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

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THE CHARLOTTE MEDICAL JOURNAL.
iutesUue, typhoid fever is an intoxication been spoken of as the "latent" developproduced
during the struggle between the ment of the bacilli, and it is what goes on
typhoid bacillus on the one hand, and the very probably for several days previous to
body cells and juices on the other. The the occurrence of a relapse as well as at the
typhoid bacilli produce a poison which is
retained within the micro-organism, i.e., it
is an f?idoloxiii, and it is only by the death
beginning of the disease,
It can now be seen what we meant when
it was said that a rapidly and energetically
of the bacillus that it can do harm, for with
the destruction or breaking down and disintegration
of the bacteria the toxin is liberacting
immunity might be actually inimical
to its own proper purpose, because it set
free too much intracellular poison (Endoated
and then can exert its inimical effects toxin ) within too short a space of time,
on the body cells. In this respect the ty- The powers of elimination are limited and
phoid bacillus differs fundamentally from are furthermore crippled by the action of
the organisms of diphtheria and tetanus, the poison so that excessive toxin produc-
And in typhoid fever we do not have there- tion means rapid accumulation within the
fore an antitoxic immunity but one directed body. On the other hand, if, with the same
against the bacillus itself. In other words eliminative powers, the toxin production be
the juices and cells of the body attack and spread out over a period of several weeks
kill the bacteria and in so doing actually instead of one week then the intoxication
do something which is harmful to the body, will be comparatively mild and not perhaps
"It is a little disconcerting to be told that dangerous to life.
the more quickly the body kills and disinte- The opsonic theory, of which lately we
grates the bacteria the more severe may be have heard so much, teaches that in the
the symptoms of the disease; this seems, majority of bacterial diseases the power of
however, to be a necessary assumption the blood to destroy the germs is below
when all the facts are considered, though normal. In typhoid fever the opsonic inuntil
we learn how to utilize or control a dex is above normal. Patients do not die,
high bactericidal power of the blood the
physician may not be able to gather many
apparently, because this protective function
is diminished, but possibly because there is
grains of comfort from the reflection that
the blood of his sickest patient may have
too great a bactericidal power in the body,
In these days when we are hoping for such
the greatest bactericidal power" (Barker), great things in the way of artificially pro-
On this theory let us now attempt a few duced immunity, typhoid fever introduces
inferences as to what may happen when the problem not of increasing but of detyphoid
bacilli have entered the blood of an creasing the physiological immunizing
individual, and in considering the toxic power of the blood. Perhaps we might aceffects
of any substance which acts as a count for the good effects of the cold bath
poison to the tissues we must not forget in typhoid fever on this idea. It may be
that the body possesses to a greater or less that the destruction of the invading germ,
extent the power of eliminating these undesirable
products by way of the bowel, the
whether it be through bacteriolysis or phago-
cytosis, is accomplished largely through
kidneys, the skin and the lungs. Those digestive ferments,' whose action becomes
which can be gotten rid of rapidly enough much impaired in the presence of lowered
will necessarily cause little disturbance,
The severity of an intoxication will theretemperatures.
The cold bath, then, inhibits
the action of the destructive ferments over
fore depend upon several factors, viz: The the large area of the skin, thus diminishing
rapidity of the intoxication, the size of the toixn liberation, the temperature drops, the
dose, the virulence of the poison and the patient feels better and the tissues have a
ability of the eliminative functions to throw few hours' respite from hyper-intoxication,
it off. In the case of typhoid infection let For the same reason drugs which would
us suppose that the bacillus is neither de- lower cellular activity might well be indistroyed
nor eliminated, but continues to cated. Quinine is such a drug and its use
multiply. What happens? The immediate might possibly be justified by such reasoneffect
may be ;///, for, according to our ing.
theory, there is no intoxication until there Prof. Vaughan, of the University of
is bacterial destruction. It is, therefore, Michigan, has employed, in a series of cases
conceivable that the body should contain of typhoid fever, a non-toxic residue of
bacilli in large numbers and still show no bacilli grovvu outside the body. By inocusigns
of^ disease. The individual remains lating patients with these substances it apwell.
That this assumption is true is proven peared that the cases were not so severe,
by the fact already mentioned, that bacilli although thev ran a somewhat longer course,
have been cultivated from the blood of per- Richardson, of Boston, has confirmed these
sons who had been exposed to the disease, observations. Probably by introducing this
but had as yet shown no signs. This has non-toxic residue with its specific affinity