1st Is Typhoid Fever a disease “sui generis?” That is, a fever separate and distinct from all the other fevers, accompanied with prostration of the nervous system, such as Nervous Fever, Typhus Fever, &c.? He remarked that he had been very carefully and faithfully taught, and he thoroughly learned from his teachers, that it was a disease — “sui generis;” But his observations and experience during sixteen years of practice had not revealed to him a sufficient amount of difference between this and the other continued fevers to cause him to think it worth while, practically at least, to consider it a separate disease. Hence he was inclined to view Typhoid fever as only a modified form of all the other continued fevers which are attended with prostration, &c., of the nervous system The main, if not the only pathognomonic and constant lesion, with its concomitant symptoms, (being connected with the glands of Peyer and Brunner were not, in his mind, of sufficient practical importance to dignify this fever as worthy of a distinct name. Still he uses the term among his patients, especially when the abdominal symptoms are prominent.
2nd. Is Typhoid Fever contagious? He thought not, neither did he think Typhus or Nervous Fever contagious; but all were infectious. The practice of proper hygienic measures in connection with these fevers will prevent them from attacking the healthy, — but no influence of an hygienic character will prevent the spread of a contagious disease.
4th. Does Typhoid Fever ever occur more than once in the same individual? Authors generally agree that it occurs but once; but he thought he had seen something of the kind the second time in the same person.
5th. May it ever exist in so mild a form as to permit the patient to be on his feet, more or less, throughout its course, or even to go out? He had met with a number of cases, in which the patient was able to drag about and attend more or less to his business, though it was in much weakness and accompanied with occasional pains. Such, were more lingering than the more aggravated cases, which required the patient to remain in bed.
6th. What is the usual duration of a case of Typhoid Fever? About three weeks, to the beginning of convalescence. Some cases begin to improve in two weeks and others are prolonged to the fourth week. He thought the duration of this disease coincided with the Septenary periods, i. e., if the case went on over the end of the second week no particular improvement appeared till the end of the third week, and so on to the fourth week. In all his oases, the fever appeared to have entirely subsided by the end of the fourth week, and when the patient did not recover at that time, there was as a product of the disease, an ulceration of the bowels, which in several cases terminated fatally.
7th. Can this complaint be arrested after it has once fairly set in? As a general rule, it cannot be arrested. But sometimes there appear remissions in about one, two or three weeks, at which time, it has seen to him that the exhibition of an antiperiodic, like Arsenicum, China, or Quinia at once arrested the disease. So much is this the case that he now watches for this remission, which his observation has taught him to think it hardly worth while to look for at any other than the Septenary periods before mentioned. The duration of the complaint may also be shortened by judicious treatment.
8th. Has any medicine been found to act as a prophylactic in this disease? Rhus tox. in his hands appeared to ward off the disease; though he used also Mercurius and Arsenicum at about the same time. He was inclined to believe that the prompt use of Rhus, and Mercurius vivus in the incipient stage, would prevent the confirmed disease. Of the two remedies, Rhus, is the most important, — used every three to six hours, in the first decimal dilution, for twenty-four hours.
9th. What are the most prominently useful medicines in the treatment of this fever 7 Of course every case will require its own particular medicines which will vary in its different stages; but he has been most pleased with the effects of Bryonia, Rhus. tox., Merc. vivus, Bell, and Are., in the majority of cases.
For the ulcerated state of the mucous membrane and of the glands o Brunner and patches of Peyer he found no remedy to avail. He desired an expression of the experience of others on this particular point.
Dr. J. R. COXE, Jr., considered Typhoid Fever a disease “sui generis” — not contagious, caused, in general, by vitiated atmosphere produced by large bodies of men crowded together, also by fatigue, either mental or bodily. The particular organic lesion of Typhoid Fever (which is never seen in any other disease) is, inflammation, swelling and ulceration of Peyer's and Brenner's glands. When this is not present, it is net true Typhoid Fever, however much it may in other respects simulate it. The blood in this fever is materially changed; it is decomposed, loses its red color, and its fibrine is more fluid, hence epistaxis, &c. The lungs are always more or less affected. The duodenum is never diseased and the stomach very seldom. The colon is healthy, but generates gas in very large quantities, (a curious feet). This gas produces great pain by the inflation of the abdomen.
When the cerebral system is attacked, the tongue is red and quivering; if the lungs, the tongue is saburral; if the abdomen, the tongue is dry and black with red edges. In true Typhoid Fever there is always an acute pain in the right illiac fossa, on pressure, while in general all the rest of the abdomen is insensible to it
The urine is of great value. In the commencement it is turbid and whitish, but leaves no sediment. It soon becomes limpid and natural in color, though close examination will disclose a slight turbidness in the upper portion. This turbidness descends slowly in a few days — the central portion then appears turbid, while the upper and the lower are clear. When this cloudiness descends slowly but surely, it is a very favorable symptom; but if it ascends, it is unfavorable. When the sediment reaches the bottom of the vessel and is changed into a sandy grey or greyish red color which adheres to the sides of the vessel, we may expect a perfect and speedy cure. We may now permit some nutritious food, gum-water only having previously been allowed. When the sediment becomes all sand and at the same time decreases in quantity we must order rich food, beef tea, mutton, Ac., with small quantities of wine and water.
