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A Case of Typhoid Fever

Problems:

T. E. SMITH, M. D., MT. CARMEL, ILLINOIS

I have a case just recovering from a very serious attack of typhoid fever, with cerebral complications, which I wish to report briefly. On Dec. 22nd I was called while passing Mr. C.'s residence to see Mr. C. who was sitting by the fire complaining of extreme chilliness, and suffering from aching, and as he described it, shooting pains through all his muscles and through his head. His eyes were red and suffused with tears. The temperature was 102°F., pulse 56. The tongue was heavily coated with a pasty yellowish substance.

I diagnosed his case as "la grippe." He is a painter by trade and had been engaged in calcimining a basement of a large building for some days previous. He is about 40 years old, five feet ten inches in height and weighs, in health, about 160 pounds.

He said that he had taken a dose of cathartic pills the evening previous but they had not acted on the bowels. I advised him to take another portion of cathartic tablets and to follow that, early the next morning, with a large dose of quinin and capsicum, if there was but little fever. For the pain in the head and fever I left a mixture composed of gelsemium one dram, macrotys, half a dram; veratrum, twenty drops; water, four ounces. Take a teaspoonful every two hours. For soreness and muscular aching I prescribed acetate of potassium, two drams; water, four ounces; a teaspoonful every two hours.

I told him I would see him the next day. He replied he would be at work next day. I did not see him until the 25th (Christmas day). He was in bed and delirious. The pulse was 46, temperature 104° in the morning. A very bad diarrhea, the tongue was still heavily coated (on one side only) with a dry brownish substance, the other side clean, dark and fissured. He complained of severe pains passing through the head from the front to the occiput, starting just above the eyebrows. The eyes were red and suffused; bowels very tender and tympanitic. His clothes and the bed were clean, and yet the odor was almost unbearable; sordes was at this early date collecting on his teeth. He was very delirious, talking of his work and of his business, picking at the bed clothes, and reaching out into space, feeling for and picking at imaginary objects.

For the fever and for the existing conditions I prescribed

Specific aconite drops 15
Specific gelsemium dram 1
Specific echafolta drams 1.5
Specific hyoscyamus dram .5
Water q. s. ozs. 4

Mix. Sig. Teaspoonful every two hours.

For fever with slow pulse, bright suffused eyes, and for the pain in the head, with a cadaveric odor of the breath, this is a compound without an equal, with sufficiently active antiseptic properties. It will quiet delirium and allay nervous excitement. One peculiar feature was the high temperature in the forenoon, 104°, and a drop to 102.5° or 102.8° during the afternoon and evening. For more than a week this condition prevailed. The above prescription was uniformly followed through the three weeks.

For the diarrhea I used a compound I learned to use more than 20 years ago, and my medicine case has not been without it a day since.

Best willow charcoal,
Subnitrate of bismuth,
King's diaphoretic powder, of each, drams 8

Mix thoroughly. Sig. 2, 4, 6 or 8 grains every two hours until the effect is produced. This is the best thing I have ever compounded for offensive diarrhea in typhoid, as well as for summer complaint in babies.

For the soreness and general tired feeling, I advised about three grains of the acetate of potassium, in a teaspoonful of water, every time the patient desired a drink.

About the third day, an eruption broke out around the mouth. While his fever was high, I ordered him sponged with hot salt water, and ordered his hands and face and head sponged with hot water several times during the day and night.

I had him fed with milk, and beef tea every three hours regularly. For the dry tongue which became clean after the seventh day, and had a violet tinge, I gave dilute nitromuriatic acid, drams 2; syrup simplex, ounces 4. Mix. A teaspoonful three times a day, largely diluted with water.

After the bowels were controlled, we did not disturb them for several days, when they were moved by an enema. For the slow action of the heart I gave him 1/100 grain of sulphate of strychnin every four hours. This brought the pulse up to 65 per minute and for a time about the eighth day, to about 70 beats per minute. His fever left him on the 21st day of treatment. The delirium lasted about 18 days. That much of his life is a blank to him.

For soreness and tenderness over the bowels and for the tympanites, I had prepared

Olive oil ounces 1
Tr. lobelia ounces 2
Turpentine ounces 2
Camphor gum drams 2
Strong aqua ammonia ounces 2

Mix. Sig. Bathe the bowels occasionally and cover them with a warm flannel. After his fever left him, I gave him two doses of quinine each forenoon for about a week, but none while there was delirium with tongue dry, and deficient secretions. He lost flesh rapidly from the fifth day to the twentieth day.

Mr. C. is now convalescing very nicely and is up and about the house. While there is probably nothing very extraordinary about this case, and may be nothing scientific in the prescriptions and in the management of the case, it was a severe case, and the friends and myself are satisfied and pleased with the results.


Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.



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