Vol. 60, 1909 - University of North Carolina at Chapel Hill

The Charlotte Medical Journal
Some Recent Views Concerning the
Nature of Typbold Fever.*
By L. v.. Xcwell, A.I!., M.L)., Charlotte, N. C.
We are approaching the Utopian threshold
of accurate knowledge with unprecedented
rapidity; whether it shall ever be
reached we do not know; certainly it is little
to be desired that man will ever have
come to dwell in those Elysian Fields where
there need be no more work or effort.
Would life be worth the living if we knew
all and there were no new "worlds to conquer?"
Relatively speaking it has not been
long since typhoid fever, as a distinct disease,
emerged from the obscurity of confusion
with a number of other fevers which
bear a more or less close resemblance. Only
a few decades ago Ivberth isolated the />ua7lus
typhosus and described it so accurately
that succeeding investigators have been able
to add but little to his observations concerning
the active cause of the disease. However,
little by little, our knowledge has extended
until modern conceptions of the
disease differ in many ways from those
which obtained when even some of the
younger members of the profession entered
the ranks as practitioners. Some will be
perfectly familiar with what I shall say in
this paper; others perhaps will not agree
with the views advanced: but in any case it
can do no harm if I attemiit to present
imperfectly enough perhaps—some thoughts
along the line of the more recent developments
in the study of typhoid fever.
Perhaps, indeed, wUjt i shall have to say
is not all true: at least, however, it is a
fascinating theory upon which we may account
for some phases of what may be
called the pathological physiology of one
of the commonest of all diseases. Hy contrasting
some of the older ideas with the
new it will doubtless be the easier to make
the latter clearer.
I"or a long time it was lielieved that the
bacillus, after having been taken into the
intestine, multiplied and developed its poisons
chiefly in the lumen of the gut and in
the lymphatic tissues of the bowel wall,
and that the poisons absorbed into the body
itself caused the constitutional symptoms.
It was later discovered that the germs could
be found in other organs and tissues in
practically all cases. This established the
fact that the blood must convey the bacilli
•Read by title before the Medical Society of the
SUte of North Carolina, A.sheville, N. C, June
15-18, 1909.
—
CHARLOTTE, N. C, AUGUST, 1909.
from the intestine to the various parts inside
the body, for we may consider that the
gastro-intestinal tract, including gall-bladder,
as well as the urinary bladder, ureter
and pelvis of the kidney are not within the
body but really outside. It was believed
that the micro-organisms did not pass into
the blood in any considerable numbers, and
that it was only late in the course of the disease
that this happened. Within the past
few years, however, we have come to realize
that typhoid fever is not a local disease
in the sense that specific micro-organisms
develop in portions of the body as is the
case in diphtheria, but that it is really a bac-
tercemia— a general infection of the blood
—
and that the intestinal and mesenteric lesions
are merely local manifestations of the infec-
tion. The lymphoid elements of the intestines,
carrying out the function of the
lymphatic tissues, acting simply as outposts,
take up the bacteria and, in their efforts to
destroy them, become inflamed just as any
lymphatic gland does into which an infected
area drains.
It is not necessary to repeat what many
of us know already: that the presence of
typhoid bacilli in the intestine does not
necessarily mean that the patient has typhoid
fever, for there are many individuals
who are apparently healthy, but who nevertheless
are carrying constantly millions of
typhoid bacilli within their bowels. For a
person to manifest the symptoms of typhoid
fever it is necessary for the bacilli to enter
the blood. And indeed something more is
necessary, for it appears that so long as
these micro-organisms are alive, i.e., so
long as they are not attacked and destroyed
by the cells of the body, no symptoms are
manifest. In proof of this one might cite
the fact that typhoid bacilli have actually
been isolated from the blood of individuals
who gave absolutely no evidence of any
infection at the time, but who subsequently
come down with the disease. In other
words bacilli were found to be present in
the blood during the period of incubation
— a period which, in the light of such evidence,
might be counted by days or weeks
or months or years. It can readily be seen,
however, that this could be demonstrated
relatively infrequently because of the few
opportunities for such investigation.
Now, with these ideas before us let us ask
and answer the query: what is the essential
nature of typhoid fever? Instead of being
an intoxication resulting from the absorption
of toxins produced by the bacilli in the