of distant villages, of shootings, of street robbers, Merc.; of
"
288
A TREATISE ON TYPHOID FEVER.
animals biting, with outcries, and waking, with anxiety, Phos.; as if
cut and hacked by soldiers, with desire to escape, Bry.; anxious every
night, Sulph., full of images, Nux vom.; with subsequent vomiting of
green, tenacious slime, Verat.; sleep full of and restless before
midnight, irrational talk in his sleep, like delirious dreams, Sulph.;
frightful and frequent waking, and never that state of quiet,
profound coma, Rhus tox.; restless, with constant, heavy, Secale.;
dreaming at night, Bry., Phos., Rhus tox.; restless sleep, with frightful
— of being drowned, Verat.
Restless, from abdominal symptoms, Nux mosch.;
in bed, Sulph.;
-
tossing at night
tossing, as if from great heat, Puls.; only snatches
of sleep, Camphor; sleepless, wandering mind, Bapt.; intolerable -,
anxiety and discomfort at night in bed, with sleeplessness, Merc.;
with outcries and loud laughing, Lyc.; with groaning and moaning,
and frequent movements of the mouth, like chewing, Bry.,
turbed sleep, with frequent turning, and throwing off the bed-cover-
ing, Rhus tox.; — throwing about in bed, Puls.; at night, continual
restless sleep and vomiting, Bell.
dis-
Sleeplessness, Phos.; with great restlessness, and tossing about the
bed, Ars.; from same idea rousing him from slumber, Calc. ost.;
from nervous excitability, Hyos.; utter from over activity of mind,
Calc. ost.;
with strong desire to sleep, Bell.; stupid, with phantasies
of dragons, skeletons, horrible spirits, ghosts, in a state of half sleep-
ing and waking, Opium; frightful imaginations prevent his sleeping
in the evening, Merc.; with restlessness and delirium, or incomplete
visions and phantasies, Opium ; on account of various visions as
soon as he falls in a doze, Ignatia, Calc. ost„; or constant sleep, with
muttering, Hyos.; — with carbo-nitrogenoid constitutions, Sulph.
Waking, half awake, phantasies of headless bodies, and dead
acquaintances, Nux vom.; waking suddenly from sleep, with start and
fright, Bell.; frequently as if from fright, or from wakefulness,
with much tossing, Merc.; - from each sleep, with fright, as if from a
terrifying dream, Sulph.; in fright from the least noise, Nux vom.;
K
- frequently from sensation of heat, Phos.; insensible, Cinchon.; stu-
pefied, as if drunk, dizzy, staggering, Phos.; on going to sit up, giddy,
has to lie down again, Opium.
When awaking, exceedingly cross, irritable, scolding, screaming,
behaving disagreeably, Lyc.
After waking, anxious phantasies, as from ghosts, or his employ-
ments, from which he cannot at once free himself, Sulph.
Waking delirium, Bry.; with loud outcries, Stram.; that which he
has dreamed seems a reality, Sulph., Nat. mur.
On waking, whirling in the head, by which sleep is made more dis-
tressing than pleasant, Merc.; weak, sluggish, drowsy lassitude,
Bry.
After sleep, much exhausted, Secale; after morbid sleep, stammer-
ing, difficulty of moving the tongue, nausea, Opium; aggravation
of all the symptoms, Lach,
SYMPTOMATIC INDICATIONS.
289
Sleeplike state, from which he emerges with consciousness and
speech, Merc.; sleeps all the time, awakes conscious. but while awake,
taciturn, apathetic, Phos. ac.
Sleep unrefreshing, and full of dreams, Arn.; after sleep, weary as
before, Bry., Nux vom.; feels after light sleep as if he had not slept at
all, Puls.; as if he had too little sleep, Verat.
Loss or interruption of sleep is followed by great loss of strength,
Coccul.
At night, diarrhoea worse, Puls.; after midnight, dryness and thirst,
Rhus tox.; at 3 A. M., nosebleed, Bry.; anxiety, Kali carb.; all symptoms
worse about and soon after midnight, Ars.; after midnight, delirium,
Kali carb.; worse after than before midnight, Rhus tox.; at night,
delirium, Bry.
Morning remission, Rhus tox.; delirium, Bry.; dry tongue, Opium,
Sulph.; sudamina appear, Merc.
