ENTERIC FEVER IN BENGAL. Bj
J. B.
and Tiiouas
Hannah, M.D., O'Fahuell, M.A., M.D., Assistant Surgeons, 63rd Regiment. (Concluded from
page 249, Vol.
VI.J
July 29th, having present he has a hot skin, quick pulse, tongue covered with a thick white fur, bowels loose, stools fluid, of a dirty yellow colour, no pain in tho right iliac region, but the abdomen is generally tender. Case XVII.?Drummer J. S. complaining for three days
been
,
admitted
previously.
At
August.?Since last report, there lias been no diarrhoea, night, when his bowels were moved several times. The temperature of the body, as seen in the table, has continued very high. On the 2nd, he appeared to improve a little, although the fever still continued; urine 1026; acid re-action, no albumen. No pain complained of in the iliac region; he was at the stool four times during the night, but only passed a small quantity of fa;cal 1 st
until last
matter, of On the
a
brown colour.
3rd,
he
was
worse; restless delirium
during the whole
January 1, 1872.]
ENTERIC FEVER IN BENGAL.?BY J. B.
laboured ; tongue has
changed
to
a
brown
colour. On the
however, is crepitant throughout, and floats in water. Weight right 1 lb. 4 ozs.; left 16 ozs. Heart.?Empty. Weight 11 ozs. There is a good deal of fat on the outside, but the valves, &c., are perfectly healthy. Liver.?Small in size. Weight 3 lbs. 3 ozs. Left lobe very much prolonged and thin ; colour pale, structure healthy. Spleen.?Enlarged, extremely friable, substance being.almost fluid on opening the capsule. Weight 14 ozs. Intestines.?A considerable amount of fat about the mesentery; great enlargement of all the mesenteric glands, some being nearly the size of a 'pigeon's egg : they are filled with a soft, friable substance, which breaks up completely under the fingers. Stomach.?Cardiac end congested, healthy; intestines aro filled with a quantity of yellow-coloured fluid faocal matter. The minute vessels of the duodenum, jejunum and ileum very much engorged, and presenting a marked arborescent appear-
4th, the breathing was still more obstructed?58 resper minute; restlessness and delirium increased; bowels were moved four times during the night; stools semi-consistent, yellowish in colour, no appearance of blood; no pain nor
pirations
gurgling whatever
in the iliac
of
region.
5th.?There was no change for the better; temperature still very
high; respiration extremely obstructed; breathing
somewhat
stertorous.
6th.?Evidently sinking ; has been very restless and delirious the night, respirations very rapid; no pain nor gurgling in the abdomen, but some tympanites set in. No improvement took place, and he died comatose at 11 p.m. Throughout the course of this case, although there was some diarrhoea, yet the character of the stools varied, and at no time were they sufficiently characteristic to lead one to expect that such extensive typhoid lesions existed, as were discovered after death. There was no marked pain or gurgling in the iliac region; no rose spots ; the tongue, until the three days before death, was covered with a white fur, but moist. There was a strong tendency to cerebral congestion from the outlet; though the urine was examined frequently, albumen only appeared on the last day. There was great diaphoresis from the first. It will be seen that this case might readily be mistaken for intensely severe remittent fever, and until a day or two before death, was consi. dered as such, and had he recovered, would probably have been
during
Post-mortem
appearances?9
large quantity
hours
with
after death. calvarium; great
of blood in the
congestion of the vessels of the dura mater. Longitudinal sinus distended with blood; vessels at the brain very much congested; vessels of the pia
the base of mater and
MONTH. Datk. Day oi' disease.
The whole of the
ance.
returned so.
Head.?A
mucous
coat of the ileum is covered
yellow jelly-like mucus. Up to within 3 feet of the ccecum, Peyer's patches are healthy ; after this they become gradually raised, until they aro \^>th of au inch above the surface of the surrounding membrane. In the first patch so affected, a small ulcer exists close to the margin. The solitary glands aro also ulcerated. Approaching the ccecum, the condition of the agminated glands become worse, until the whole patch is involved in one mass of ulceration, and for the last 4 inches, the ulceration of patches and solitary glands is quite confluent. For the large intestine, there is no ulceration, but the whole surface of the mucous membrane is very much congested. Solitary glands in the large gut aro neither ulcerated, enlarged, nor even visible to the naked eye. a
No entozoa.
JULY.
Temperature.
Ac.
lateral ventricles congested; a quantity of fluid in the ventricles ; white substance of the brain dotted all over with minute vascular points. Weight 3 lbs. 3 ozs. Lungs.?Congested at the base and posterior portion of both ! this is more extensive on the right side. 1 he lung structure,
bowels still a little loose ; character of stools similar to last report; no appearance of "rose spots" over any part of the body ; great pain in the head complained of; face and eyes
night;
suffused, respiration
HANNAH,
AUGUST.
