of exciting glands, identical with that observed in. enteric fever. Dr. M. Leon Colin, one of the latest and most able writers on the subject, observes:?"I must be allowed to state distinctly that I do not in the least admit the original fusion of these diseases, that I only conceive this typhoid fever
pre-disposition
is
engendered in the system, capable
disease of the intestinal
to be
a
transformation of the morbid train of
one
of the mani-
malaria, which, in consequence of the condition in which it places the organism, especially by the excess and duration of the fever and gastric disturbance, gives it the This power of generating spontaneously abdominal typhus." author maintains that he has carefully watched cases in which the train of symptoms during life, and the post-mortem appearfestations of the
ance
were
such,
to leave
as
remittent fever noticed
passed
at times into
that Dr.
after
genuine
Colin has correctlj
ditions he describes,
but
long experience
we
from
doubt in his mind that the
the French troops in Rome enteric fever. It is quite possible
interpreted can
typical intermittent, or
the
pathological
with confidence affirm
in various parts of
met with the lesions
dying
no
among
Bengal,
we
con-
that,
have never
.typhoid fever among persons the so-called remittent fevers of
of
this part of India. The reader will find an admirable description of the characteristic appearance of the intestinal mucous " membrane, resulting from the so-called typhoid deposit," in Dr. Aitlceris Science and Practice- of Medicine, sixth Edition,
Vol. I, p. 555. We are malarial fevers fall into the
that
patients suffering from typhoid condition, and we have met aware
with several instances in which persons who have been greatly weakened by attacks of intermittent and remittent fever have contracted cnteric
fever; but of the vast number of cases of passed under our observation, we have no recollection of ever having noticed the transformation of one type of fever into another such as that described by Dr. Colin ; nevertheless, those who hold with Dr. Murchison that typhoid fever may be generated de novo among people living in a state of filth and destitution will be much inclined to the opinion expressed by Dr. Colin, for it would seem very probable that if, when the healthy nutrition of the body is destroyed by want of proper food and unhygienic circumstances, it passes into a state of enteric fever, typhoid fever may also be induced when a similiar condition of innutrition is engendered by the debilitating effects of long continued malarial disease. Our own. opinion however is that, whatever may be the immediate cause of typhoid fever the disease can only be produced by that cause. one During the famine of 1866-67 our hospitals were crowded with half-starved creatures, many of them suffering from malarial fever, and, although diarrhoea was very common.' among these cases, we failed during life, or after death, to recognise more than a few instances of typhoid fever among them. The fevers commonly met with under these circumstances were characterised by a sudden development of pyrexia, the thermometer in many cases rising in a few hours to 104 or 105 degrees ; there was often intense bilious vomiting and great depression after a few hours' fever ; all this is utterly unlike tiie history of enteric fever. In fact, we concur in the opinion expressed by Dr. Aitken that the course of typhoid fever is typical, and the type characteristic, distinguishing enteric fever from every other disease, and when irregular cases occur, irregularity may sometimes be traced to a special cause." "We are quite ready to admit that if the early history and symptoms malarial fever that have
?De ^ lift tan iiftctrical #asctte. FEBRUARY 2, 1874.
ENTERIC FEVER. A question' has often been raised in the pages of this and other medical journals, which is of especial interest to practitioners in India, and has reference to the convertibility of iutermittent or remittent fever into abdominal typhus. Those
?who hold that the conversion of one into the other form of fever is possible, base their ideas on the notion that, under a prolonged: attack of intermittent or remittent fever, a special
"
Eebiujaey 2,
MICROSCOPIC EXAMINATIONS OF AIR.
1874.]
exhibited by the patient are neglected, it is impossible, at first, to diagnose the exact nature of the fever he may be suffering from, the more so in the absence of any characteristic eruption ; but, under these circumstances, a little patience and a few days' careful observation will enable us to clear up the
matter; and we must bear in mind the fact that, among the dark-skinned people of this county, we may have much difficulty in recognising the typhoid spots; nevertheless, the thermometer will the other us
to
a
help us out of the difficulty, and, in conjunction with phenomena presented by the disease, will most surely lead
correct conclusion
as
to the nature of the fever from
which the patient may be suffering. M. Maillot, writing on this subject, observes that, if we " separate our quinine fevers, and
especially this pseudo-continued from the typhoid fever, we shall only be right, but also avoid the introduction of an element of incertitude in the treatment of malarial fevers, by confounding them with other morbid states." We perfectly agree with this opinion, but we would not by any means make the term malarial fevers synonymous with fevers curable by quinine, for we are convinced that, invaluable as this medicine is in most cases of paludal poisoning, it by no means follows that all malarial fevers can be cured with quinine. not
45
pre-disposition
is
engendered in the system, capable
disease of the intestinal
to be
a
transformation of the morbid train of
one
of the mani-
malaria, which, in consequence of the condition in which it places the organism, especially by the excess and duration of the fever and gastric disturbance, gives it the This power of generating spontaneously abdominal typhus." author maintains that he has carefully watched cases in which the train of symptoms during life, and the post-mortem appearfestations of the
ance
were
such,
to leave
as
remittent fever noticed
passed
at times into
that Dr.
