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Vol. IX. No. 1.
THE COLLEGE AND CLINICAL RECORD.
existence of pyæmia. The liver is free from
pyæmic patches, either in its structure or upon TYPHOID FEVER, COMPLICATED its surface. The kidneys are large and con
WITH SUPPURATING BUBO— gested, but show no sign of the pyæmic process. ACUTE IDIOPATHIC PERICARDI- The peritoneum and pleura are not thickened. TIS ASSOCIATED WITH MITRAL It would therefore appear that this is one of REGURGITANT DISEASE.
those rare cases of suppurating gland in the A Clinical Lecture delivered at the Pennsylvania- Hospitali,JPE
course of typhoid fever; and it is evident 10th, 1887,
that the exhaustion produced by the suppuraBY J. M. DA COSTA, M.D.,
ting process in one already weakened by a low Physician to the Hospital, and Professor of the Pactice 3 edil&gever was the main cause of death. cine in the Jefferson Medical College.
AGUDE IDIOPATHIC PERICARDITIS ASSOCIReported by William H. MorbusokM.D.,
ATED WITH CHRONIC MITRAL REGURGITYPHOID FEVER COMPLICATED WITH 'su.
The case which I now bring before you
is GENTLEMEN I have here some specimens one of great clinical rarity. This boy, an from a case of typhoid fever, which are instruc- Italian, 17 years of age, was admitted to the tive simply as specimens. There is nothing hospital December 5th-five days ago. He very remarkable about the case itself, except, came in very ill, prostrated, extremely pale, perhaps, the fact that the death was due to a breathing short, and with every evidence of rare complication of typhoid fever, namely, a being in great danger. It was difficult to obsuppurating bubo. These specimens give us tain his history, partly on account of his constrikingly fine illustrations of typhoid fever dition and partly because of his inability to lesions. The Peyer's patches show the char- i communicate with us in an intelligible manner; acteristic lesions, ulcerated in the centre, but the nevertheless, we have been able gradually to peritoneum is intact. There is also rather more elicit the following statements : He has been involvement of the solitary glands than is in this country two years, chiefly engaged at usually seen. As near as could be determined, “ tailor work." While in Italy he had occathe patient died at the end of the second or sional sharp pains in the cardiac region, the beginning of the third week of the dis- but no other symptoms of cardiac distress,
I also show you the spleen. It is Never, indeed, had he any acute illness; never enlarged to twice its normal size, its vessels acute rheumatism or rheumatism in
form. are engorged, and its pulp softened.
He did not have palpitation or dyspnea. The occurrence of the bubo in the left These are his statements; how accurate they groin at once suggested the possibility of are I cannot say. One of them, that with specific disease. The man, from the time of reference to the absence of dyspnea, I should his admission, was so ill that it was impossible fairly question.
to get an accurate account of his previous his- His present illness began about one month • tory; but so far as we are able to judge, the ago, with a chill, followed by severe pain in
bubo was not specific. It was limited to the the cardiac region. Dyspnoea and palpitation left side; no ulcer or cicatrix was found on then appeared. The pain in the cardiac the penis, and there was no enlargement of the region was of a sharp, acute character. There post-cervical or of the glands in any other was no pain in any other part of the body. part of the body. The external evidence On admission, as I have already stated, he would therefore lead us to believe that the was very ill. His temperature was only 99°; bubo was not specific.
the tongue was clean and the bowels constiThe question of pyæmia suggests itself; but pated. The face was somewhat swollen, so there is no evidence of this condition. The much so as to suggest the presence of a spleen, as you have seen, does not indicate the kidney affection; but the examination of the