acid in re-action, scanty and passed with difficulty. Stools of a yellow-brown colour. July 10th.?He has a dry brown tongue, with white edges; stools of a golden yellow colour; intense meteorism supervened, requiring the long rectal tube to relieve it. There was great restless delirium during the night, requiring constant care him leaving his bed; no improvement took place the 11th and 12th, meteorism recurred frequently; he passed his stools in bed, was incessantly throwing off and picking at his bed clothes, until he became comatose, and died on the
prevent
to
on
morning
of the 14th
June,
or
the 22nd
day
Post-mortem examination 8 hows
of the fever.
after
death.
Head.?Great congestion of the membranes and brain substance, with some serum in the lateral ventricles. Lungs.?Lining membrane of trachea and bronchi intensely increased
congested, which, gradually,
as
the tubes became
smaller.
ENTERIC FEVER IN BENGAL.
By J. B. Hannah, M.D., and Thomas O'Farreli, M.A., M.D., Assistant
Surgeons,
Regiment.
63rd
(Continued from
page
Heart.?Liver and pancreas normal. Abdomen.?There were slight adhesions of the omentum
229.J
As this Case XY.?Private D. G , admitted 27th June. proved fatal, it is given at some length. On admission, he states that he had feverish symptoms, accompanied by diarrhoea, for four days previously. At present, he has a hot skin, furred tongue, gurgling and pain on pressure in the right iliac region; case
diarrhoea; no eruption was visible over any part of the body; he remained in this state, having a dusky countenance up to the 7 days from the out-set of disease, when he became delirious and was very restless during the night; there was an eruption of rose spots over the abdomen and back; his stools were fluid and of a yellow-brown colour. On the 2nd
30th
June,
Congestion of the posterior portion of both lungs, apex of right lung congested, bronchial tubes filled with bloody serum, Bronchial glands very much no trace of tubercular deposit. enlarged.
or
July, or the 9th day of the disease, he was in the following condition:?tongue white and rough, great thirst, restless delirium, slight pain in the head, the purging is excessive, motions of a thin brown watery character, with yellow bran-like particles suspended in them, and he vomited several times during the night. 3rd July, or 10th day from the accession of the fever,?restless, delirium still continues; has been constantly endeavouring to leave his bed; the tongue is rough, and white; purging decreased, but the stools are still fluid and similar in character to those yesterday described; he complains greatly of pain in the temples. There is a tendency to meteorism. On the 4th, the delirium increased, there was great insomnia in spite of every remedy; stools of a bright yellow color; pain in the
abdomen increased. On the 5th and 6th, delirium still continued both night; purging of a similar character.
generally. and of
a
congested,
Mesenteric glands enlarged, intensely congested dark colour on section. The kidneys were intensely and
weighed?right
the mesenteric attachment coloured and congested.
along
are
very much
enlarged,
dark
On opening the gut, the stomach is found tolerably healthy in appearance ; the intestinal canal is filled with a quantity of thin, bright yellow-coloured fluid matter. The mucous lining of the canal is healthy, until the first of Peyer's patches is reached : this is raised
slightly with deposit, and congested. This condition of the agminated glands exists in all the patches, but gradually increases until ulceration begins about five feet from the C0GCum. From this downwards every patch is ulcerated, the having raised, well-defined edges. In some, ulceration has advanced to such an extent that the peritoneal coat shines through. The ulcers are about lj inches long by ? inch
ulcers
are situated opposite the mesentery in the long A great number of the solitary diameter of the gut. glands are also ulcerated, they are circular in shape, about |-th
broad; they
with thickened edges; there are other which are filled with deposit, but not quite advanced to the stage of ulceration. Large intestine.?The solitary lenticular glands are filled with deposit, presenting in the centre of each a fine black point. of
inch in
an
diameter,
day
and
Except ulcers
a
few close to the ccecum, none are ulcerated. These precisely similar to the small ulcers in the ileum.
were
JULY.
