July 1, 1874.]
ENTERIC FEVER?BY THOMAS O'EARRELL.
of the United
ENTERIC FEVER. Thomas O'Farrell, M.A., M.D., Surgeon, A. 31. D.
That enteric fever is prevalent in India, especially among those who have recently changed their residence from England to this country, is a well-recognized fact, yet here, as well as at
home, a variety of opinions propagation of the disease.
are
held as to the causation and
common
. 7oz., congested posteriorly, but floats on water. still more Left lung congested, congested part sinks in water. Weight of left lung lib. 12oz. There was no trace of tubercle in either lung. Ihere was some straw-colored fluid in the Heart. pericardium ; heart weighed 8oz ; right side flabby with a good deal of chicken fat" clots extending fat on the surface. There were from the right auricle through its ventricle into the pulmonary artery. Similar clot from left auricle into its ventricle; opening and valves healthy. Abdomen.?On opening the abdomen the large intestine bulged "
out
to
an
extent from inflation
of bile not softened.
quantity
out as
a
With respect to the treatment the use of the wet sheet had very decided effect in reducing the temperature, allaying nervous excitement, and diminishing stupor, and I regret it had not bee had recourse to sooner; cold water sponging we have
frequently:
benefit, and there seems reason to bel'eve cold bath, the wet sheet, and cold sponging are deserving extended trial in this country considering how beneficia
used with decided
have been found at home in the treatment of the fever under consideration and other hyperpyrexitil states. effects of cold water in the treatment of insolation, a disease
they now
gorged with blood.
will show
being common to both the agues and enteric fever apparent as in those cases which have a more prolonged of course, and indeed the milder and more prolonged the case enteric fever, the greater the resemblance it bears to the paroxysmal fevers, thus leading to difficulties in distinguishing between them and in many cases to jjost mortem diagnosis. As before mentioned the evening temperature is higher than the morning, or at least as high, still the highest temperatures are not reached at night, and in our experience between noon and 4 p.m. is the period of greatest pyrexia. This we have also found to be the time when the body-heat is greatest in the agues and allied diseases. Should this prove to be a thermometric character of both diseases, and not a chance circumstance dependent on limited observation, it is needless to suggest what bearing it would have on the subject at issue, especially if bear in mind the fact insisted on by Trousseau " in intermittent or marsh fevers the paroxysm generally commences in the morning, or at least before noon ; on the other band the attacks of certain symptomatic intermittent fevers, also quotidian, such as those so often accompanying tubercular disease and the commencement of some pyrexia, supervene towards evening." pointed
of more
was
body-heat
is not so
that the
Spleen, enlarged; weighed lib., and
of
that the remarkable sudden variations of temperature formerly
Liver.?
of air.
;
bladder; no entozoa. glance at the record
urine in the
Remarks.?A
weight 3lbs. 14oz. There was a in the gall bladder; liver very pale on section,
enormous
Surface of the liver pale
Some of the ulcers in this situation
yellow stuff attached to them, similar to the stuff contained in the bowel; this matter was detached with difficulty^ The lower part of the ileum was very thin; arborescent vessels have some
Under the influence of the wet 3heet the nervous movements of the hands ceased, he became calmer and brighter; 16 oz. of urine were drawn off by catheter; bowels moved twice. it to 103?.
1874.
Right and left kidneys, healthy; weighed 9 and 8oz. respectively. Pancreas, hard. Intestines.?Stomach, healthy. The intestines contained a large qnantity of bright yellow liquid with white particles in it, mostly about the consistence of thick mucilage. At the end of the small intestines, however, there wag a semi-consistent ball of yellow stuff as large as a pigeon's egg. This yellow matter was characteristic of the enteric fever stool, and the large quantity contained in the bowel was accounted for by his not having had an evacuation for some hours before death.
crowded and more advanced.
day.?Was comatose, was five times at the stool; evacuations characteristic; temperature 6 a.m. 105?. From 7-45 to 8-SO he was enveloped in wet sheets, and the 21 st
[July 1,
July 1, 1874.]
"UMRIT SAGUE".?BY T. H. HENDLEY.
believe always associated with a high temperature of body, sufficiently indicates that there is no objection to the application of c?ld to the highly pyrexial body in this country. The so-called ardent tropical fevers would seem" to offer a field for putting this method of treatment'to a fair test. Jhansx, Bundlecund, 25th May 1874.