after
genuine
Colin has correctlj
ditions he describes,
but
long experience
we
from
doubt in his mind that the
the French troops in Rome enteric fever. It is quite possible
interpreted can
typical intermittent, or
the
pathological
with confidence affirm
in various parts of
met with the lesions
dying
no
among
Bengal,
we
con-
that,
have never
.typhoid fever among persons the so-called remittent fevers of
of
this part of India. The reader will find an admirable description of the characteristic appearance of the intestinal mucous " membrane, resulting from the so-called typhoid deposit," in Dr. Aitlceris Science and Practice- of Medicine, sixth Edition,
Vol. I, p. 555. We are malarial fevers fall into the
that
patients suffering from typhoid condition, and we have met aware
with several instances in which persons who have been greatly weakened by attacks of intermittent and remittent fever have contracted cnteric
fever; but of the vast number of cases of passed under our observation, we have no recollection of ever having noticed the transformation of one type of fever into another such as that described by Dr. Colin ; nevertheless, those who hold with Dr. Murchison that typhoid fever may be generated de novo among people living in a state of filth and destitution will be much inclined to the opinion expressed by Dr. Colin, for it would seem very probable that if, when the healthy nutrition of the body is destroyed by want of proper food and unhygienic circumstances, it passes into a state of enteric fever, typhoid fever may also be induced when a similiar condition of innutrition is engendered by the debilitating effects of long continued malarial disease. Our own. opinion however is that, whatever may be the immediate cause of typhoid fever the disease can only be produced by that cause. one During the famine of 1866-67 our hospitals were crowded with half-starved creatures, many of them suffering from malarial fever, and, although diarrhoea was very common.' among these cases, we failed during life, or after death, to recognise more than a few instances of typhoid fever among them. The fevers commonly met with under these circumstances were characterised by a sudden development of pyrexia, the thermometer in many cases rising in a few hours to 104 or 105 degrees ; there was often intense bilious vomiting and great depression after a few hours' fever ; all this is utterly unlike tiie history of enteric fever. In fact, we concur in the opinion expressed by Dr. Aitken that the course of typhoid fever is typical, and the type characteristic, distinguishing enteric fever from every other disease, and when irregular cases occur, irregularity may sometimes be traced to a special cause." "We are quite ready to admit that if the early history and symptoms malarial fever that have
?De ^ lift tan iiftctrical #asctte. FEBRUARY 2, 1874.
ENTERIC FEVER. A question' has often been raised in the pages of this and other medical journals, which is of especial interest to practitioners in India, and has reference to the convertibility of iutermittent or remittent fever into abdominal typhus. Those
?who hold that the conversion of one into the other form of fever is possible, base their ideas on the notion that, under a prolonged: attack of intermittent or remittent fever, a special
"
Eebiujaey 2,
MICROSCOPIC EXAMINATIONS OF AIR.
1874.]
exhibited by the patient are neglected, it is impossible, at first, to diagnose the exact nature of the fever he may be suffering from, the more so in the absence of any characteristic eruption ; but, under these circumstances, a little patience and a few days' careful observation will enable us to clear up the
matter; and we must bear in mind the fact that, among the dark-skinned people of this county, we may have much difficulty in recognising the typhoid spots; nevertheless, the thermometer will the other us
to
a
help us out of the difficulty, and, in conjunction with phenomena presented by the disease, will most surely lead
correct conclusion
as
to the nature of the fever from
which the patient may be suffering. M. Maillot, writing on this subject, observes that, if we " separate our quinine fevers, and
especially this pseudo-continued from the typhoid fever, we shall only be right, but also avoid the introduction of an element of incertitude in the treatment of malarial fevers, by confounding them with other morbid states." We perfectly agree with this opinion, but we would not by any means make the term malarial fevers synonymous with fevers curable by quinine, for we are convinced that, invaluable as this medicine is in most cases of paludal poisoning, it by no means follows that all malarial fevers can be cured with quinine. not
45