Afternoon, dryness and thirst, Rhus tox.; sleepy, Bell.
All day, heavy and weak, Sulph.
Evening aggravation, Bry.; frightful phantasies, Cinch.; delirious,
Bry.; bleeding from the nose, Phos.; pale, sick aspect, Phos.; dry
mouth, without thirst, Nux mosch.; fever and fainting, Lachesis.
Symptoms recur at the same hour, Moschus.
Cold and warmth, washing in cold water relieves, Fluor. ac.; heat
aggravates all the symptoms, Jodium; relieves icy coldness of body,
Lachn.; weariness, as if from overheated air, Verat.; external warmth
is unbearable, warm sensation, as if in an overheated room, or as if
hot air were blowing on one, which excites headache, Puls.
External heat is intolerable, causing a sense of heat with distress,
uncovering, however, is followed immediately by a chill at the early
stage, Puls.
Uncover themselves, Pell.; desire to throw off the covers, Fluor. ac.;
would not be covered up, Secale; desire to be covered, with dry heat,
or with sweat, Rhus tox.
Immoderate sensibility to the open air, Nux vom., Selen.
Temperature, sunken, Coccul.; collapse with it, Camphor; quickly
decreasing, most on limbs, Camphor.
Chilliness and coldness, coldness, and no other symptoms, Lyc.;
of the whole body, especially the feet and hands, would not be cov-
ered, Secale; with cold sweat upon the hands, feet and face, Verat.
vir.; clammy, cold skin, Camphor; covered with clammy sweat, Rhus
tox.; skin cool, heat internal, face flushes, Jodium; sweat on one side,
coldness of the other, Puls.; shiverings, Bapt.; and heaviness of
body, Puls.; violent chill, each time after eating or drinking, Tarax;
all day, Bapt.; with soreness of the whole body, Bapt.; with
sighing, Ipecac; begins with chills, headache, and backache, pain in
the limbs, Bapt.; chill and fever, simultaneous, with soreness of the
flesh, Bapt.; chills alternating with heat, moist skin, Bapt.
Fever and heat, temperature of the body not high, and even all
over, Phos. ac.; burning heat, Ars.; increased warmth, Stram.; moderate
290
A TREATISE ON TYPHOID FEVER.
warmth of skin, Helleb., skin dry and warm, Mur. ac.; and clammy,
Phos. ac.; dry skin, burning hot, Phos. ac.; biting hot, Bell.; burning
of the skin while laying the hand on any part of the body, Hyos.;
local heat, Calc. ost.; heat only on one side, Puls.; heat at night,
Bapt.; heat worse in the afternoon, Lach.; heat and delirium on going
to sleep, Ginseng; burning fever, with somnolency and delirium,
Lachn.; sensation of heat in body, most in head, Bry., Rhus t.; fever,
with circumscribed redness of the cheeks in the evening, Ars.; and
brilliant eyes, Lachn.; heat intense, with raw mouth, Arum triph.; heat
and thirst, Bry., Rhus tox; heat, without desire to drink, Hyos.; burn-
ing and vomiting, Cham.; anxious and restless, with burning, as if
hot water were flowing through the veins, or with throbbing in the
head, and desire to throw off the bed-covers, Ars.; trunk hot, but
limbs cold, Colch.; skin normal temperature, Helleb.; mostly dry, with
increased temperature, Mur. ac.; hot and dry, Gels.; dry skin burns,
Puls.; dry or clammy, Phos. ac., heat all over, with sweating, most in
the evening, in bed, or during the day, with pale face, Verut.; skin
dry, Colch.; and burning, Apis.; like parchment, and pungent, hot,
Ars.
M
Sweat, cold, Carb. veg., Verat.; on whole body, Verat.; all over,
Camphor; on forehead, Coccul.; on forehead only, Verat.; in
face, Bell.; mostly on face and forehead, Sec.; only on head and
trunk, Verat.; on hands Cocc.; on hands, feet and face, Carbo v.;
with trembling of the whole body, Puls.; — cold and clammy, Ars.;
hot on the face, Rhus tox.; inclination to perspire, with very hot
skin, Bell.; disposed to much
Carb. v.; profuse, whole body
bathed in it, (Stram).; general and profuse, Secale; profuse
Phos. ac., and stupor, Kali carb., with desire to be magnetized,
Silic.; clammy, partial, Apis; sticky, constant, Phos. ac., and
cold, Ars., Phos. ac., Secale, Verat.; frequent —, Bapt.; copious, debili-
tating, Merc.; critical sweat on forehead and face, Bapt.; acid — at
night, preceded by thirst, with pressing drawing in the head towards
the end of the sweating, followed by confusion of the head, Bry.
