HOSPITAL OF 59tu REGIMENT. ?
?
CASES OF ENTEllIC FEVER.
By
Henry
Waghorn, Staff
Assistant
/
Surgeon.
A paper on " Enteric Fever in Bengal," appeared in a number of the Indian Medical Gazette, a short time ago, in which the author states his opinion, that cases of this disease are probably more common than is usually suspected. The three following cases which have occurred in rapid succession, irrespective of subseof a somewhat similar nature, seem to indicate quent seizures tliat this malady is, by no means, uncommon in the presidency of Bombay, and may assume an equally fatal nature with those in Bengal. 21 : this man, strong and Case No. I.?Private G , aged muscular, was admitted into hospital September loth, with ague and constipation of bowels. About ten days after admission, he became very restless, and could not sleep at night, complained of pains in the back and loins, also head-ache, and a general feeling of malaise or good-for-nothingness. There were a considerable number of rose-colored spots about the abdomen and thorax, each spot being slightly elevated above the cuticle, and its color disappearing on pressure. On surrounding each spot with a dark marking the spots were found to disappear in the course of a day At this period, there was also a or two, reappearing elsewhere. good deal of paiu about the abdomen, increased 011 pressure, and accompanied with abdominal gurgling. There were subsequently sordes about the lips, tongue very dry, and coated with a darkbrown furred appearance, and some slight delirium, most marked towards night, diarrhoea being present, motionsof a yellow colour, skin hot and dry. During the first week the temperature was on an average 102, with a pulse of 98 to 100, weak, regular and soft. During the second week the temperature was seldom below 103, but between that and 105 ; and during the third week, the temperature has varied considerably, being sometimes almost natural, at other times as high as 103; towards evening at the present time, the temperature is about normal with a slight increase towards evening, pulse 78. This case was treated by belladonna as recommended by Kellie of Dublin, and is now apparently convalescent. Case No. II.?Private K. , aged 20, a spare, delicate-looking man, admitted into hospital September 24tb, with of soreness ague. About six days after admission, he complained of the throat, and pains about the abdomen accompanied with diarrhoea, the stools being of a yellow color and watery. Though the temperature of on admission his bowels were constipated, the body had risen to 103 on the 2nd October, and gradually increased to 105 on the 3rd of October, eight days after admission, when death took place : a post-mortem examination shewed The lesions and a perforation of the intestines by ulceration. of Case appearances of the internal organs resembled those No. Ill, with the exception that the ulceration of the intestine the spleen proportionally larger and was more extensive, and softer than in Case No. III. also a spare, delicateCase No. III.?Private S. , aged 19, looking young man, admitted into hospital on the 2nd of Octo-
ber, with ague aud slight diarrhoea, motions of
a
yellow color,
88
TTIE INDIAN MEDICAL GAZETTE.
with a feeling of a weakness and inability to sleep, but he did not complain ot' pain about the abdomen. 4th day, October Qth.?He became delirious, with a hot dry skin, and temperature of body about 104, pulse 110, small, frequent, regular, but weak; accompanied with pain in the abdomen, increased on pressure , also abdominal gurgling with some slight dryness about the lips, and tongue dry and coated with a lightbrown furred appearance. 6th day, October 1th.?Five days after admission the temperature of the body at midday was 103f, pulse 120, but he has not bjen so delirious as yesterday. 6th day, October 8th.?At 6 a. m., pulse 112, small, weak, but regular; temperature 103f; at midday, his pulse was 118, and temperature of body 103, at 4 p. 21., pulse 120, temperature 104 ; at 9 p.m., pulse 110, temperature 103f; bowels very loose, motions of a yellow color passed involuntarily ; some few rosecolored spots observable on the abdomen, resembling those of Case No. I. 7th day, October, 9th.?He appears to be much worse this morning; temperature at 6 a. m., 104, pulse 120 ; though he is perspiring freely the abdomen has an increased number of spots over it; at midday, his pulse was 116, temperature 103f; at 4 p. m., pulse was 120, temperature 105^; and at 9 p. m., pulse 120, temperature 104; he became delirous during the night. 8th day, October \0th.?He appears to be dying ; temperature at 6 a.m., 104f; at midday, 106; pulse scarcely perceptible; died at 6-20 p.m. Sectio cadaveris?12 hours p.m.: body emaciated and covered ?with discoloured patches of petechial appearance, rigor mortis fairly marked. Head?brain, and its membranes congested, brain substance softer than natural; lateral ventricles contained a fair amount of fluid congestion of choroid plexus. Thorax?heart small and flabby, but otherwise normal; right side contained some blood, and a fibrous clot plugged the pulmonary
accompanied
artery; lungs congested posteriorly.
and
softened; liver slightly congested,
Abdomen?spleen enlarged
normal in size and structure; stomach and containing flatus; intestines both small and great more or less congested in patches; the whole of Peyer's patches were extensively ulcerated throughout the ileum; there was also ulceration of the glands generally, of the large intestine, most marked near the ileo-ccecal valve, where the intestine presented one mass of ulceration, accompanied with dark purple discolourations in patches surrounding the points of ulceration, though the ulceration had not anywhere perforated through the entire substance of the intestine, death in this case probably being caused by a septic poison acting on and paralysing the ganglionic nerve centres which preside over the nutritive and secretive functions, and so destroying their innate power of selecting and assimilating from the blood their proper nutritive material.