MONTH. Date.
10
7
Day of disease.
17
15
Morning .Evening Morning
103*4 105
Ie Evening /
Kespiration
sur-
face in the upper portion healthy; in the ileum, there is a good deal of discoloration and vascular, congestion of the vessels of the sub-mucous tissue. The chains of glands
solitary glands
July 8th.?There is great abdominal pain; is unable to protrude his tongue; sometimes almost insensible, and at other timeg violently delirious; urine free from albumen: sp. gr. 1006,
Temperature
7 oz., and the left 8 oz.
Intestines.?The general appearance of the peritoneal
Morning
102-1
102*3
102*2
102-3
100-1
103
102-4
103*1
101
102
loo
10a
110
104
118
120
99-4 100-2
11
12
13
19
20
21~
99-3 101
101-2 102
126
...
102 120" 140
34
"1 Evening
Case XVI.?Private J. L aged 22, admitted July 7th,1871, complaining of pyrexia for the last three days. At present, he has headache, hot skin, gurgling in the right iliac region, ,
diarrhoea, great thirst, tongue dry and coated; evening temperature 103-2; pulse 116. no
THE INDIAN MEDICAL GAZETTE.
243 Si'.h.?Restless,
iliac
and did not
sleep; pain
on
pressure in
9th.?'Tongue brown down the centre; bowels have been opened thrice during the past 24 hours; stools of brown colour and fluid; there is still great insomnia, and he has a dull appearance ;
quantity of dark coffee-coloured fluid, having the appearance of altered blood; no pain or gurgling in the iliac region; pulse 108. On the following day, there were three or four fresh suspicious-looking spots over abdomen. Bowels opened once during the night; stools a dirty brownish yellow colour, semiconsistent, with a quantity of fluid similar to the day previous. Severe aphthous ulceration of the fauces. 22nd.?Tongue brown and dry; throat better; sp. gr. of urine 1024 ; no albumen. There was no change, until the 24th, when very severe diarrhoea set in; stools of a bright yellow colour, with bran-like particles; great gurgling in the right iliac region, but no particular pain except on considerable pressure ; tongue moist and covered with white patches; extreme restlessness during the night. 25th.?No diarrhoea; had a fair night; tongue brown and glazed; gurgling, but no pain in the iliac fossa; throat and cough still troublesome.
far he has not been delirious. His bowels "were not opened the 10th, 11th or 12th ; during that period there was pain in the right iliac fossa ; body bathed in perspiration ; skin covered so
on
with sudamina and
prickly heat; tongue brown and dry; no general symptoms. moved three times. Dejecta consisting of a blood; pain still in the iliac fossa. Extreme
in the
13th.?Bowels
quantity of dark restlessness, but no
delirium.
15th.?Much weaker this morning; a small quantity of clotted blood passed from the bowels; restless, and had no sleep last night; perspires most profusely; tongue white and moist; some bronchial irritation commencing ; urine sp. gr. 1022; acid
re-action, and no albumen. Vespere.?His bowels have been opened once, and stools consisted of scybalaj and fluid blood : this was repeated during the night, but the quantity of blood was larger ; restlessness still continues ; tongue brown and dry. 17th and 18th.?No change; bowels have not been moved since 5 there was great thirst, sleeplessness, and restless delirium. 19th.?During the night diarrhoea began again; he was twice at the stool; dejecta of a peculiar, violet colour, and fluid, with bran-like particles suspended through them; urine, sp. gr. 1026 ; no albumen. 20th ; or nth day coloured spots
on
26th.?Restlessness still continues ; three well-marked rose on abdomen ; a good deal of bronchial irritation and some
spots
meteorism
are present. 27th.?Tongue red, with white patches ; bowels moved three times; stools of a greenish yellow colour, and semi-consistent. From the 30th, or the 27th day of the disease, he began to improve, and on the 3rd August, an injection of olive oil brought away a large quantity of yellowish-white, clay-coloured foecal
of the fever.?There were two or three roseabdomen; these might have existed at an from the outset of the disease, the skin has
matter. On the 12th, his temperature was less than normal in the at night. His appetite is much imis able to sit up.
the
earlier period, but
Diurnal
Temperatures
in the Case
of
morning, but over 100 proved ; sleeps well, and Pte. James L
,
(Case No. XVI) Hours?A.M.
