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

for typhoid anti-bodies the destructive action
was diverted from the typhoid bacilli
themselves, less endotoxin was liberated
and the intoxication was therefore milder.
This picture of the essential nature of
typhoid fever makes a number of phenomena
often observed in the disease more
rapidl\- comprehensible. Sometimes one
observes a curious drop in the temperature
which, under routine treatment, occurs without
apparent cause. This might mean that
a period of over-activity on the part of the
tissues is followed by a resting stage in
which no bacilli are destroyed, no toxin set
free, and so the temperature must fall. A
chill, though rare, may represent a sudden
destruction of bacilli as contrasted with the
more evenly distributed production of toxin
which occurs in the majority of cases. A
sudden onset is often associated with a chill,
the coarse of such cases is commonly very
severe and the mortality is high. As we
have already said it seems probable that,
in such instances, the protective mechanism
acts too well and that the victim is overwhelmed
as a result of his own zeal. We
have been in the habit of thinking of relapse
as a re-infeelion; but it is possible that
during the afebrile period the bacilli are
still present, perhaps increasing in numbers
in the absence of resistance, and that it is
only when the body takes up the work of
destruction that symptoms reappear. It
may be that in this connection the hyper
susceptibility produced by a primary attack
has much to do with notably quick rise of
temperature often seen in relapses as contrasted
with the typically gradual onset of
the first attack.
Lastly, we may explain the characteristic
temperature curve of typical cases by employing
our theory. At first there is a steplike
rise. At this time more endotoxin is
being set free than is eliminated; it collects
in the body, the degree of intoxication receding
slightly each morning, because of
the natural tendency to lowered function
during this part of the twenty-four hours,
only to go still higher as a result of the day's
increased activities: consequently the effect
is cumulative.
Having reached a high level—the fastigium—the
intoxication is so intense that
the comparatively small amount of poison
excreted has no appreciable effect on the
general condition. In the latter weeks,
however, when there are comparatively few
bacilli left in the body, then, although the
daily toxin production (liberation) is sufficient
to carry the temperature up to a high
figure, the degree of intoxication is really
small and is more than counterbalanced by
the toxin excretion. As a result the receding
morning temperature is seen. Gradually
ORIGINAL COMMUNICATIONS. 63
the elimination exceeds the production of
poisons until finally the emunctories have
entirely freed the body of them. Convalescence
is then established.
In these views I make no claim to originality—they
are merely the results of study
of some of the more recent contributions on
the ever fruitful subject of a disease which
is universal, and therefore a never-ending
source of serious thought and study.
Bibliography.
Richardson, Boston Medical and Surgical
Journal, May 7, 1908.
Barker, Charlotte Medical Journal, May,
1908.
Adami, Prin. of Path.
McCrae, Osier's Modern Medicine.
McFarland, Pathogenic Bacteria.
Mabee, Boston Med. and Surg. Journal,
June 8, 1908.
Pringle, Dublin Medical Journal.
Conradi, Klin. Jarb., 1907.
Conradi, Deutsche Med. Wchnschr, Oct.,
1907.
Clark, J. A. M. A.. Dec. 26, 1906.
Vaughan and Moag, Cellular-Toxins,
1908.
Busse, Munch. Med. Woch.
Clark and Simmons, Jour. Infec. Dis.,
January, 1908.
Clinical Notes on Sanatorium Work.
Hy J. C. Walton, M.D., Richmond, \'a., Physicianin-Charge
of the Hydro-Electro-Therapeutic
Sanatorium.
Xo explanations or apologies are necessary
for presenting a clinical paper illustrating
therapeutic progress before an audience
that has a national reputation for
scientific and practical work. One great
advantage of physiotherapy is the absolute
impossibility of producing any effects which
would interfere with the administration of
any other therapeutic procedure, and they
should always be accompanied by appropriate
hygienic, dietetic and medicinal
measures.
High Frequency Currents.
Careful clinical studies, embracing not
only my own work, but the opportunity of
seeing the work of many eminent clinicians,
have thoroughly convinced the writer that
for the relief and treatment of hypertension,
anteriosclerosis, tuberculosis, obesity,
chronic nephritis, neuritis, neurasthenia,
and other disorders of metabolism, that the
high frequency currents come nearer meeting
the therapeutic indications than any
other methods of treatment.
The high frequency apparatus giving the
currents D'Arsonval, Tesla andOudin, can
be excited from a coil or a large static ma-