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[From The Johtm Hopkins Hospital BuUttin, Ko. M, May, 1898 ] 
 
 GLOSSITIS IN TYPHOID FEVER, WITH REPORT OF A CASE. 
 
 By Thomas MoCbae, M. B., 
 Assistant Resident Physician, lllie Johns Hopkins Hospital. 
 
 The cases of the occurrence of this complication in typhoid 
 fever reported in the literature appear to be very few, the con- 
 dition itself being a comparatively rare one. In over 700 cases 
 of typhoid fever treated in the Johns Hopkins Hospital this 
 is the first time that this condition has been found. In the 
 case to be reported it is of especial interest, in that it occurred 
 during convalescence from the original attack and ushered in 
 a relapse. 
 
 There are numerous references by the older writers to the 
 association of glossitis with the eruptive fevers. Thus, Kerr, 
 writing on glossitis in a Cyclopedia of Practical Medicine pub- 
 lished in London in 1833, speaks of "tumefied states of the 
 tongue which occur in typhoid and various fevers attended with 
 an atonic condition of the system." There are numerous refer- 
 ences to glossitis coming on during the course of or in conva- 
 lescence from acute febrile diseases. Clark in his work on 
 the tongue says, "Indeed, slight attacks of intercurrent 
 glossitis are not infrequent in the course of eruptive fevers." 
 But neither he nor Butlin in his " Diseases of the Tongue " 
 refers to any instance in which it occurred with typhoid fever. 
 No reference to the association of the two was to be found in 
 any of the text-books of medicine. Hoffmann in his book on 
 the pathological conditions in typhoid fever does not speak of 
 it. Sorel' in his statistics of 871 cases does not report its 
 occurrence, nor Freundlich in a statistical report of cases in 
 Freiburg. Renou" and Gallety-Bosviel,' in special articles on 
 the tongue and mouth in typhoid fever, do not mention glos- 
 sitis. The reports of Berg,* Jenner' and Studer,' embracing 
 the reports of the examinations of ] 984 cases, do not speak of 
 
I 
 
 it. Holecher,' u\ the statistics of 2000 cases, speaks of "puru- 
 lent iiiflltration " of the tongue in three cases, while Dopfer' 
 in 927 cases found the same condition in two cases. 
 
 Nichols' has reported a case of "septic infection in typhoid 
 fever" in which two days before death swelling of the right 
 half of the tongue was noted. The case came to autopsy and 
 the tongue was found red, swollen and glazed in its right half. 
 On section it showed haemorrhages and small abscesses. Cul- 
 tures yielded streptococci, staphylococci and the colon bacil- 
 lus. This may perhaps be the same condition as Holscher and 
 Dopfer have spoken of as "purulent infiltration" of the 
 tongue. 
 
 The case reported is from Dr. Osier's clinic in the Johns 
 Hopkins Hospital : 
 
 W. II., aged 27, white, dredger. Admitted on November 
 27, 1897, with a mild attack of typhoid fever. The previous 
 history was unimportant. The attack was quite characteris- 
 tic — fever, rose spots, enlarged spleen and the Widal reaction 
 all being present. The temperature fell to normal on the 16th 
 day and he made an uninterrupted recovery. He was dis- 
 charged on December 31, 1897, on the 37th day of his disease, 
 and after 22 days of normal temperature. He seemed per- 
 fectly well on discharge. 
 
 On January 3, 1898, the fourth day after leaving the hos- 
 pital, he was re-admitted, complaining of pain in the throat 
 with soreness and swelling of the tongue. He gave a history 
 of having f^lt well until January 2nd, when he had a chill, 
 soon followed by pain in the head and throat. Swelb'ng of 
 the tongue and behind the jaw accompanied by pain on swal- 
 lowing also came on. There was no history of the taking of 
 mercury or the application of any irritant. His condition 
 rapidly grew worse until his admission. 
 
 On admission — temperature 104.2°, pulse 100, face fl"'hed, 
 the neck full and swollen at the angles of the jawe The 
 mouth presented a striking picture. The tongue was much 
 swollen, protruding between the teeth and preventing the clos- 
 ing of the mouth. There wa: a profuse constant flow of 
 saliva. The tongue wp.s red, inflamed, symmetrically enlarged, 
 markedly tender and somewhat indurated as far back as could 
 be felt. No spot of softening could be found. The throat 
 
 t 
 
3 
 
 -hed, 
 J?he 
 
 could not be seen. Swallowing was difficult. Cultures were 
 taken from the left hal{ of the tongue by Dr. Gwyn. Bleed- 
 ing followed the punctures. On the following day the swell- 
 ing was less and the left half was rathf»r smaller than the 
 right, due probably to the bleeding following the punctures. 
 Two days later there was less swelling, less pain and the mouth 
 could be closed. Three days later the tongue was practically 
 normal. 
 
 The temperature, which on admission was 104.2*, fell to 
 normal on the day after admission and then rose gradually 
 each day until it reached 104° on January 7th. With this 
 he had a typical relapse, with continued fever, rose spots and 
 enlarged spleen. This lasted for about two weeks and was 
 mild throughout. The temperature fell to normal on the 
 16th day of the relapse and he was discharged ,7ell on Janu- 
 ary 36th. The cultures from the tongue were negative. 
 
 In this case after 24 days of normal temperature the 
 glossitis seemed to be the first symptom of the relapse. The 
 relapse itself was mild save for the severe onset, and as soon as 
 the swelling subsided the patient had no further trouble in 
 swallowing or distress of any kind. The diminution of the 
 swelling in the left half of the tongue after the blood removed 
 in taking the cultures supports the value of the treatment 
 advised in severe cases, namely, free incisions into the sub- 
 stance of the tongue. 
 
 Ebfbeencbs. 
 
 1. Sorel : Bull, et m6m. soc. med d'h6p. de Paris, 1889, 3. s., 
 224-246. 
 
 2. Renou : Bull. Soc. de med. d' Angers, 1875-76, n. s. 89-90, 
 pp. 103-109. 
 
 3. Gallety-Bosviel : Contrib. 4 I'etude des alterations de la 
 bouche dans la fi^vre typhoide. Paris, 1889, No. 233. 
 
 4. Berg: Deut. Archiv f. klin. Med., Bd. LIV, Heft 2 
 and 3, 1895, p. 161. 
 
 5. Jenner: Edin. Month. Jour, of Med., 1850, Vol. X, p. 311. 
 
 6. Studer: Deut. Archiv f.klin. Med., Bd. XLIX, Heft 2 
 and 3. 
 
 7. Holscher: Miinch. Med. Wochen., 1891, pp. 44 and 62. 
 
 8. Dopfer: Munch. Med. Wochen., 1888, p. 621. 
 
 9. Nichols : Montreal Medical Journal, 1896, p. 104.