Hours?P.M. Sate.
10
12
103-1
July 18th.
1871.
been so affected with prickly heat and sudamina, as to render their presence difficult to satisfactorily determine. The bowels were moved only once; stools consisted of scybalse, and a
right
region.
improvement
[Decembek 1,
103-2
103
1103-2
102
1
19th
103-1 102-1
20th 103
27 th
103-1
28th ?
29th
?
30th
?
31st
August
1st
101-3
...
103-1 101-3
101.2
102-2 101-2 102-3
101-4
103-2
101-1 102-3
...
102*2
100-4
101-3
100'
101-4 103-2
2nd 3rd
...
100-4
4th
...
102-2
6th
...
Oth
...
7th
...
8th
...
9th
...
10th
...
11th
...
99-4 103-2
100-2
100
101-4 101 101
100-4 101-1
101
102-1
101-2
102-1
101-1
102-1
99-3
100-4
99-2
100-4
100-1 99 2
97-4 98 1 97-4
Decembeb 1, 1S71.]
ON MALARIAL SITES AND FEVERS.?BY J. MEREDITH. Private J. L
,
aged
22.
JULY.
MONTH. Date.
5
16
Day of disease.
2
13
(
Temperature 1 I
103
Morn.
102-1
Eve.
103-3 1103-3
l"3-2
...
MONTH.
108
1
108
108
Temperature Pulse
,
20 17
102-i
102 1
102*
103-1
101-1
102
1031
103
104-4
103-3
103-4 i 102-4
20
|
103
!
108
AUGUST, 30
("Morn. (.Eve. ("Morn.
19 16
JULY.
Date.
Day of disease.
23
18 15
yti
3
Eve.
17
1101-2
( Morn.
Pulse
249
25 100
26
31 28
33
101
97 4
102-4
i Eve.
(To
38
be
continued.)
prevent
to
on
morning
of the 14th
June,
or
the 22nd
day
Post-mortem examination 8 hows
of the fever.
after
death.
Head.?Great congestion of the membranes and brain substance, with some serum in the lateral ventricles. Lungs.?Lining membrane of trachea and bronchi intensely increased
congested, which, gradually,
as
the tubes became
smaller.
ENTERIC FEVER IN BENGAL.
By J. B. Hannah, M.D., and Thomas O'Farreli, M.A., M.D., Assistant
Surgeons,
Regiment.
63rd
(Continued from
page
Heart.?Liver and pancreas normal. Abdomen.?There were slight adhesions of the omentum
229.J
As this Case XY.?Private D. G , admitted 27th June. proved fatal, it is given at some length. On admission, he states that he had feverish symptoms, accompanied by diarrhoea, for four days previously. At present, he has a hot skin, furred tongue, gurgling and pain on pressure in the right iliac region; case
diarrhoea; no eruption was visible over any part of the body; he remained in this state, having a dusky countenance up to the 7 days from the out-set of disease, when he became delirious and was very restless during the night; there was an eruption of rose spots over the abdomen and back; his stools were fluid and of a yellow-brown colour. On the 2nd
30th
June,
Congestion of the posterior portion of both lungs, apex of right lung congested, bronchial tubes filled with bloody serum, Bronchial glands very much no trace of tubercular deposit. enlarged.
