ENTERIC FEVER IN NATIVES By ANDREW
OF
INDIA.
BUCHANAN, M.A., M.D.,
Major, i.m.s., Superintendent, Central Jail, Nagpur, G.'B,
(Continued
from page
.
K\L
401.)
13th day?Stool thin, uniform in consistence, resembles pea soup. 14th and 15th, two stools like pea soup, with white particles adhering to the bottom of the vessel. In B. the bowels were loose on the 4th and 5th day. From the 7th to the 14th day the
stools
were
passed unconsciously.
In C. there was constipation for a few days. On the 7th the bowels were open twice. On 12th stool thin with whitish deposit. In D. on the 6th and 7th the lltli day two stools.
two
days
stools,
In E. one thin yellowish stool on the 5th From this it will be seen that diarrhoea not at all a marked symptom.
on
day. was
The characteristic pea soup stools were not for more than a few days in any of the The white curdy particles adhering to cases. the bottom of the vessels were seen in all cases. These particles are commonly seen in cases of enteric fever. Whipham, of St. George's Hospital, has examined them microscopically, and he is of opinion that they are bits of milk curd. seen
Seymour Taylor (Clinical Journal, pp. 130, 94, Vol. II) states that the diarrhoea is largely due to the diet. No doubt the diet is an important factor in increasing or diminishing the amount of diarrhoea, but possibly the amount of diarrhoea may. depend on the extent to which the bowel is involved.
Temioerature.?The accompanying chart shows
the temperatures and weekly C. D. Taking the first four cases, the?
2nd 3rd 4th 5 th
weighments
one
of B.
notices that
day the morning temperature
on
in 4 is normal
,,
,,
5,
,,
,,
?
3 2
?
?
?
none
,,
From the 6th to the 10th day there is a general tendency upwards with slight morning remissions. On the 11th day there is a remission. This 11th day remission I have not seen noticed in books?Professor Cuming, ex-President of the British Medical Association, has mentioned it. From the 11 th to the 14th day the ture varies in the different cases.
tempera-
In A. and D. the morning and evening temdo not change much from day to day ; a is there morning remission of from two to three degrees.
peratures
ENTERIC FEVER IN NATIVES OF INDIA.
Dec.
1899.]
THE INDIAN MEDICAL GAZETTE.
By ANDREW
BUCHANAN, M.A.,
M.D.
DeCi 1899. J
ENTERIC FEVER IN NATIVES
OF INDIA.
447
B. IWi
marked.
day.?Nine spots In B. and C. there is an upward tendency 13th day.?More spots noticed; those of prebetween the 1.1th and 14th da}Ts, and the mornvious day are the same. ing remission was slight or absent. 14th
nine
of 12th
day have present. yesterday B. were on the 14th day; the highest eveningdisappeared up to 105"2?] temperatures in C. were on tlie 12th and 13th [Note.?Temperature noticed on 10th gone by C.?Spots very few; days; but the temperature on the I4th was15th. not distinct in this case. Spots almost as high. D.?Five small spots noticed on 8th day. The highest morning temperatures were on [Note.?Temperature 105? on 7th day.] the 13th, 14th, 13th, 12th, 9th, respectively. 10th day.?A second crop appeared. On the 12th and 13th days the temperature 11 thday.?Those of 8tli disappeared. of B. was lower than that of A. C. D.; but B. lath day.?Three doubtful spots. that time was in a much more serious The
during
highest evening temperatures
in A. and
day.?The
spots
; six marked
The skin of this man is fair for a native and The temperature then does not the spots were surrounded with a caustic or ink directly indicate the severity (or mildness) ofmark. the attack. Many medical men would be inclined to doubt It is said that if the temperature in any case the eruption could be seen in a Native; that should go up to 105? the case is nearly always fatal. Seymour Taylor of the West End Hos- but the eruptions in these cases were examined whom I pital, London, states that of 400 cases he had only by several other medical men, among may mention Surgeon-Colonel Newman, Surseen four recover who had above temperatures 105? F. Three of these five cases had a tempera- geon-Major Harris, Surgeons-Captain Price and It Faichnie, and one lady practitioner, Dr. Agnes ture of 105?, and yet they all recovered, should be stated, however, that the temperatures Henderson; they all agreed that the eruption here recorded were taken in the mouth, and the was undoubtedly that of enteric fever. The spots had a pink tinge, were slightly mouth and axillary temperatures often differ b}7 more than two degrees, as will be seen from raised, could be felt by the finger, lasted for about four days. In Europeans a yellow stain the following temperatures which-were recorded remains where the spot appeared. In Natives 111 the case of E. (female):? the situation of the spot is marked by a black In axilla. stain which could be seen for some weeks after In mouth. the date of disappearance of eruption. On 12th 103' 105*4 day?at 2 P. M. E. 11th day.?One suspicious spot under right 102 6 103*4 6 P. M. ? breast. 