JV1.
6 la 104-3
E.
104-2
AL. Pulse. E. Al.
Bespirations.
E.
Dally temperatures?in
48
the Case
Hocus?A.M.
of
Drummer J. S?.
(Crt.sc
iVb.
61
XVII.)
Houbs?P.M.
Houbs?A.M.
Houbs. 8
J uly
?,
10
6
13
105-4
30
7;30
31
105'2
August 1
105-1 7-30 103-3
j
7-30 104-4
105-4
105-2
105-1
103-:
101-1 1-30
i-30
104-3
101-3 104-3 2-30 102-4
?30 103-3
10 30
105-1
106
103-1
104-4
103
1-30
10-30 105 4
103-4
101-2
105
104-4
105-1
1043
104.2
104-2
105-1
106
THE INDIAN MEDICAL GAZETTE. We have thus given seventeen cases, five of which proved fatal; these, the most marked lesions of typhoid fever were
Iu the other, or the case of Private G. P , Peyer's not affected, although there were a number of ulcers in the lower portion of the ileum, and enlargement of the solitary glands of the large intestine. This was a case the were
precise type of which was difficult of determination, although towards the latter stage, all the symptoms bore a strong resemblance to the others, except iu the mode of death. We merely of a "hybrid" character. It is it as a fever give
probably
regretted that thermometric observations were only days, owing to the want of an instrument.
be
to
1872.
evening is higher than the morning temperature, still the greatest elevation did not necessarily occur at that time. Frequently the highest body heat was reached at noon or somewhat later. Almost constantly the lowest temperature was about 5 a. m. The thermometers were Hawksley's and Aitken's patterns, and were only divided into fifths of a degree. The average daily atmospheric temperature in the hospital during the months of May, June, July and August, while these observations were being
in four of
present. patches
[Janttahy 1,
made,
was
as
follows for each month
taken
Max.
:
?
Med.
Min.
for last six In the taken
case
of Private G
morning
and
evening
,
thermometric observations were day of fever to the
end of the third week, when he died. Comparing these with Wunderlich's typical chart of uncomplicated European typhoid temperatures, a difference will be observed, yet the autopsy shewed the most characteristic lesions of enteric fever. A study of the several observations recorded shew some divergence from the typical one. Whether this is the peculiarity of enteric fever in India, we are not in a position to say, neither can we
affirm that some of the above cases have not stamped upon them marks of malarial periodicity. But from most careful observa-
tions of the correlation of the pulse, temperature and respirations taken in conjunction with the general symptoms, we have no hesitation in saying that, whatever complication existed?malarial
otherwise?enteric fever was the chief disease, and the postfully verified this opinion.
or
mortem examinations
Since this paper was commenced, an important article bearing the subject has appeared in a recent number of the Lancet, which the following is stated:?" The occurrence of in typhoid fever in India did not attract the attention of the profession prior to 1853. There can, however, be no doubt that on
and
of this fever occurred as far back
as 1843, and it is probable that many cases returned as remittent fever infantile remittent, were in reality enteric fever." These
examples more
than
observations were made with reference to the report of the Commissioner of Madras on the presence of enteric fever in the station of Bangalore. The Commissioner believes
Sanitary
that, whether Dr. Budd's or Dr. Murchison's theory be accepted, the conditions favorable to the incidence of the disease were present there. That such conditions are also present in a very great degree in most Indian cities, cantonments or villages is apparent, and if any faith can be placed in the second annual report of the State Board of Health of Massachusetts, this disease should be of common enough occurrence in Hindoo'stan. Without committing ourselves to any theory on the origin or propagation of the typhoid poison, it may be interesting to mention their conclusions, namely, that it is considered to be a disease of scattered communities,
rather than crowded towns?of rural rather than urban districts " The simple continuous thread and they summarize as follows
probability which we have been able to follow in this enquiry, uniformly to the decomposition of organized (and chiefly vegetable) substances as the cause of typhoid fever as it occurs in Massachusetts." We have prepared tables of the temperature of cases XI to XYII taken morning and evening, between the hours of
leads
of 7 and 9 a. m. and 5 and 6 p. m. In the cases XYI and XVIII observations at various hours during the day and night were registered. Our readers will find no difficulty in these
reducing diagrammatic form.* From these and several other hourly notings it appears to us that, although, as a rule, the
to the usual
*
Diagrams of temperature accompanied this paper, but they would absorb too much space.?Eds., I. M. Q-.
that
May
from the ninth
it
was
found
..
June
July August '
..
..
12th
..