Sour sweat at noon, and sour diarrhoea in daytime, Rhus tox.;
most in afternoon and in upper part of body, Fluor. ac.; makes
patient thirsty, Jodium ; without thirst, Rhus tox., Sambuc., Sepia,
Verat. alb.
Fetid sweat, Bapt.; offensive and sour, Ars., and breath offensive,
Arn.; a cadaverous smell scents the whole atmosphere, Ars.
Great disposition to sweat, Colch.; during the day, Puls.; gentle
sweating, during which he wishes to be covered, Rhus tox.; anxious
sweat, preventing sleep, with sighing, short cough and pressure in
chest, Bry.
In sleep, Cinch., in bed in the morning, Rhus tox.; nocturnal, also
continued, mostly in a long sleep, Verat.
With great weakness and stupidity, Hyos.
From the head to the epigastrium, Secale.
SYMPTOMATIC INDICATIONS.
291
On one side, on the right side of the face, or on one side of body,
either the right or left, Puls.
Over the whole body, except the head, Rhus tox.; moist skin all
over, Bry.
With the rash, Stram.
Suppressed sweat, Colch.
Sweat did not relieve, Laches., Merc., Phos.; children, with great
dryness followed by hot sweat, without relief; not Merc., but Stram.
Long lasting sweat in reconvalescence Psorin.
Gets bedsores on parts sweating, Fluor. ac.
Directions; complaints, which go from above downwards, Selen.,
commencing below and spreading upwards. Fluor. ac., Guaco.
Periodicity; fever comes on by short periods, Bell., Calc.
Sensations; neuralgic pains leave suddenly, Phos.; exalted irrita-
bility of all the organs, Bell.; sensation as of lead in the veins, worse
when sitting, Merc.; stiffness (in the beginning), Bry.
Rheumatic; pains, Bry., Camphor, Rhus tox. The more rheumatic
pains in beginning, the more we may expect abdominal localization.
The patient will call pains rheumatic, but they are nervous and
decrease when thinking about it. Camphor. Jahr.
Dull, pressive, or stitching, tearing pains, worse from motion and
opening the eyes, Bry.
Shooting pains in one or the other part of body, whilst the part is at
rest, Rhus tox.
Pains throbbing, Bry.
Tissues; throbbing in veins; they enlarge here and there, Jodium.;
bleedings from the beginning, Nit. ac.; hæmorrhagés, Alum. p. s.,
Ars., Bry., Carbo. veg., Cinch., Nit. ac., Phosph., Rhus tox., Sulph. ac.
Exhaustion from loss of fluids, Cinch., anæmia; Chin., Sulph.
Little or no affection of mucous membranes of intestines, Helleb.,
Mur. ac.
Acrid ichorous discharge from nose, excoriating mucous membranes
alæ nasi, upper lip making them raw and sore, Arum. triph.
Soreness in all the bones, Puls.; aching in bones and back, Bapt.
Want of firmness in all the joints, Bry.; the joints seem too weak to
carry the body, Carbo v.; weakness of joints, Phos.
Relaxation of the muscles with exhaustion from the slightest exer-
tion, Laches.; muscles relaxed, with waxy skin, Verat.
Trifling loss of flesh, Helleb.
Emaciation, Ars., Colch., Merc., Opium; extreme, Nuphar; rapid,
Secale.
Fetor of breath, sweat, urine and focal discharges, Bapt.
Putrid decomposition of fluids, Rhus tox.; great prostration with
disposition in the fluids to decompose, Bapt.; no signs of putrid disso-
lution, Helleb.
Touch; sensibility of the surface, Colch., Hamam.; bed-covering
causes pain, Lach., Sulph.; when touched, pain in hypogastrium,
abdomen and loins, Phos.
292
A TREATISE ON TYPHOID FEVER.