100-8 1022 12 p.m. On 13th day? 6 p. m. 100 6 101*0 Sudamina.?Noticed in B. on 18th day, along 97'4 98*6 m. lip. In D. on the loth day tfte sides of the chest. ? was a marked crop of sudamina over the there With this rapid fall there was marked imchest and abdomen, but chiefly over the middle provement in her condition. It was practically of the sternum; also in E. on the 13th day. a fever. crisis, and this is unusual in enteric the mouth T. was 104-8 and she had The difference of temperature in the mouth (Note free perspiration). and in the axilla many account for the different Headache.?All complained of headache, and temperatures taken as indicating hyperpyrexia when asked to show the situation they generally by different authorities. Dr. John Curnow of the forehead indicating that the headache grasped King's College Hospital, Clinical Journal, page was frontal. This tallies with what is found in 227 of* as indicating hyperpy, takes 104? Europeans. rexia. Abercrombie of Charing Cross, takes Deafness-? Is most marked in Europeans 10G? F., as indicating hyperpyrexia. between the 10th and 14th days (Roberts). Pulse.?The slow pulse with high temperIn A. it was noted on 9th day, was still ature is said to be one of the peculiarities of on 28th day marked though improving. enteric fever. The pulse in A. was 95? on the B.?Noted on 10th day, still present on the 14th day when the temperature was above 102.? 29th day?though much less. In C. pulse 102?, while temperature was 101.? In C.?Noted on 13th day, continued till 25th. IX the pulse was markedly dicrotic, this was well D.?Noted on lltli daj^, less on the 15th. elbow seen in the brachial artery near the joint E.?Noted on 10th day. Attendants say that when the arm was bent. had been slightly deaf for a few days before. she 12th Eruption.?In A. it was first see?) on themade In the first four cases it was most marked not been had ^ay> but a careful search about the 14th day. earlier: six spots were marked. Delirium and loss of consciousness.?Sey14th day.?One more seen, others disappearing. mour Taylor (Clinical Journal, page 127 of 94, 17tli day.?Spots disappeared. Vol. I), says delirium at night in cases of even * I have not this volume at hand and regret that I cannot moderate severity is the rule. give the exact reference.
condition.
THE INDIAN MEDICAL GAZETTE.
448 A.
when
on
the 13th
spoken
day
would not answer
questions
to.
B. on the 9th day began to pass urine and stools unconsciously : this continued till the 14th day. He was very drowsy during this time. C. was sensible but was slow in giving replies. D. and E. were not at any time delirious.
Relapse.?Seymour Taylor (Clinical Journal,
states that relapse may between the 4th and 10th days after end of the first attack and that the usual duration is 10 days.
94-, Vol. II, page 124) come on
(To
be
continued.)
[Dec.
1899.
OF
INDIA.
BUCHANAN, M.A., M.D.,
Major, i.m.s., Superintendent, Central Jail, Nagpur, G.'B,
(Continued
from page
.
K\L
401.)
13th day?Stool thin, uniform in consistence, resembles pea soup. 14th and 15th, two stools like pea soup, with white particles adhering to the bottom of the vessel. In B. the bowels were loose on the 4th and 5th day. From the 7th to the 14th day the
stools
were
passed unconsciously.
In C. there was constipation for a few days. On the 7th the bowels were open twice. On 12th stool thin with whitish deposit. In D. on the 6th and 7th the lltli day two stools.
two
days
stools,
In E. one thin yellowish stool on the 5th From this it will be seen that diarrhoea not at all a marked symptom.
on
day. was
The characteristic pea soup stools were not for more than a few days in any of the The white curdy particles adhering to cases. the bottom of the vessels were seen in all cases. These particles are commonly seen in cases of enteric fever. Whipham, of St. George's Hospital, has examined them microscopically, and he is of opinion that they are bits of milk curd. seen
Seymour Taylor (Clinical Journal, pp. 130, 94, Vol. II) states that the diarrhoea is largely due to the diet. No doubt the diet is an important factor in increasing or diminishing the amount of diarrhoea, but possibly the amount of diarrhoea may. depend on the extent to which the bowel is involved.
Temioerature.?The accompanying chart shows
the temperatures and weekly C. D. Taking the first four cases, the?
2nd 3rd 4th 5 th
weighments
one
of B.
notices that
day the morning temperature
on
in 4 is normal
,,
,,
5,
,,
,,
?
3 2
?
?
?
none
,,
From the 6th to the 10th day there is a general tendency upwards with slight morning remissions. On the 11th day there is a remission. This 11th day remission I have not seen noticed in books?Professor Cuming, ex-President of the British Medical Association, has mentioned it. From the 11 th to the 14th day the ture varies in the different cases.
tempera-
In A. and D. the morning and evening temdo not change much from day to day ; a is there morning remission of from two to three degrees.
peratures
ENTERIC FEVER IN NATIVES OF INDIA.
Dec.
1899.]
THE INDIAN MEDICAL GAZETTE.
By ANDREW
BUCHANAN, M.A.,
M.D.
DeCi 1899. J
ENTERIC FEVER IN NATIVES
OF INDIA.
