The Medical clinics of North America . cing evidence of a leukopenia and relative lympho-cytosis to be added to the general appearance, splenomegaly,and rash, or will rule it out by a frank leukocytosis. It is tobe regretted that the advent of the numerous clinical labora-tories seem to make it beneath the dignity of the physicianto do blood-counts, and. in consequence, the patient is burdenedwith the necessity of considerable added expense, or, what ismore usual, no decent investigation at all. One cannot placeas much reliance on the Widal reaction as formerly owing tothe prevalence of the us
The Medical clinics of North America . cing evidence of a leukopenia and relative lympho-cytosis to be added to the general appearance, splenomegaly,and rash, or will rule it out by a frank leukocytosis. It is tobe regretted that the advent of the numerous clinical labora-tories seem to make it beneath the dignity of the physicianto do blood-counts, and. in consequence, the patient is burdenedwith the necessity of considerable added expense, or, what ismore usual, no decent investigation at all. One cannot placeas much reliance on the Widal reaction as formerly owing tothe prevalence of the use of typhoid vaccine as a prophylacticor in the shape <»t foreign protein therapy. Usually the fever,once started, does not reach normal until defervescence occurs,and it has long been stated as a rule that a fiver which reai he-normal after the first week cannot be typhoid. In this con-nection the churl shown in Fig. 67 is of interest. The boy of twenty-one entered the ward on the sixth day ol FEVER OF LONG DURATION 315. t 5 m * n m r-iooco^qgoooooocncRo fHrHiHiHiHiHrHf-t 316 LEROY H. BRIGGS illness. The only findings on repeated examinations were aslight splenic enlargement and some questionable was considered most unlikely on account of the typeof temperature, but the demonstration of the bacillus in theblood, with later a positive Widal, and the further course, leftno doubt, although the fever did not approach the usual pic-ture until the third week. Probably the commonest cause of prolonged fever is thetubercle bacillus. In most cases the physical findings leave noquestion as to the etiology, and, fortunately, the instances ofmiliary tuberculosis with high fever and little to show for it arerare. Here a rapid pulse and respiratory rate, with cyanosisout of proportion to what is in the lungs, are the most suggestivesigns. Blood-counts are of little help, although the leukocytesas well as the percentage of neutrophils are apt to be higherthan
Size: 952px × 2625px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, booksubjectclinicalmedicin, booksubjectmedicine