93 86 82 85
85*5 80 77 5 81
78 76 73 77
J. B.
and Tiiouas
Hannah, M.D., O'Fahuell, M.A., M.D., Assistant Surgeons, 63rd Regiment. (Concluded from
page 249, Vol.
VI.J
July 29th, having present he has a hot skin, quick pulse, tongue covered with a thick white fur, bowels loose, stools fluid, of a dirty yellow colour, no pain in tho right iliac region, but the abdomen is generally tender. Case XVII.?Drummer J. S. complaining for three days
been
,
admitted
previously.
At
August.?Since last report, there lias been no diarrhoea, night, when his bowels were moved several times. The temperature of the body, as seen in the table, has continued very high. On the 2nd, he appeared to improve a little, although the fever still continued; urine 1026; acid re-action, no albumen. No pain complained of in the iliac region; he was at the stool four times during the night, but only passed a small quantity of fa;cal 1 st
until last
matter, of On the
a
brown colour.
3rd,
he
was
worse; restless delirium
during the whole
January 1, 1872.]
ENTERIC FEVER IN BENGAL.?BY J. B.
laboured ; tongue has
changed
to
a
brown
colour. On the
however, is crepitant throughout, and floats in water. Weight right 1 lb. 4 ozs.; left 16 ozs. Heart.?Empty. Weight 11 ozs. There is a good deal of fat on the outside, but the valves, &c., are perfectly healthy. Liver.?Small in size. Weight 3 lbs. 3 ozs. Left lobe very much prolonged and thin ; colour pale, structure healthy. Spleen.?Enlarged, extremely friable, substance being.almost fluid on opening the capsule. Weight 14 ozs. Intestines.?A considerable amount of fat about the mesentery; great enlargement of all the mesenteric glands, some being nearly the size of a 'pigeon's egg : they are filled with a soft, friable substance, which breaks up completely under the fingers. Stomach.?Cardiac end congested, healthy; intestines aro filled with a quantity of yellow-coloured fluid faocal matter. The minute vessels of the duodenum, jejunum and ileum very much engorged, and presenting a marked arborescent appear-
4th, the breathing was still more obstructed?58 resper minute; restlessness and delirium increased; bowels were moved four times during the night; stools semi-consistent, yellowish in colour, no appearance of blood; no pain nor
pirations
gurgling whatever
in the iliac
of
region.
5th.?There was no change for the better; temperature still very
high; respiration extremely obstructed; breathing
somewhat
stertorous.
6th.?Evidently sinking ; has been very restless and delirious the night, respirations very rapid; no pain nor gurgling in the abdomen, but some tympanites set in. No improvement took place, and he died comatose at 11 p.m. Throughout the course of this case, although there was some diarrhoea, yet the character of the stools varied, and at no time were they sufficiently characteristic to lead one to expect that such extensive typhoid lesions existed, as were discovered after death. There was no marked pain or gurgling in the iliac region; no rose spots ; the tongue, until the three days before death, was covered with a white fur, but moist. There was a strong tendency to cerebral congestion from the outlet; though the urine was examined frequently, albumen only appeared on the last day. There was great diaphoresis from the first. It will be seen that this case might readily be mistaken for intensely severe remittent fever, and until a day or two before death, was consi. dered as such, and had he recovered, would probably have been
during
Post-mortem
appearances?9
large quantity
hours
with
after death. calvarium; great
of blood in the
congestion of the vessels of the dura mater. Longitudinal sinus distended with blood; vessels at the brain very much congested; vessels of the pia
the base of mater and
MONTH. Datk. Day oi' disease.
The whole of the
ance.
returned so.
Head.?A
mucous
coat of the ileum is covered
yellow jelly-like mucus. Up to within 3 feet of the ccecum, Peyer's patches are healthy ; after this they become gradually raised, until they aro \^>th of au inch above the surface of the surrounding membrane. In the first patch so affected, a small ulcer exists close to the margin. The solitary glands aro also ulcerated. Approaching the ccecum, the condition of the agminated glands become worse, until the whole patch is involved in one mass of ulceration, and for the last 4 inches, the ulceration of patches and solitary glands is quite confluent. For the large intestine, there is no ulceration, but the whole surface of the mucous membrane is very much congested. Solitary glands in the large gut aro neither ulcerated, enlarged, nor even visible to the naked eye. a
No entozoa.
JULY.
Temperature.
Ac.
lateral ventricles congested; a quantity of fluid in the ventricles ; white substance of the brain dotted all over with minute vascular points. Weight 3 lbs. 3 ozs. Lungs.?Congested at the base and posterior portion of both ! this is more extensive on the right side. 1 he lung structure,
bowels still a little loose ; character of stools similar to last report; no appearance of "rose spots" over any part of the body ; great pain in the head complained of; face and eyes
night;
suffused, respiration
HANNAH,
AUGUST.