\
/
[February 1,
1872.
?
CASES OF ENTEllIC FEVER.
By
Henry
Waghorn, Staff
Assistant
/
Surgeon.
A paper on " Enteric Fever in Bengal," appeared in a number of the Indian Medical Gazette, a short time ago, in which the author states his opinion, that cases of this disease are probably more common than is usually suspected. The three following cases which have occurred in rapid succession, irrespective of subseof a somewhat similar nature, seem to indicate quent seizures tliat this malady is, by no means, uncommon in the presidency of Bombay, and may assume an equally fatal nature with those in Bengal. 21 : this man, strong and Case No. I.?Private G , aged muscular, was admitted into hospital September loth, with ague and constipation of bowels. About ten days after admission, he became very restless, and could not sleep at night, complained of pains in the back and loins, also head-ache, and a general feeling of malaise or good-for-nothingness. There were a considerable number of rose-colored spots about the abdomen and thorax, each spot being slightly elevated above the cuticle, and its color disappearing on pressure. On surrounding each spot with a dark marking the spots were found to disappear in the course of a day At this period, there was also a or two, reappearing elsewhere. good deal of paiu about the abdomen, increased 011 pressure, and accompanied with abdominal gurgling. There were subsequently sordes about the lips, tongue very dry, and coated with a darkbrown furred appearance, and some slight delirium, most marked towards night, diarrhoea being present, motionsof a yellow colour, skin hot and dry. During the first week the temperature was on an average 102, with a pulse of 98 to 100, weak, regular and soft. During the second week the temperature was seldom below 103, but between that and 105 ; and during the third week, the temperature has varied considerably, being sometimes almost natural, at other times as high as 103; towards evening at the present time, the temperature is about normal with a slight increase towards evening, pulse 78. This case was treated by belladonna as recommended by Kellie of Dublin, and is now apparently convalescent. Case No. II.?Private K. , aged 20, a spare, delicate-looking man, admitted into hospital September 24tb, with of soreness ague. About six days after admission, he complained of the throat, and pains about the abdomen accompanied with diarrhoea, the stools being of a yellow color and watery. Though the temperature of on admission his bowels were constipated, the body had risen to 103 on the 2nd October, and gradually increased to 105 on the 3rd of October, eight days after admission, when death took place : a post-mortem examination shewed The lesions and a perforation of the intestines by ulceration. of Case appearances of the internal organs resembled those No. Ill, with the exception that the ulceration of the intestine the spleen proportionally larger and was more extensive, and softer than in Case No. III. also a spare, delicateCase No. III.?Private S. , aged 19, looking young man, admitted into hospital on the 2nd of Octo-
ber, with ague aud slight diarrhoea, motions of
a
yellow color,
88
TTIE INDIAN MEDICAL GAZETTE.
with a feeling of a weakness and inability to sleep, but he did not complain ot' pain about the abdomen. 4th day, October Qth.?He became delirious, with a hot dry skin, and temperature of body about 104, pulse 110, small, frequent, regular, but weak; accompanied with pain in the abdomen, increased on pressure , also abdominal gurgling with some slight dryness about the lips, and tongue dry and coated with a lightbrown furred appearance. 6th day, October 1th.?Five days after admission the temperature of the body at midday was 103f, pulse 120, but he has not bjen so delirious as yesterday. 6th day, October 8th.?At 6 a. m., pulse 112, small, weak, but regular; temperature 103f; at midday, his pulse was 118, and temperature of body 103, at 4 p. 21., pulse 120, temperature 104 ; at 9 p.m., pulse 110, temperature 103f; bowels very loose, motions of a yellow color passed involuntarily ; some few rosecolored spots observable on the abdomen, resembling those of Case No. I. 7th day, October, 9th.?He appears to be much worse this morning; temperature at 6 a. m., 104, pulse 120 ; though he is perspiring freely the abdomen has an increased number of spots over it; at midday, his pulse was 116, temperature 103f; at 4 p. m., pulse was 120, temperature 105^; and at 9 p. m., pulse 120, temperature 104; he became delirous during the night. 8th day, October \0th.?He appears to be dying ; temperature at 6 a.m., 104f; at midday, 106; pulse scarcely perceptible; died at 6-20 p.m. Sectio cadaveris?12 hours p.m.: body emaciated and covered ?with discoloured patches of petechial appearance, rigor mortis fairly marked. Head?brain, and its membranes congested, brain substance softer than natural; lateral ventricles contained a fair amount of fluid congestion of choroid plexus. Thorax?heart small and flabby, but otherwise normal; right side contained some blood, and a fibrous clot plugged the pulmonary
accompanied
artery; lungs congested posteriorly.
and
softened; liver slightly congested,
Abdomen?spleen enlarged
normal in size and structure; stomach and containing flatus; intestines both small and great more or less congested in patches; the whole of Peyer's patches were extensively ulcerated throughout the ileum; there was also ulceration of the glands generally, of the large intestine, most marked near the ileo-ccecal valve, where the intestine presented one mass of ulceration, accompanied with dark purple discolourations in patches surrounding the points of ulceration, though the ulceration had not anywhere perforated through the entire substance of the intestine, death in this case probably being caused by a septic poison acting on and paralysing the ganglionic nerve centres which preside over the nutritive and secretive functions, and so destroying their innate power of selecting and assimilating from the blood their proper nutritive material.
\
/
[February 1,
1872.