Pneumonia very frequently appears as a sequel of the disease and is known by a dry cough dyspnea, quick and feeble pulse, and a bright red spot on the cheeks; the skin varies, being cold in some portions and hot in others; the extremities, however, are nearly always cold.
Sudamina on the neck are so frequent as almost to be characteristic of true Typhoid Fever. The skin is always dry and sticky, and at times is ulcerated in spots. When a sweat appears all over the body, it is generally critical and is a favorable symptom.
He said that in all the oases he had been called to treat, he had not been able to give a certain and correct diagnosis for the-first two or three days. He did not think it could be done, because many of the symptoms are similar to those of other diseases. The pulse was slower in this disease than in eruptive fevers. He thought it not contagious, although he had attended a family in which there were six down with it at one time. Three of which were under his and three under allopathic treatment.
He had never seen a case of Typhoid Fever convalescent in two weeks, and thought, where this was the case, we have reason to doubt whether or no it is Typhoid Fever. His cases began to convalesce in the fourth, fifth, or sixth week — some, sooner, in the mild form of the disease.
He then related the case., of a female, in which a violent hemorrhage from the bowels had set in, about the fourth week. He need Acon., Bryonia, Sabina, Rhus, and a number of other remedies with no perceptible benefit He then resorted to injections of Nitric acid with immediate relief.
He said, he had noticed a “peculiar smell” in this disease, which he could always detect, no matter how clean the chamber in which the patient lay was kept. He had at times even ventured a diagnosis on its presence alone, before he had examined the patient.
Dr. J. K. LER thought it was not possible to abridge true Typhoid Fever after it had once fairly set in, although we could meet unfavorable symptoms and conduct cases safely through the disease. The patient is never out of danger while the soreness remains in the right iliac region.
In his treatment of the disease, he attached much Value to proper hygienic regulations. He believed with Dr. Brown, that there was attending this disease an odor of a distinctive character. He considered the disease non-contagious. He could not agree with Dr. Coxe, that the miasmatic influence of this fever extended only a few feet from the patient; but believed it extended throughout the whole room.
Dr, C. B. Compton said, in reference to the urine in his experience, that while the thickness or turbid condition continued, his prognosis was doubtful; but when the cloud begins to settle to the bottom of the vessel, he has invariably been able to say positively that his patient would recover with proper care and good nourishment. This healthy phenomenon of the urine occurs about the third week. He never knew a case to get well under six weeks.
DR. TOOTHAKER desired a description of the odor; but the pending motion to postpone the subject until the next meeting prevailed. After which, the meeting adjourned to meet at Dr. COXE'S in one month.
In reference to the odor which Dr. Brown said was noticeable in this disease — he stated he could not detect it before the second or third week, or when the disease was fully developed. The odor was of a peculiar character which he could not describe.
In regard to the duration of the disease, Br. J. R. Coxe remarked, that the average coarse was much shorter under homoeopathic treatment than under the allopathic, or even the “Do-nothing” treatment. He would not say that the disease cannot be cut short under our system of treatment.
Dr. Brown said, he had observed the remissions in several cases. He related one in which an excessive hemorrhage from the bowels took place at the end of the second and also at the end of the third week of the disease. In another case, a little girl, all the symptoms were much aggravated both at the end of the second and third week. He did not believe it was a constant symptom. His cases varied a good deal; some would have constipation for nearly two weeks, while others would have their bowels moved two or three times every day.
Dr. Lee differed from Dr. Brooks on this point. He thought such cases might be more of a hectic form of fever, in which we know there are remissions. So far, he had heard of these occurring only in some cases; to be a characteristic symptom they should be found in all cases. There are a great variety of concomitant symptoms in this disease, and we must not confound them with the characteristic ones.
Dr. L. L. COXE desired to know what was to be understood by the word “remission,” whether or not it was another term for “crisis” or the “critical days” which Hippocrates mentions, at which time there is a change in the disease; although this change might either be an amelioration or an aggravation.
Dr. Brooks said, what he meant was, that the disease would be apparently checked and all the symptoms show an improvement for several hours. It might be a step in a “crisis” but not a “crisis” itself.
Dr. Lee regarded it a turning point in the disease, and said the literal term meant — a turning back of the disease. There might be a moderate perspiration on the fourteenth day, this he supposed would be called a symptom of remission.
|The American Homoeopathic Review Vol. 02 No. 08, 1860, pages 365-369
|American Provers' Union, Transactions 1860-01-12, 1860-02-09
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