or
July, or the 9th day of the disease, he was in the following condition:?tongue white and rough, great thirst, restless delirium, slight pain in the head, the purging is excessive, motions of a thin brown watery character, with yellow bran-like particles suspended in them, and he vomited several times during the night. 3rd July, or 10th day from the accession of the fever,?restless, delirium still continues; has been constantly endeavouring to leave his bed; the tongue is rough, and white; purging decreased, but the stools are still fluid and similar in character to those yesterday described; he complains greatly of pain in the temples. There is a tendency to meteorism. On the 4th, the delirium increased, there was great insomnia in spite of every remedy; stools of a bright yellow color; pain in the
abdomen increased. On the 5th and 6th, delirium still continued both night; purging of a similar character.
generally. and of
a
congested,
Mesenteric glands enlarged, intensely congested dark colour on section. The kidneys were intensely and
weighed?right
the mesenteric attachment coloured and congested.
along
are
very much
enlarged,
dark
On opening the gut, the stomach is found tolerably healthy in appearance ; the intestinal canal is filled with a quantity of thin, bright yellow-coloured fluid matter. The mucous lining of the canal is healthy, until the first of Peyer's patches is reached : this is raised
slightly with deposit, and congested. This condition of the agminated glands exists in all the patches, but gradually increases until ulceration begins about five feet from the C0GCum. From this downwards every patch is ulcerated, the having raised, well-defined edges. In some, ulceration has advanced to such an extent that the peritoneal coat shines through. The ulcers are about lj inches long by ? inch
ulcers
are situated opposite the mesentery in the long A great number of the solitary diameter of the gut. glands are also ulcerated, they are circular in shape, about |-th
broad; they
with thickened edges; there are other which are filled with deposit, but not quite advanced to the stage of ulceration. Large intestine.?The solitary lenticular glands are filled with deposit, presenting in the centre of each a fine black point. of
inch in
an
diameter,
day
and
Except ulcers
a
few close to the ccecum, none are ulcerated. These precisely similar to the small ulcers in the ileum.
were
JULY.
MONTH. Date.
10
7
Day of disease.
17
15
Morning .Evening Morning
103*4 105
Ie Evening /
Kespiration
sur-
face in the upper portion healthy; in the ileum, there is a good deal of discoloration and vascular, congestion of the vessels of the sub-mucous tissue. The chains of glands
solitary glands
July 8th.?There is great abdominal pain; is unable to protrude his tongue; sometimes almost insensible, and at other timeg violently delirious; urine free from albumen: sp. gr. 1006,
Temperature
7 oz., and the left 8 oz.
Intestines.?The general appearance of the peritoneal
Morning
102-1
102*3
102*2
102-3
100-1
103
102-4
103*1
101
102
loo
10a
110
104
118
120
99-4 100-2
11
12
13
19
20
21~
99-3 101
101-2 102
126
...
102 120" 140
34
"1 Evening
Case XVI.?Private J. L aged 22, admitted July 7th,1871, complaining of pyrexia for the last three days. At present, he has headache, hot skin, gurgling in the right iliac region, ,
diarrhoea, great thirst, tongue dry and coated; evening temperature 103-2; pulse 116. no
THE INDIAN MEDICAL GAZETTE.
243 Si'.h.?Restless,
iliac
and did not
sleep; pain
on
pressure in
9th.?'Tongue brown down the centre; bowels have been opened thrice during the past 24 hours; stools of brown colour and fluid; there is still great insomnia, and he has a dull appearance ;
quantity of dark coffee-coloured fluid, having the appearance of altered blood; no pain or gurgling in the iliac region; pulse 108. On the following day, there were three or four fresh suspicious-looking spots over abdomen. Bowels opened once during the night; stools a dirty brownish yellow colour, semiconsistent, with a quantity of fluid similar to the day previous. Severe aphthous ulceration of the fauces. 22nd.?Tongue brown and dry; throat better; sp. gr. of urine 1024 ; no albumen. There was no change, until the 24th, when very severe diarrhoea set in; stools of a bright yellow colour, with bran-like particles; great gurgling in the right iliac region, but no particular pain except on considerable pressure ; tongue moist and covered with white patches; extreme restlessness during the night. 25th.?No diarrhoea; had a fair night; tongue brown and glazed; gurgling, but no pain in the iliac fossa; throat and cough still troublesome.
far he has not been delirious. His bowels "were not opened the 10th, 11th or 12th ; during that period there was pain in the right iliac fossa ; body bathed in perspiration ; skin covered so
on
with sudamina and
prickly heat; tongue brown and dry; no general symptoms. moved three times. Dejecta consisting of a blood; pain still in the iliac fossa. Extreme
in the
13th.?Bowels
quantity of dark restlessness, but no
delirium.