ENTERIC FEVER?BY THOMAS O'EARRELL.
of the United
ENTERIC FEVER. Thomas O'Farrell, M.A., M.D., Surgeon, A. 31. D.
That enteric fever is prevalent in India, especially among those who have recently changed their residence from England to this country, is a well-recognized fact, yet here, as well as at
home, a variety of opinions propagation of the disease.
are
held as to the causation and
common
. 7oz., congested posteriorly, but floats on water. still more Left lung congested, congested part sinks in water. Weight of left lung lib. 12oz. There was no trace of tubercle in either lung. Ihere was some straw-colored fluid in the Heart. pericardium ; heart weighed 8oz ; right side flabby with a good deal of chicken fat" clots extending fat on the surface. There were from the right auricle through its ventricle into the pulmonary artery. Similar clot from left auricle into its ventricle; opening and valves healthy. Abdomen.?On opening the abdomen the large intestine bulged "
out
to
an
extent from inflation
of bile not softened.
quantity
out as
a
With respect to the treatment the use of the wet sheet had very decided effect in reducing the temperature, allaying nervous excitement, and diminishing stupor, and I regret it had not bee had recourse to sooner; cold water sponging we have
frequently:
benefit, and there seems reason to bel'eve cold bath, the wet sheet, and cold sponging are deserving extended trial in this country considering how beneficia
used with decided
have been found at home in the treatment of the fever under consideration and other hyperpyrexitil states. effects of cold water in the treatment of insolation, a disease
they now
gorged with blood.
will show
being common to both the agues and enteric fever apparent as in those cases which have a more prolonged of course, and indeed the milder and more prolonged the case enteric fever, the greater the resemblance it bears to the paroxysmal fevers, thus leading to difficulties in distinguishing between them and in many cases to jjost mortem diagnosis. As before mentioned the evening temperature is higher than the morning, or at least as high, still the highest temperatures are not reached at night, and in our experience between noon and 4 p.m. is the period of greatest pyrexia. This we have also found to be the time when the body-heat is greatest in the agues and allied diseases. Should this prove to be a thermometric character of both diseases, and not a chance circumstance dependent on limited observation, it is needless to suggest what bearing it would have on the subject at issue, especially if bear in mind the fact insisted on by Trousseau " in intermittent or marsh fevers the paroxysm generally commences in the morning, or at least before noon ; on the other band the attacks of certain symptomatic intermittent fevers, also quotidian, such as those so often accompanying tubercular disease and the commencement of some pyrexia, supervene towards evening." pointed
of more
was
body-heat
is not so
that the
Spleen, enlarged; weighed lib., and
of
that the remarkable sudden variations of temperature formerly
Liver.?
of air.
;
bladder; no entozoa. glance at the record
urine in the
Remarks.?A
weight 3lbs. 14oz. There was a in the gall bladder; liver very pale on section,
enormous
Surface of the liver pale
Some of the ulcers in this situation
yellow stuff attached to them, similar to the stuff contained in the bowel; this matter was detached with difficulty^ The lower part of the ileum was very thin; arborescent vessels have some
Under the influence of the wet 3heet the nervous movements of the hands ceased, he became calmer and brighter; 16 oz. of urine were drawn off by catheter; bowels moved twice. it to 103?.
1874.
Right and left kidneys, healthy; weighed 9 and 8oz. respectively. Pancreas, hard. Intestines.?Stomach, healthy. The intestines contained a large qnantity of bright yellow liquid with white particles in it, mostly about the consistence of thick mucilage. At the end of the small intestines, however, there wag a semi-consistent ball of yellow stuff as large as a pigeon's egg. This yellow matter was characteristic of the enteric fever stool, and the large quantity contained in the bowel was accounted for by his not having had an evacuation for some hours before death.
crowded and more advanced.
day.?Was comatose, was five times at the stool; evacuations characteristic; temperature 6 a.m. 105?. From 7-45 to 8-SO he was enveloped in wet sheets, and the 21 st
[July 1,
July 1, 1874.]
"UMRIT SAGUE".?BY T. H. HENDLEY.
believe always associated with a high temperature of body, sufficiently indicates that there is no objection to the application of c?ld to the highly pyrexial body in this country. The so-called ardent tropical fevers would seem" to offer a field for putting this method of treatment'to a fair test. Jhansx, Bundlecund, 25th May 1874.
