Excerpt from The Retrospect of Practical Medicine and Surgery, 1875, Vol. 70: Being a Half-Yearly Journal, Containing a Retrospective View of Every Discovery and Practical Improvement in the Medical Sciences
The condition of the tongue in typhoid is very variable. Most commonly in the early stage it is covered with a whity brown fur and somewhat dry; at a later period it becomes very dry, and is covered with a thick brown fur, the tip and edges being often at the same time red and sore-looking. There are also sordes on the teeth and the lips are parche'd. In other cases, however, the tongue has only the whity brown fur and is not quite dry during the whole illness; and in yet others the tongue is throughout morbidly red, glazed, and ﬂssured. Usuall as convalescence advances, the fur gradually recedes from the tip towards t e root of the tongue, leaving the external surface red and sore-looking; but sometimes the coating is rapidly shed and the whole surface a asumes the same condition.
The abdominal symptoms are generally predominant. At the commence ment of the attack there is usually more or less diarrhma, the bowels being moved from three or four to six or eight times in the twenty-four hours, and the stools are of a pale yellow or greenish or brownish colour, and are almost entirely ﬂuid. With the progress of the disease the diarrhaea generally sub sides, the stools are passed less frequently and become more consistent, and at a still later period the relaxation generally ceases and is replaced by constipa tion. In some cases, however, the diarrhwa will be yet more severe, so that the bowels may be moved every few minutes. There may be blood in the stools, and the evacuations may be passed in bed, either from the patient being unconscious or from his being too weak to retain them. In yet other cases, on the contra there may be an entire absence of diarrhoea, evacuations only being procur during the whole course of the fever, by the exhibition of ape rients or of enemata. Of the cases reported upon, in several there was no diarrhoea, and in one of these there was obstinate sickness and vomiting, and in two others the same symptoms occurred, though the bowels were also relaxed. In four cases blood was discharged by stool. In one of these the hemorrhage occurred on the fourth day after admission and the sixth from seizure, but the patient had been ailing for a longer time, and death rapidly ensued. In another case the bleeding did not take place till the twenty-ninth day from admission and the forty-third of illness, and the patient survived three days. The other two cases terminated favourably, though in one of them the patient bled pro fusely from the nose and also vomited blood. The hemorrhage occurred two days after admission or on the thirteenth day of illness. In the other case the bleeding was in progress when the patient was admitted after a week's se vere illness, but he had been ailing before. In a filth case which recovered the patient had passed blood in the stools before admission after being three weeks ill, but he had no bleeding afterwards. It is well known that epistaxis is a very common symptom at the commencement of typhoid, and I have known in several cases very large quantities of blood so lost. In two such in stances, not included in this calculation, the patients would certainly have bled to death had the nostrils not been plugged.
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