Sensitive to pressure on stomach, Ars., Phos.; on abdomen, Phos.
Dullness and bruised pains in the limbs, Lach.; with sensation as if
bruised, lasting the whole night, Puls.; bruised soreness, every posi-
tion feels too hard, Arn.
Bluish red spots on the parts which the patient lies upon, Phos. ac.
Decubitus, on the sacrum and trochanter, Zincum; bedsores, Arn.,
Ars., Carb. veg., Cinchon., Fluor. ac., Moschus., Nux vom., Phos. ac.;
gangrenous, like sphacelus, Carb. veg.
Skin; small transparent vesicles filled with watery fluid, appearing
in the morning on various parts of the body (Sudamina), Merc.
White rash, Apis, Lach, Mur ac.; in beginning Bry.; white miliary
rash, Ars.; with anxiety in the region of the heart, Bry.
Red rash, Phos.; insufficient, Lyc.; scattered, Phos. ac.; red miliary
spots on chest and back, Cinch.; after stupefaction of the head, dull-
ness of vision, beclouding of all the senses, the rash appears on the
back, with sweating, Stram.
Repeated breaking out with short frequent breathing, Ars.
Miliaria purulenta with anasarca, Sulphur.
Miliary rash, Rhus tox., on the trunk, Phos., about the neck, then
back, then chest, gradually all over, lastly upon the feet, Phos. ac
Lenticular red spots with small vesicles in the centre, Rhus tox.
Numerous roseola spots, Rhus tox.
Exanthem delayed, and on the fourteenth day, fever again rising,
with new symptoms of cerebral irritation, twitchings, delirium, fright-
ful visions or great anguish (whether diarrhoea is present or not,
Calc. ostr.
Bluish spots, Nux mosch.; extravasation under the epidermis, Ars.
Ecchymosis, Carb. veg., Phos. ac.; on trunk, Arn., Phos.; ecchymotic
spots here and there, Carb. veg.
Large purple spots on the body, particularly on the feet, Secale.
Red spots like flea-bites, or blood stains, or petechiæ, on chest, abdo-
men, face and neck, Bell.
An eruption like flea-bites, Puls.
Petechiæ, Ars., Bry., Secale, Rhus tox., Stram.; small shining, star-
shaped, on the face, throat and chest, Stram.; with great weakness,
even to the loss of all strength, Rhus tox.
After sudamina and petechiæ have appeared, and no diarrhoea set
in, Bry.
Icteroid color of the skin, Merc.; waxy, pale, pale as wax, Rhus tox.
See face.
Jaundice with diarrhoea, Leptan.
Skin cool, bluish, Carb. veg.; relaxed, pale, Phos. ac.; wrinkled,
Verat.; small, red, itching spots here and there on the body, Opium.
Ulcerations, Bapt.; boils, Merc.
Decubitus. See touch.
Constitutions; at the very onset all further progress may be cut off,
in persons inclined to grow fat, by, Calc. ostr.; weak, debilitated indi-
viduals, old age or children, Ars.
SYMPTOMATIC INDICATIONS.
293
In cholera time, Cuprum, Sulphur, Verat.
Other drugs; after abuse of Calomel Nit. ac.; after Opium, Helleb.;
after abuse of Chlorum, Nit. ac., Merc., Sulphur; Calc., Lyc.;
Bry., Mur. ac.
-
Camphor in cases like Carb. veg., but symptoms more rapid.
Bry. and Rhus tox. rarely in alternation, but Rhus tox. and Nux vom.,
Bry. and Puls. (Bonninghausen) of course not without being indi-
cated by the changing symptoms.
When Rhus tox. or Bry. are insufficient in catarrhal or pneumonic
symptoms, compare Phos.
If Nit. ac. be insufficient in bleeding from anus, the symptoms may
have been more for .Mur. ac., also Ars. or Phos. See GROSS' Materia
Medica Comparativa. Alum. p. s., may be the only resort. See
Materia Medica.
When Rhus tox. or Ars. are insufficient in cases of great prostration,
compare Mur. ac., after it Carb. veg.
In hepatic affections, after Bry., Lach. and Lyc. had failed, Merc.
was given with success.
MODEL CURES.