JV1.
6 la 104-3
E.
104-2
AL. Pulse. E. Al.
Bespirations.
E.
Dally temperatures?in
48
the Case
Hocus?A.M.
of
Drummer J. S?.
(Crt.sc
iVb.
61
XVII.)
Houbs?P.M.
Houbs?A.M.
Houbs. 8
J uly
?,
10
6
13
105-4
30
7;30
31
105'2
August 1
105-1 7-30 103-3
j
7-30 104-4
105-4
105-2
105-1
103-:
101-1 1-30
i-30
104-3
101-3 104-3 2-30 102-4
?30 103-3
10 30
105-1
106
103-1
104-4
103
1-30
10-30 105 4
103-4
101-2
105
104-4
105-1
1043
104.2
104-2
105-1
106
THE INDIAN MEDICAL GAZETTE. We have thus given seventeen cases, five of which proved fatal; these, the most marked lesions of typhoid fever were
Iu the other, or the case of Private G. P , Peyer's not affected, although there were a number of ulcers in the lower portion of the ileum, and enlargement of the solitary glands of the large intestine. This was a case the were
precise type of which was difficult of determination, although towards the latter stage, all the symptoms bore a strong resemblance to the others, except iu the mode of death. We merely of a "hybrid" character. It is it as a fever give
probably
regretted that thermometric observations were only days, owing to the want of an instrument.
be
to
1872.
evening is higher than the morning temperature, still the greatest elevation did not necessarily occur at that time. Frequently the highest body heat was reached at noon or somewhat later. Almost constantly the lowest temperature was about 5 a. m. The thermometers were Hawksley's and Aitken's patterns, and were only divided into fifths of a degree. The average daily atmospheric temperature in the hospital during the months of May, June, July and August, while these observations were being
in four of
present. patches
[Janttahy 1,
made,
was
as
follows for each month
taken
Max.
:
?
Med.
Min.
for last six In the taken
case
of Private G
morning
and
evening
,
thermometric observations were day of fever to the
end of the third week, when he died. Comparing these with Wunderlich's typical chart of uncomplicated European typhoid temperatures, a difference will be observed, yet the autopsy shewed the most characteristic lesions of enteric fever. A study of the several observations recorded shew some divergence from the typical one. Whether this is the peculiarity of enteric fever in India, we are not in a position to say, neither can we
affirm that some of the above cases have not stamped upon them marks of malarial periodicity. But from most careful observa-
tions of the correlation of the pulse, temperature and respirations taken in conjunction with the general symptoms, we have no hesitation in saying that, whatever complication existed?malarial
otherwise?enteric fever was the chief disease, and the postfully verified this opinion.
or
mortem examinations
Since this paper was commenced, an important article bearing the subject has appeared in a recent number of the Lancet, which the following is stated:?" The occurrence of in typhoid fever in India did not attract the attention of the profession prior to 1853. There can, however, be no doubt that on
and
of this fever occurred as far back
as 1843, and it is probable that many cases returned as remittent fever infantile remittent, were in reality enteric fever." These
examples more
than
observations were made with reference to the report of the Commissioner of Madras on the presence of enteric fever in the station of Bangalore. The Commissioner believes
Sanitary
that, whether Dr. Budd's or Dr. Murchison's theory be accepted, the conditions favorable to the incidence of the disease were present there. That such conditions are also present in a very great degree in most Indian cities, cantonments or villages is apparent, and if any faith can be placed in the second annual report of the State Board of Health of Massachusetts, this disease should be of common enough occurrence in Hindoo'stan. Without committing ourselves to any theory on the origin or propagation of the typhoid poison, it may be interesting to mention their conclusions, namely, that it is considered to be a disease of scattered communities,
rather than crowded towns?of rural rather than urban districts " The simple continuous thread and they summarize as follows
probability which we have been able to follow in this enquiry, uniformly to the decomposition of organized (and chiefly vegetable) substances as the cause of typhoid fever as it occurs in Massachusetts." We have prepared tables of the temperature of cases XI to XYII taken morning and evening, between the hours of
leads
of 7 and 9 a. m. and 5 and 6 p. m. In the cases XYI and XVIII observations at various hours during the day and night were registered. Our readers will find no difficulty in these
reducing diagrammatic form.* From these and several other hourly notings it appears to us that, although, as a rule, the
to the usual
*
Diagrams of temperature accompanied this paper, but they would absorb too much space.?Eds., I. M. Q-.
that
May
from the ninth
it
was
found
..
June
July August '
..
..
12th
..
93 86 82 85
85*5 80 77 5 81
78 76 73 77
