1918 Journal of the American Medical Association  
{Continued from page 26) The Chronic Disease It has become evident that in a large proportion of trench fever patients invalided to England there is a tendency to advance through a subacute toward a chronic condition with symptoms of disordered action of the heart and also in some cases of neurasthenia. The features of the chronic condition are most easily described by citing a case history of one of our patients, an A 1 man who went through his training without difficulty. In November, 1915,
more » ... n November, 1915, he went to France, where he remained at full duty till the spring of 1916, when he reported sick several times with pains in the back, head and legs. This was diagnosed as "influenza." After he returned to duty he noticed much aching in the knee joints and also some headache. He was admitted to hospital in France three times, each time with fever. In September, 1916, he was admitted to hospital (his third admission) with pains in the back and legs, and a temperature of 103 F. He was confined to bed for four weeks. A diagnosis of rheumatic fever was made and the patient invalided to England, where he spent two weeks in bed and ten weeks more in hospital. On getting, up he noticed that he was breathless. His headaches continued until his return to France in March, 1917. Four days later he reported with fever and was excused duty for four days. He then finished his retraining. In the middle of June he again reported sick with fever and pains in the head, back and legs, becoming worse in the evening. This time he was excused duty for ten days. June 30, 1917, he was sent to a field ambulance with symptoms as above. From there he passed to a base hospital where he remained fourteen days. His case was diagnosed as trench fever and he was invalided to England. He was admitted to hospital at Hampstead, July 14, 1917. This was approximately the four hundred and seventieth day of the disease. From this date there were frequent small rises of temperature. The patient was a man of good physique but looking ill. He complained of constant aches in the legs and shins and said his legs felt like giving way under him. The hands and feet were sweating and tremulous. A vivid red tache was present on light stroking. The area of splenic dttlness was enlarged to percussion, but on account of tendernes of the left hypochondrium the spleen could riot be palpated. The patient complained also of breathlessness on exertion, palpitation of the heart, pain over the precordium and giddiness, the symptoms known as effort syndrome or disordered action of the heart. The heart was not enlarged, and the sounds were normal. He was markedly exhausted.
doi:10.1001/jama.1918.26020280004009 fatcat:6k5peul6qndyflmirhs3yclnxe