Contributions to the pathology and therapeutics of typhus fever / by Joseph Bell.

  • Bell, Joseph, 1837-1911.
Date:
[1860]
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to the pathology and therapeutics of typhus fever / by Joseph Bell. Source: Wellcome Collection.

    3/100 (page 387)
    of sequence—to ascertain which is the primary, and which the secondary lesion. Being convinced that post-mortem examinations afford the only correct means by which these questions can be solved—during the last twenty-three years I have omitted no opportunity which I could command, to inspect the bodies of those who died under my observation from typhus. To the numerous examinations which were made in private I do not intend to refer (further than that I may merely make a passing allusion or so), simply because it might be alleged by those whose opinions are not in accordance with my experience, that preconceived notions may have modified the description of the results of my observations. Whilst I had charge of the fever hospital in the years 1852 and 1853, the patients were too numerous to permit time to make many inspections. The few cases that w~ere then examined I do not intend to quote at length, but shall bring the principal post¬ mortem appearances under notice, at the proper part of this paper. Since my present appointment in November last year, fever cases have not been very numerous ; I have therefore endeavoured to obtain an inspection in every fatal case. It is my wish to bring the results of these examinations under the notice of the readers of this Journal. Be it observed that these cases during the progress of the disease, and at the subsequent post-mortem examinations, were witnessed by the clerks and a very large number of students. (During the summer months, the clinical class consisted of upwards of 130 pupils.) In the present paper, though I will confine my remarks to the pathological changes which were found in the muscular tissue of the heart, yet the morbid alterations which were defected in the intestines will be fully described. I intend to embrace an early opportunity of discussing these latter lesions. In the meantime, I beg to solicit special attention to the important facts, that the cases which I am about to narrate were undoubted instances of typhus, and that the abdominal lesions which were found, were those which Dr. Jenner and the other advocates of non-identity contend are never present in that disease, but, on the contrary, form the local pathological condition in the so-called typhoid. REPORT OF CASES. Case I.—Maculated Typhus Fever—Failure of Heart s Impulse and Loss of First Sound—Abdominal Symptoms Death on the ninth day—Autopsy.—(Reported by Mr. Shaw.) P. M‘C-, aged 9 years, admitted on the 19th May, 1859 ; pyrexial symptoms of four days’ duration. On admission eyes suffused; tongue furred and dry; skin hot, but no eruption. Pulse 120. Pressure over abdomen gave rise to pain. Heart s sounds normal. Bowels confined.