447
B. IWi
marked.
day.?Nine spots In B. and C. there is an upward tendency 13th day.?More spots noticed; those of prebetween the 1.1th and 14th da}Ts, and the mornvious day are the same. ing remission was slight or absent. 14th
nine
of 12th
day have present. yesterday B. were on the 14th day; the highest eveningdisappeared up to 105"2?] temperatures in C. were on tlie 12th and 13th [Note.?Temperature noticed on 10th gone by C.?Spots very few; days; but the temperature on the I4th was15th. not distinct in this case. Spots almost as high. D.?Five small spots noticed on 8th day. The highest morning temperatures were on [Note.?Temperature 105? on 7th day.] the 13th, 14th, 13th, 12th, 9th, respectively. 10th day.?A second crop appeared. On the 12th and 13th days the temperature 11 thday.?Those of 8tli disappeared. of B. was lower than that of A. C. D.; but B. lath day.?Three doubtful spots. that time was in a much more serious The
during
highest evening temperatures
in A. and
day.?The
spots
; six marked
The skin of this man is fair for a native and The temperature then does not the spots were surrounded with a caustic or ink directly indicate the severity (or mildness) ofmark. the attack. Many medical men would be inclined to doubt It is said that if the temperature in any case the eruption could be seen in a Native; that should go up to 105? the case is nearly always fatal. Seymour Taylor of the West End Hos- but the eruptions in these cases were examined whom I pital, London, states that of 400 cases he had only by several other medical men, among may mention Surgeon-Colonel Newman, Surseen four recover who had above temperatures 105? F. Three of these five cases had a tempera- geon-Major Harris, Surgeons-Captain Price and It Faichnie, and one lady practitioner, Dr. Agnes ture of 105?, and yet they all recovered, should be stated, however, that the temperatures Henderson; they all agreed that the eruption here recorded were taken in the mouth, and the was undoubtedly that of enteric fever. The spots had a pink tinge, were slightly mouth and axillary temperatures often differ b}7 more than two degrees, as will be seen from raised, could be felt by the finger, lasted for about four days. In Europeans a yellow stain the following temperatures which-were recorded remains where the spot appeared. In Natives 111 the case of E. (female):? the situation of the spot is marked by a black In axilla. stain which could be seen for some weeks after In mouth. the date of disappearance of eruption. On 12th 103' 105*4 day?at 2 P. M. E. 11th day.?One suspicious spot under right 102 6 103*4 6 P. M. ? breast. 100-8 1022 12 p.m. On 13th day? 6 p. m. 100 6 101*0 Sudamina.?Noticed in B. on 18th day, along 97'4 98*6 m. lip. In D. on the loth day tfte sides of the chest. ? was a marked crop of sudamina over the there With this rapid fall there was marked imchest and abdomen, but chiefly over the middle provement in her condition. It was practically of the sternum; also in E. on the 13th day. a fever. crisis, and this is unusual in enteric the mouth T. was 104-8 and she had The difference of temperature in the mouth (Note free perspiration). and in the axilla many account for the different Headache.?All complained of headache, and temperatures taken as indicating hyperpyrexia when asked to show the situation they generally by different authorities. Dr. John Curnow of the forehead indicating that the headache grasped King's College Hospital, Clinical Journal, page was frontal. This tallies with what is found in 227 of* as indicating hyperpy, takes 104? Europeans. rexia. Abercrombie of Charing Cross, takes Deafness-? Is most marked in Europeans 10G? F., as indicating hyperpyrexia. between the 10th and 14th days (Roberts). Pulse.?The slow pulse with high temperIn A. it was noted on 9th day, was still ature is said to be one of the peculiarities of on 28th day marked though improving. enteric fever. The pulse in A. was 95? on the B.?Noted on 10th day, still present on the 14th day when the temperature was above 102.? 29th day?though much less. In C. pulse 102?, while temperature was 101.? In C.?Noted on 13th day, continued till 25th. IX the pulse was markedly dicrotic, this was well D.?Noted on lltli daj^, less on the 15th. elbow seen in the brachial artery near the joint E.?Noted on 10th day. Attendants say that when the arm was bent. had been slightly deaf for a few days before. she 12th Eruption.?In A. it was first see?) on themade In the first four cases it was most marked not been had ^ay> but a careful search about the 14th day. earlier: six spots were marked. Delirium and loss of consciousness.?Sey14th day.?One more seen, others disappearing. mour Taylor (Clinical Journal, page 127 of 94, 17tli day.?Spots disappeared. Vol. I), says delirium at night in cases of even * I have not this volume at hand and regret that I cannot moderate severity is the rule. give the exact reference.
condition.
THE INDIAN MEDICAL GAZETTE.
448 A.
when
on
the 13th
spoken
day
would not answer
questions
to.
B. on the 9th day began to pass urine and stools unconsciously : this continued till the 14th day. He was very drowsy during this time. C. was sensible but was slow in giving replies. D. and E. were not at any time delirious.
Relapse.?Seymour Taylor (Clinical Journal,
states that relapse may between the 4th and 10th days after end of the first attack and that the usual duration is 10 days.
94-, Vol. II, page 124) come on
(To
be
continued.)
[Dec.
1899.
