Richardson, Hugh

2018-01-31T11:35:55Z

2018-01-31T11:35:55Z

1903

The large numbers of troops engaged during the War have naturally afforded a very considerable amount of material for study for medical men.

Apart from gunshot wounds, the most frequent cause of disability of the soldier has been fever of some kind. The fact of the great importance of the diagnosis and treatment of these febrile conditions, both to the army surgeon, the general in command, and the patient himself, is my reason for writing on the subject.

The army surgeon has a duty to perform towards the army as well as towards his patient. He has to do his part in keeping the army up to its highest fighting strength, by preventing disease, but also this fighting strength depends to a large extent on his accurate diagnosis and treatment of disease when it does arise and by his prognosis thereof. The success of an army in the field depends on the medical officer to a much larger extent than is often supposed; for example, we may note the importance of diagnosing between a case of Enteric Fever and a case of socalled Simple Continued Fever occurring in a soldier at the front. Let us suppose the case is diagnosed as Enteric Enteric Fever and the patient is sent to the base, very probably it has to be diagnosed within a day or two after being seen for the first time in order to take advantage of transport; now perhaps the case turns out to be one of Simple Continued Fever lasting possibly only a week or two and having no intestinal lesions, and t}he man fit for duty three or four days later. By a wrongful diagnosis of Enteric Fever in this case, the services of an able man at the front would have been lost for probably a very considerable period.

The following is an example where the prognosis May be seriously affected by an early wrong diagnosis. Lhe medical officer is in charge of a small field ospital at an advanced post some thirty miles from a eneral hospital, transport is irregular and precarious, and he has only a few bell tents for the accorciodation of his patients. His object is, when trans - port is available, to transfer as many patients as are fit for the journey in order to keep up his power f accommodation. A case having had fever a few !days is proposed for transfer, if it is really Enteric ever it is at any rate in an early stage and stands he thirty miles in an ambulance probably quite atisfactorlly. , 3. satisfactorily. On the other hand the medical officer may think it is a case of Simple Continued Fever and keeps him in the expectation that he will be fit for duty in a few days, but it turns out to be Enteric later on. In these circumstances the prognosis is most unfavorably affected, the patient may have to be transferred at a later stage when not in such a good state to stand the journey and much more liable to perforation or haemorrhage; or, on the other hand he may be kept at the Field hospital where the conditions for his treatment would not be nearly so good as they would have been at the General hospital to which he might have been transferred early if the correct diagnosis of Enteric Fever had been made at once.

In the first of these examples the medical officer would have failed through faulty diagnosis in his duty towards the army; in the second, in his duty towards his patient. I have mentioned these examples to show the importance of the early diagnosis of fevers on active service.

The fevers which caused the greatest perplexity to army surgeons were Enteric Fever, and the fever which which in the army returns we called Simple Continued Fever. It is with a wish to aid in clearing up the subject of this latter fever that I have chosen this subject to write on. Other fevers which must be considered in connection with these two are Malarial Fever, Sun Fevers, Fever of dysentery, and the pyrexias of Influenza and Pneumonia.

Typho -Malaria should also be named independently the definition of which is "Typhoid in a person who has been exposed to Malarial infection." Manson.

http://hdl.handle.net/1842/27266

The University of Edinburgh

Annexe Thesis Digitisation Project 2017 Block 16

Some fevers met with in South Africa : their treatment and diagnosis from clinical observation during the Boer War, 1899-1902

Thesis or Dissertation

MD Doctor of Medicine