Sessional_Paper_1905 — Page 343

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TYPHOID FEVER WITH COMPLICATIONS. RECOVERY.

Two cases with Jaundice and Glycosuria.

1. European male, aged 32, admitted with fever. Patient was very ill, dry tongue, great restlessness and very tremulous, having been drinking heavily. Jaundice was well marked and the urine on examination showed a trace of albumen and sugar (gr. i to 3 i). This patient had a very severe attack indeed being delirious for days, great abdominal distensions, passing his motions in bed and several severe hemorrhages from the bowel. Jaundice disappeared on the 22nd day, and the sugar on the 17th. His temperature fell to normal on the 18th day, was intermittent for another three days before finally keeping normal. He was 74 days in hospital and lost considerably in weight.

2. Japanese adult, aged 37, was admitted on the 8th day of the fever with a a dry furred tongue, well marked jaundice, liquid yellow stools and delirium. His urine showed a trace of albumen and sugar (gr. 3). The delirium persisted to the 25th day. Widal's Reaction was positive on the 18th day. The jaundice persisted up to the 22nd and the sugar to the 20th day.

The temperature was normal on the 16th day and then intermittent up to the 40th, when he had an alarming hemorrhage from the bowel and finally re- mained normal on the 55th day. The patient spent 63 days in hospital.

Remarks. Both these complications are rare. Sugar is rarely found in the urine" (BRANNAN XX Centy of Medicine). "Jaundice is a symptom of extreme rarity" (Idem). MURCHISON only met with three cases, all fatal. Both of the above cases were extremely ill and tested the nursing to the utmost. The treat- ment throughout was symptomatic only.

A CASE WITH ACUTE DYSENTERY.

A French sailor from Saigon was admitted on 5th July, 1904, with a history of 12 days' fever of a remittent type accompanied by diarrhoea, fùrred tongue and general malaise. The fever fell to normal on the 27th day and the following day the diarrhoea increased in frequency the stools being full of bloody mucus with Amabæ. The patient was treated with salines and chloride of calcium, but as the condition did not improve much a daily enema of Ipecacuanha 3 i was given. as well. The dysentery was, however, very obstinate to treatment and naturally made the convalescence slow and tedious. The patient eventually recovered and left for France on 6th September.

Remarks.-This association is somewhat rare though it has been mentioned by various observers. No doubt the double infection was acquired at the same time and the incubation period of the dysentery prolonged by the typhoid infection.

ACUTE GLOSSITIS FOLLOWING TONSILLITIS.

A European female, aged 28, was admitted to hospital on 20th May. She had been under treatment for three days previously for acute tonsillitis with high fever (104°). The day before the temperature fell to normal and swallowing was fairly easy.

On the morning of the 20th she first complained of the increased size of her tongue and swallowing again became troublesome. Free incisions were inade in the tongue by her medical attendant (Dr. RENNIE) and her removal to hospital advised in case further interference should be necessary. On admission her temperature was 101, the tongue very foul and much enlarged protruding from the mouth for about one inch and the patient was quite unable to talk. Four grains of calomel were at once given an: four hourly mixture containing V. Aconiti nii and Liq: Ammon: Acetat 5, with ice to suck. As the incisions were bleeding freely no further treatment in this direction was adopted.

The condition slowly and steadily improved an in four days' time the patient was able to take semisolid food and talk. The tongue was now well inside the mouth and half the original size. On the 27th both the tongue and throat were quite normal and the patient was discharged.

Remarks. From personal experience and from the literature at our disposal this condition is evilently a rare one and worth reporting. The condition looked alarming on admission and in view of the rapid increase in size the possibility of tracheotomy was considered. The free and early incisions no doubt saved the necessity for this serious operation.