In the war-typhus of 1813 to 1814, where in the first stage of the fever
Rhus tox. or Bry. (never in alternation), in the second stage Hyos., in
the twelfth centesimal, answered so well, that from 183 cases only one,
an old person, died, there sometimes occurred a third stage, a sort of
lethargy of the sensorium, a kind of half paralysis of the mental
organs. The patient remained lying indolently without sleeping or
speaking; he scarcely answered whatever might have been done to
induce him to do so; he appeared to hear, without understanding
what was said or without allowing it to make any impression on him
(the few words he said, he whispered; but not irrelevantly); he
appeared to feel almost nothing and to be almost immovable, and yet
not quite paralyzed. In this case Sweet Spirit of Nitre was useful. It
must be so old, thas it no longer reddens the cork. One drop is to be
shaken up with an ounce of water and given by teaspoonfuls so as to
be consumed in the four and twenty hours. In the course of a few
days. this state passed into health and activity. Samuel Hahnemann's
Lesser Writings, p. 634.
An extreme case. Great thirst, but fluids caused pain and gurgled
through the intestines, making a noise as in an empty cask. Hydroc.
ac. Haynel.
In prevailing fever, with sopor. No complaint except thirst. On
lifting the head dullness and vertigo, had to lie down, Opium.
Wm.
Gross.
The patient lies in an unconscious state, with both arms lying
stretched out by the side of the body; now and then starts up sud-
denly as if mad, and strikes about him; with screaming, tossing to
and fro, or even clonic spasms. All in consequence of erosions and
ulcers of inner organs, f. i. the intestinal canal, or an inflammatory
condition of the membranes of the brain, Canthar. W. Gross.
294
A TREATISE ON TYPHOID FEVER.
Typhoid fever with the greatest indifference, putrid breath, and red
spots like suggilations on the body, Arnica. C. Hg.
An elderly man given up with a typhoid fever, suddenly took a
change for the better after Plumbum 30, not only because many of his
(altogether objective) symptoms were similar to it, but he had been an
opium-eater for years. After consciousness came back, he turned
yellow all over, his appetite came back and he recovered fully. C. Hg.
Relapse in third week; sudden stupor and speechlessness with a
brown parched tongue as hard as a board, teeth and gums covered
with a brown mucus, on the nose dried up hard crusts. Rhus tox. in
water, a teaspoonful every two or three hours; followed by recovery
within three days. Jahr.
Malignant ship-fever; ninth day; lying on his back unconscious;
eyes wide open, glaring, fixed on the ceiling; pupils dilated; cheeks
red and hot; mouth wide open; jaw hanging down; lips and tongue
dry, black, cracked; picking of bed-coverings; pulse 200. Involun-
tary urination at night, on the sheets a large deposit of red sand, like
brick-dust. Lyc. 200 in half a tumbler of water a spoonful every two
hours; after six or eight hours, eyes and mouth closed, sleep and sweat
and full recovery. A. Lippe.
Violent delirium with severe pains in the limbs, great weakness,
dry tongue (red or black); dry, brown or black lips; heat and redness
of the cheeks, carphologia, pulse quick and small, lethargic slumber-
ing, with murmurs and snoring, Rhus t. Wells.
Large purple spots on the body, particularly on the feet; body cold,
especially the feet and hands, aud would not be covered up; cold per-
spiration, mostly on the face and forehead; copious vomiting of
greatly degenerated thick black bile, mixed with tenacious bilious
mucous; this bilious matter was badly mixed with black bile, mucus,
degenerate substance, etc.,— it was a horrible mixture; would vomit
about a quart at a time, Secale corn. high. Guernsey and Lippe.
In case of ship-fever, apparently sinking, quick fluttering pulse,
could hardly move, Iris vers. Guernsey.
Tongue dry and brown. Thirst for large quantities. Delirium at
night. Desire to get out of bed and go home. Talking about business of
the past few weeks. Bry. 200, 2000. J. B. Bell.
Much headache. Dreaming and talking in his sleep about business of
the past few weeks. Thinks about it in daytime. Bry. 200, 2000. J. B.
Bell.
Violent subsultus tendinum. When spoken to answers correctly, but
quickly relapses into stupor. Hyos. 200, in twenty-four hours. A young
man, third week of typhoid fever. J. B. Bell.
