The Continued Fever of this Year.
The fever of this year presents some peculiarities worthy of notice, and attention has already been called to that which may be properly classed as typhoid.
The low range of temperature in many cases is unusual. In a fever running a course of twenty-one days, we will find the evening range will not average more than 103°. The morning range about 101°.
The pulse is not small and frequent as in some seasons. Sometimes it will not exceed 100 beats per minute, and is unusually full.
There is more pain than is common, commencing with the deep basilar pain; sometimes pointing backwards—occipital, or forwards—frontal we have pain in the larger articulations, or in fibrous tissue, very much as in rheumatic fever.
There is also a tendency to serous disease, as shown above in painful articulations, but especially in a sub-acute pleuritis in chest trouble, and peritonitis in disease of Peyer's glands.
In the typhoid fever, the disease of Peyer's glands shows itself in various ways. In one case, it was announced at the commencement of the disease by very severe pain simulating colic, yet showing peritonitis. In another there was obstinate constipation with marked tympanitis—the abdomen as large as a woman at full term, with marked resonance on percussion. In other cases, diarrhoea preceded chill and fever; in others it was a late symptom.
In some cases the disease was so decidedly remittent that the physician in attendance concluded that Quinine must be the remedy, and persisted in giving it in large and small doses—but without the least good effect.
In three cases it seemed to be an ordinary ague, but Quinine exerted no more influence upon it than so much water. In one of these, there was disease of Peyer's glands the third week, and the fever assumed the continued type.
As a rule, patients are dull and inclined to sleep, rather than excited and delirious, and this may be regarded as a favorable feature. I think this comfortable condition is in part due to the medicine given—Veratrum, Bryonia, and especially to Baptisia, though there is the natural inclination in this direction.
In the typhoid fever the diarrhoea is not inclined to be troublesome, one even to the extent of four to six evacuations daily is not exhausting. If troublesome, it may be readily controlled by Epilobium, Bismuth, or Ipecac. When there is abdominal pain Epilobium is an excellent remedy; Nux Vomica is also a good remedy, especially when it is associated with nausea and vomiting.
Quinine acts very kindly in small doses as a nervous stimulant. In some cases, especially when sleep is needed, a small portion of Morphia is combined, as: Rx Quinia Sul., grs. x.; Morphia Sul., gr. j. Make ten pills, and give one every four hours, or less frequently, if a less number will answer.
As already noticed, there are some cases markedly benefited by Podophyllin. If there is no tendency to enteric disease, it may be given in usual doses, at the commencement of the fever, to free catharsis. Even in the typhoid, it may be given in small doses, one-tenth of a grain, with Bismuth, with marked advantage. The indications for it are general fullness of tissue, especially fullness of subcutaneous veins.
The Eclectic Medical Journal, Vol. XXXIV, 1874, was edited by John M. Scudder, M.D.