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

XXIV THE CHARLOTTE MEDICAL JOURNAL
constantly to the head and the bowel irriga- She was placed on a liquid diet with dessert- i
tions of ice water were continued at inter- spoonful doses of an acid pepsin mixture i
vals of every three hours. every three hours. The usual cleansing-
The following day the temperature lay bath was also given. Her temperature rose •
between 101 and 103 degrees and the pulse steadily from the hour of admission, and at ]
at 112. The cold spongings did not seem ') o'clock that evening registered 10,3 de- i
to agree with the patient, and external ap- grees, with a pulse of 92. She was given a i
plications were confined to the use of the cold sponge bath, and within a half-houi ;
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ice cap and the hot cleansing bath. There the temperature had fallen to 101 .2 degrees. «
seemed little gain beyond the status quo Tlie treatment and conditions remained i
ante, although there was a slight lessening praclically unchanged until the morning ol
of the daily temperature average. There January 31, the patient showing a tempera ;
was no amelioration of the subjective symp- ture curve of from 99to 101.5 degrees. The !
toms. rose spots appeared on the abdomen, and i
On January 30th an examination of the the positive Widal reaction confirmed the I
case record showed that the cyanosis of the diagnosis of typhoid fever. The patien i
fingers apparently had no relation to drug began to show emaciation and the charac
medication, since it had appeared with regu- terislic sores appeared, necessitating daih
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larity after each cleansing bath, even when cleansing of the mouth. On the mornin'
the temperature of these was sufficiently of the 31st the ice cap was ordered to th( !
high apparently to exclude the slightest head, and albumen water added to the diet
danger of unfavorable reaction. The gen- The course of the disease showed but littk
eral condition of the patient did not seem interruption, the pulse remaining betweer
satisfactory, and A-S-phen was again order- 80 and 88, and the temperature showing i
ed in five-grain doses every two hours. From somewhat lower curve, between 99.2 anc
the time of its resumption the improvement 101.3 degrees. On February 4, atnoon, the "
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in temperature and respiration became mark- temperature was 100.3, pulse 80, respira
ed and the patient's general condition im- tions 20. Bacteriologic examination showec i
proved, although the pulse continued rapid, the typhoid bacillus present in the urine ir
still registering 100 and over. The patient large numbers. The treatment was changec j
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slept better, and took and retained nourish- to A-S-phen in five-grain doses every twc
ment more satisfactorily. There was less hours, huprovement in general aopearanct
complaint of subjective symptoms. Within was almost immediate, the temperature fol i
one week, on Felaruary 6, the temperature lowing the change in medication, only onci ,
was nearly normal. A week later a dis- rising over 100 degrees, when a cleansinf
tinct rise of temperature was noticed, sev- bath was given. It remained normal will I
eral times reaching 103 degrees. This, how- a slight recorded rise late in the day to 99
ever, was attributable to a large abscess and once 99.4. Upon February 11, oiif
which had begun to form upon the back, week after the inauguration of the treat
and to a local vaginal condition, shown by ment by A-S-phen, the temperature remain
a greenish-yellow fetid discharge. These ed normal the entire day and thereafteri
conditions existed nearly ten days, but with The bacteriologic report showed practical i
their improvement under appropriate treat- elimination of the typhoid bacillus from thil
ment, the untoward symptoms vanished, urine. The patient was pronounced cure(
During this period heroin in doses of one- and was discharged from the hospital oi
twenty-fourth grain was given every four February 12.
hours. After the evacuation of the abscess Case IV.— Helen K— , aged
on February
22, a domes
2?-> the temperature never ex- tic, was admitted to Roosevelt Hospital oi
ceeded 100 degrees, and remained usually January 21 with a temperature of 102.1, in
at 99. Conditions practically normal as creasing within the hour to 103, pulse 88|
regards temperature and respiration were respirations .52. Her skin was very dry aiiii
established February 28, but the pulse con- burning, tongue coated, and she complain|
tinued at about 100. By March 4 the pulse ed of headache and general malaise, Sh!
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also began to dryp, registering at that time was given a cleansing bath, followed by
88. On March 9 a moderately full diet was sponging with iced water. The routinl
allowed, and from this time until March IS, pepsin-hydrochloric acid mixture was ordei|
when the patient was discharged as cured, ed in dessert-spoonful doses every thre
progress was rapid and uninterrupted. hours, and she was placed on a milk diet
IS a domes- The next morning the characteristic ros|
Case III.—Anna S— , aged
tic, was admitted to the hospital on Mon- spots were observed on the lower part of th;
day, January 18, 1909, complaining of gen- chest, and a positive Widal reaction com
eral malaise, and exhibiting hebetude with pleted the diagnosis of typhoid fever. Th
a low form of nervousnessr Ilerpulse count day after admission her temperature rose tj
was 72, temperature 98.3, respirations 21. 103.4 degrees, pulse 96, respirations 24. 0;
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