Third week violent and almost constant congh; expectorates bloody
frothy mucus. Stupor, profuse sweat. Involuntary stool, Pulse 120
to 140. Tongue clean on tip. pointed. Pale watery swelling in a little
bag over the eyes. Kali carb. 200. J. B. Bell.
1
INDEX.
Abdomen..
A
Abdomen sensibility of the.
Abdomen - therapeutics of....271
Abscesses..
Abuse of drugs-antidotes.... 293
Acute and chronic diseases
Age - causative.
Anatomical character.
Aphonia.
Appetite.
•
Atmospheric air.
Auscultation of arteries.
Coma-therapeutics of.
Coma-vigil....
Common form of typhoid.
Complications, uitat
Constipation..
·
Constitution-causative..
.
•
285
97
.133
.140
160
138
96
33
77
...
32
Contact..
Contagion.
61
57
.180
.147
Contagion, immediate.
Contagion, mediate..
72-3
·
73
59
129
37
fever..
71
100
Convulsions-clonic.
86
.150
... •
•
Convulsions — tonic.
84
.271 Cornea, softening of the..
113
Cough.
147
159
Auscultation of the lungs.
Aversions-therapeutics..
Baths..
B
Benign form of typhoid.
Bladder.
Bladder-therapeutics of...
Blood, state of the..
Blood, post mortem.
Borborygmus.
Carphologia..
C
Causes, lesions as.
• •
Contagion, propagation of..
Contagiousness of typhoid
Course of typhoid fever.
231-2 Curative treatm't (Allopathic) 218
170 Curative treatment (Homœo-
143
pathic).
• •
275 Cyanosis....
234
95
154
D
197
134 Death rate in Chicago..
54
Dejections.
137
Delirium..
106
87 Delirium therapeutics of………. 258
•
78 Desires-therapeutics.
254
Causes, radical.
•
Causes, natural.
Causes, non-natural..
Causes, unnatural.
76 Diagnosis.
202
31 Diagnosis, differential.
204
37 Diarrhoea..
138
50 Diathesis, ulcerative. .
120
Cognition-therapeutics of... 249
Chest.
Chest-therapeutics of the... 276 Dreams-therapeutics..
Clonic contractions...
Coma..
150 Disinfectants..
214
287
86 Duration, and termination of
typhoid fever..
173
110 Dyspnoea.
105
296
INDEX.
E
tics of....
263
Ears -- therapeutics of.....
Edoma of the glottis.
263
Heart-post mortem.
196
168
Heart-therapeutics of the... 278
Effluvia, propagation by.
62
Hæmorrhages...
138
•
Encephalon-post mortem.
192
Hippocratic face.
121
Endemia..
135
Hygienic means.
222
Entorrhagia.
51
Hygienic preventives.
216
• •
Epidemy..
53
I
Epidemic vs. contagious dis-
Icterus.
135
eases.
68
Infection..
Epiglottis - post mortem.
Epistaxis.
Eruption of typhoid.
194
66, 75
118
90
Inoculation, propagation by... 59
Intestinal hæmorrhages.
138
Erysipelas.
96
Intestinal lesions-post mor-
Etiology...
30
Evacuations, involuntary.
Excretions and retentions.
138
tem..
Intestinal perforation.
182
141
•
Introduction.
9
49
Exfoliation of the epidermis.. 95
Eyes, bleared state of the..
Eyes- therapeutics.
Involuntary evacuations.
138
113
K
262
Eyelashes, pulverent state of
Kidneys-post mortem.......
191
the..
113
L
F
Larynx.
135
•
Face.
120 Larynx, necrosis of the..
168
Face, Hippocratic.
121
Limbs..
280
Face therapeutics of the.
264
Limbs and Trunk-therapeu-
Fever.
97
tics..
153
Fever -therapeutics of....
Liver..
289
135
•
Fibrillary muscular contrac-
Liver-post mortem.
191
tion...
85
Location of typhoid fever.
175
•
First stage, treatment of…….
Floccilegia.
234
Lungs.
150
195
66
(6
CC
66
malignant.
prolonged.
putrid.
•
·
Forms, symptomatology of the
different.
Form, benign.
►
common.
87 Lungs-post mortem.
249
M
170 Macula, papulous
88
160 Malignant form of typhoid………. 171
171 Mesenteric ganglia — post mor-
169
189
•
146
49
tem..
