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Google 988 HARE AND LANDIS: TYPHOID FEVER. [Medical News thus Horton Smith" found but two cases of en- docarditis and ten of pericarditis in an analysis of the autopsy records of St. Bartholomew's Hospital for the past thirty years. The endo- carditis is usually malignant and may be the re- sult of a secondary infection or be caused by the typhoid bacillus. In the previous essay by one of the authors mention was made of a form of typhoid de- scribed by Bernheim and designated "forme cardiaque," the chief signs of which are asystole, feebleness and tachycardia. Bernheim was of the opinion that Buy Zyloprim Online the condition was due to some derangement of Zyloprim 300 Mg the cardiac nerves rather than an affection of the myocardium. Gabbi** reports a case of this kind which was Discount Zyloprim also complicated by hysteria. Involvement of the arteries is far more rare than disease of the veins. It is highly probable Zyloprim 100 Mg that the arterial damage is due to direct bacterial infection which favors thrombosis with a result- ing hemiplegia or still more frequently gangrene. The gangrene usually involves one or both of the lower extremities. Of 13 cases of arteritis re- cently reported gangrene of the lower extremi- ties occurred in 8. J. W. Smith" observed 6 cases of gangrene in the South African Hos- pitals. Phlebitis is undoubtedly the most com- mon Zyloprim Online lesion of the vascular system and as a rule is of no serious consequence. J. W. Smith states that it occurred very frequently among the sol- diers under his care in South Africa, but never led to any untoward event. Occasionally, how- ever, an infarct may take place in the lung or Zyloprim 200 Mg even more serious damage may result as in a case reported by Dettling and Remlinger"* where pneumothorax resulted. The veins most com- monly affected are the femorals and it is well known that the left is more commonly affected than the right. The iliac, saphenous and brachial veins have also been reported as involved. As the result of the secondary anemia devel- oping during the course of the disease functional disturbances are frequent during the later stages. A hemic murmur heard either at the apex or base of the heart and a soft compressible pulse are often noted. It would seem that these murmurs are more frequent in children than adults as Blackader^* noted them in 22 out of 100 cases and Barbier and Herrenschmidt" in a third of 47 cases, while Gillies"* among 129 adults oi)served them in but 1 1 cases. The Blood During the Well-Developed Stage. — Thayer,*' in a study of 829 cases occurring in the Johns Hopkins Hospital during the past eleven years clearly shows the gradually progres- sive secondary anemia which occurs as the dis- ease progresses; the existence of leucopenia, and the presence of a leucocytosis in complica- tions such as abscess, phlebitis or peritonitis. In a study of the different counts it was found that the mononuclear cells were increased while the polymorphonuclear cells and eosinophiles were reduced. While leucocytosis was Cheap Zyloprim present after liemorrhage it was of no value in anticipating the condition. The most notable and important fact connected with the blood is the progressively in- creasing number of the colorless cells following perforation. In this connection it must be borne in mind that the number of white cells in typhoid fever is reduced so that a count of 8,000 per cubic millimeter is often of grave significance. Osier,** Finney and Gushing*' in recent articles call attention to the importance of making hourly estimates of the white cells in cases of suspected perforation. If the white cells show an increase from hour to hour operation should be per- formed at once, but preperforative leucocytosis so called cannot be relied upon. C. R. Russell"* in a study of leucocytosis in perforation comes to the following conclusions: leucocytosis is the general rule but varies and may be delayed until peritonitis sets in or may be entirely absent. Leucocytosis may be present and perforation absent. Buy Zyloprim With distinct leucocytosis even in the ab- sence of sings of perforation operation is justifi- able. Morse'** believes that owing to the dimin- ished number of leucocytes in typhoid fever the presence of leucocytosis should make one wary of making a diagnosis. He also states that care- ful watch of the leucocyte count enables the phy- sician to anticipate complications. The presence of the typhoid bacillus in the blood has been demonstrated in a number of cases after death, but as yet very few cases are on record in which they have been found during life although recently excellent researches have been carried out by American investigators whose papers are still unpublished. Horton Smith" believes that with improvement of tech- nic it will Zyloprim 100 be possible to show their presence in all cases during life. He is inclined to believe that the bacilh always gain access to the blood stream, but are rapidly deposited in various or- gans or are destroyed as the blood is a bad me- dium for their existence. Order Zyloprim De Grandmaison* suc-
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