15th.?Much weaker this morning; a small quantity of clotted blood passed from the bowels; restless, and had no sleep last night; perspires most profusely; tongue white and moist; some bronchial irritation commencing ; urine sp. gr. 1022; acid
re-action, and no albumen. Vespere.?His bowels have been opened once, and stools consisted of scybalaj and fluid blood : this was repeated during the night, but the quantity of blood was larger ; restlessness still continues ; tongue brown and dry. 17th and 18th.?No change; bowels have not been moved since 5 there was great thirst, sleeplessness, and restless delirium. 19th.?During the night diarrhoea began again; he was twice at the stool; dejecta of a peculiar, violet colour, and fluid, with bran-like particles suspended through them; urine, sp. gr. 1026 ; no albumen. 20th ; or nth day coloured spots
on
26th.?Restlessness still continues ; three well-marked rose on abdomen ; a good deal of bronchial irritation and some
spots
meteorism
are present. 27th.?Tongue red, with white patches ; bowels moved three times; stools of a greenish yellow colour, and semi-consistent. From the 30th, or the 27th day of the disease, he began to improve, and on the 3rd August, an injection of olive oil brought away a large quantity of yellowish-white, clay-coloured foecal
of the fever.?There were two or three roseabdomen; these might have existed at an from the outset of the disease, the skin has
matter. On the 12th, his temperature was less than normal in the at night. His appetite is much imis able to sit up.
the
earlier period, but
Diurnal
Temperatures
in the Case
of
morning, but over 100 proved ; sleeps well, and Pte. James L
,
(Case No. XVI) Hours?A.M.
Hours?P.M. Sate.
10
12
103-1
July 18th.
1871.
been so affected with prickly heat and sudamina, as to render their presence difficult to satisfactorily determine. The bowels were moved only once; stools consisted of scybalse, and a
right
region.
improvement
[Decembek 1,
103-2
103
1103-2
102
1
19th
103-1 102-1
20th 103
27 th
103-1
28th ?
29th
?
30th
?
31st
August
1st
101-3
...
103-1 101-3
101.2
102-2 101-2 102-3
101-4
103-2
101-1 102-3
...
102*2
100-4
101-3
100'
101-4 103-2
2nd 3rd
...
100-4
4th
...
102-2
6th
...
Oth
...
7th
...
8th
...
9th
...
10th
...
11th
...
99-4 103-2
100-2
100
101-4 101 101
100-4 101-1
101
102-1
101-2
102-1
101-1
102-1
99-3
100-4
99-2
100-4
100-1 99 2
97-4 98 1 97-4
Decembeb 1, 1S71.]
ON MALARIAL SITES AND FEVERS.?BY J. MEREDITH. Private J. L
,
aged
22.
JULY.
MONTH. Date.
5
16
Day of disease.
2
13
(
Temperature 1 I
103
Morn.
102-1
Eve.
103-3 1103-3
l"3-2
...
MONTH.
108
1
108
108
Temperature Pulse
,
20 17
102-i
102 1
102*
103-1
101-1
102
1031
103
104-4
103-3
103-4 i 102-4
20
|
103
!
108
AUGUST, 30
("Morn. (.Eve. ("Morn.
19 16
JULY.
Date.
Day of disease.
23
18 15
yti
3
Eve.
17
1101-2
( Morn.
Pulse
249
25 100
26
31 28
33
101
97 4
102-4
i Eve.
(To
38
be
continued.)