169 Menstruation.
•
G
Mental passions.
Mental states-therapeutics.. 259
Gangrene.
93 Meteorism..
133
Gastric symptoms- therapeu-
Mind - therapeutics of the..
253
tics...
271
Model cures.
293
Genital organs..
146
Morale...
106
• •
Genito-urinary apparatus..... 143 Motion and rest..
Germinal matters.
Glottis, œdema of the.
46
65 Mouth.
•
•
168 Mouth, dryness of the
122
124
Gums.
•
H
Habits-causative...
123 Mouth-therapeutics of the.. 265
•
Muscles-post mortem.
Muscular contractions....
35 Muscular pains...
198
84-6
88
Head, external- therapeutics
N
of.
262
•
Head, internal - therapeutics
Nature of typhoid.
17
of..
261
Natural causes.
31
Headache..
109
Non-natural causes..
37
•
Hearing, hardness of...
116
Nose, necrosis of the.
119
Hearing and ears- therapeu-
Nose-therapeutics of the.... 264
INDEX.
297
Nostrils, pulverent state of the 119
Nervous variety of typhoid... 172
O
Odor from the body...
Otorrhoea..
P
Pains in the ear..
Pains in the epigastrium.
Pains, muscular.
Pancreas-post mortem
Percussion.
• •
Spasm, partial ...
Spasm, tonic....
Spasmodic movements, thera-
peutics..
96 Spleen, hypertrophy of.
117 Spleen-post mortem..
•
85
84
284
135
•
182
Statistics of deaths in Chicago 54
Stomach.
117 Stools..
88
Stupor...
169
•
•
132 Stools-therapeutics of.
Subsultus tendinum..
152 Sudamina.
Perforation of the intestine ... 141
Suggillations.
• •
Periodicity- therapeutics..... 291 Surgical means..
Peritonitis
Petechiæ...
Precautions hygienic..
168 Sweat-therapeutics of
..91-2
216
Premonitory stage-treatment
Precautions therapeutic..
of...
Professions-causative.
Prognosis.
Symptomatology.
Symptoms, general.
131
138
273
·
·
•
110
$6
91
92
247
290
•
249
80
17
217 Synonyms and opinions about
233
35
• •
207
typhoid fever.
T
Prolonged form of typhoid..... 169 Teeth, appearance in typhoid. 122
Prostration
Pulse...
Pulse-therapeutics of the
Pupil of the eye..
Putrid form of typhoid.
R
Rales, pulmonary.
Radical causes.
Remedies, principal.
Respiration..
Respiratory apparatus..
S
81 Temperament.
97 Temperature
•
•
278 Termination of typhoid.……
113 Therapeutic means..
169
Therapeutic preventives.
Third stage, treatment of.
Thirst...
76
Throat...
150
Throat-therapeutics.
152
252 Tissues-therapeutics.
Tonic contractions.
194 Tongue in typhoid
Tremors.
Second stage, treatment of.... 237
Senses-therapeutics of... 259
Sensibility of the abdomen
... •
140
34
100
174
231
217
240
1:0
1.8
269
291
84
123
87
218
153
22
82
111
Treatment (Allopathic)……….
Treatment (Homoeopathic)..234-249
Trunk and limbs.
Typhoid fever, what is it?…….
Sensibility of the epigastrium. 132 Typhoid inebriety...
Sensorium -- therapeutics..
Sex-causative..
Sight and eyes-therapeutics
of..
Skin
Skin, color of the…….
Skin, exfoliation of the
Skin, sensibility of..
Skin-therapeutics of the.
Sleep...
Sleep, therapeutics of.
Sleep and watching.
Smell and nose
•
of..
Somnolence
260 Typho-mania
33
•
U
•
262 Ulcerative diathesis...
88 Unnatural causes....
120
50
95 Urine, character, tests, etc.... 144
143
95 Urine, incontinence of.
96 Urine-therapeutics of the... 275
292
97
V.
284 Vehicles, contagion by.
47 Vertigo
therapeutics Vibices.
Sopor- therapeutics of.
Sounds, pulmonary.
Spasm, clonic..
• ·
•
63
•
109
92
147
131
264 Voice...
•
110 Vomiting.
286
W
150
86 What is typhoid fever?...
22

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