ENTERIC FEYER. Several medical officers in this country, have lately adopted ?what seems to us rather ambiguous views regarding the nature of enteric fever; their ideas appear to have become perplexed, in consequence of their having overlooked the fact, that the typhoid condition often exists -without the patient having suffered from remarks
this
subject that "no typhoid fever and Dr. J. M. a typhoid condition of the system Fothergill, in the September number of the Edinburgh Medical Journal, has written an article on the typhoid condition," which is well worth the study of those interested in these matters. He dwells on the hypothesis that the typhoid state depends on an increased metamorphosis or melting down of the organic matter of the blood and nitrogenous tissues of the body, and is, therefore, a necessary result of severe and long continued fever, which is in truth, a slow and steady process of excessive combustion of these organic materials in the system, and it is the accumulation of their waste products in the body which is the essential factor in the causation of a typhoid or uramic condition. Dr. Murchison, writing on this subject, remarks that although the occurrence of cerebral symptoms, and of the typhoid state in particular, be mainly due to retention in the blood of the products of tissue metamorphosis, other circumstances probably contribute to their development, such as the abnormal or defective nutrition of
typhoid
fever.
blunder is
more
DaCosta
common
on
than to misconstrue into
"
"
the central organs of the
nervous
system, and the non-aeration
January 1, 1874.]
OFFICIAL PAPEE.
21
at present than formerly ; nevertheless, the best informed native consequent on pulmonary complication." Such we need hardly remark that severe intermittent practitioners we have consulted on the matter think that enfever is frequently complicated with a typhoid state, and we teric fever is on the increase in Calcutta, and it is well to note this opinion expressed before the new drainage works have sometimes find a similar condition in low pneumonia, pyaemia, extended to the northern portion of the town; otherwise it is dysentery, meningitis, renal disease, abscess of the liver and in fact in all forms of disease in which a continued high temperature not improbable we shall be told, bye and bye, that our system of (indicating excessive combustion of the tissues) has occurred. under-ground drains has been the cause of the increasing numDr. Fothergill quotes from Tweedie as to the outward indications ber of cases of typhoid fever amongst us. of this typhoid state :?" It is announced by the decline of the previous more acute symptoms; by the pulse becoming more rapid and soft; the tongue dry and brown, tremulous, and protruded with difficulty; by the incrustation of the teeth with sordes; by the increasing intellectual disorder, indicated by the more constant low muttering delirium, and the greater insensibility and deafness; and by the condition of the muscular tremor and subsultus tendinum, and in some cases irregularity or intermission of the pulse, by the patient lying sunk on his back, or sliding to the foot of the bed, the muscles being unable to support the body even in the horizontal position." Our experience certainly coincides with that of DaCosta, for there is no blunder I
of the blood
heing the case,
more
common
than to misconstrue the above described condition
typhoid fever, and yet it is quite possible for a patient to run through an attack of enteric fever without a single one of these symptoms declaring themselves ?, but if the temperature of the patient's body is excessive or remains at a high point for many days, then the typhoid state, so graphically sketched by Dr. Tweedie, sets in; its symptoms are in fact superadded to those which are characteristic of typhoid fever, resulting probably from the cause which has excited the fever, but fortunately only developed in severe cases of the disease. "We have felt it necessary to make these remarks before entering directly on the subject of enteric fever in Bengal, for unless the distinction between the typhoid condition, and the symptoms to which enteric fever gives rise be carefully borne in mind, it is impossible to
into
comprehend
the nature of the latter affection. It is in fact in the
typhoid fever that we can best form a diagnosis Subsequently, as Murchison remarks, "it is not that uraemia from renal disease is apt to be missurprising taken for typhus ; indeed, it is sometimes impossible to distinand the same remark applies to interguish the two diseases mittent and typhoid fevers Patients suffering from either disease may pass into a typhoid condition, and it is then most difficult to determine what the primary affection has been ; but in the earlier stages of the diseases it is equally impossible to confound them, provided, of course, that a careful use is made of the thermometer?an instrument without which, we need hardly ?ay, the medical practitioner cf the present day is as much abroad, as a mariner would be without his quadrant; the latter might steer by aid of his compass for a time, but would be considered a sorry mariner now-a-days unless he made use of other appliances for navigating his vessel.
earlier stages of of the case.
'
It is not many years since it
enteric fever
was a
was asserted that typhoid or disease unknown in Bengal, but if any linger-
ing doubts exist on this point, they must have been dispelled by the records of cases such as those published in this journal by Dr. T. O'Farrell, which apply to Europeans, and the disease is no less certainly present among the native population of Bengal. With reference to the metropolis, it is difficult to determine if typhoid fever is at present on the increase, but it is quite certain that very many more cases are recognised as such
this
subject that "no typhoid fever and Dr. J. M. a typhoid condition of the system Fothergill, in the September number of the Edinburgh Medical Journal, has written an article on the typhoid condition," which is well worth the study of those interested in these matters. He dwells on the hypothesis that the typhoid state depends on an increased metamorphosis or melting down of the organic matter of the blood and nitrogenous tissues of the body, and is, therefore, a necessary result of severe and long continued fever, which is in truth, a slow and steady process of excessive combustion of these organic materials in the system, and it is the accumulation of their waste products in the body which is the essential factor in the causation of a typhoid or uramic condition. Dr. Murchison, writing on this subject, remarks that although the occurrence of cerebral symptoms, and of the typhoid state in particular, be mainly due to retention in the blood of the products of tissue metamorphosis, other circumstances probably contribute to their development, such as the abnormal or defective nutrition of
typhoid
fever.
blunder is
more
DaCosta
common
on
than to misconstrue into
"
"
the central organs of the
nervous
system, and the non-aeration
January 1, 1874.]
OFFICIAL PAPEE.
21
at present than formerly ; nevertheless, the best informed native consequent on pulmonary complication." Such we need hardly remark that severe intermittent practitioners we have consulted on the matter think that enfever is frequently complicated with a typhoid state, and we teric fever is on the increase in Calcutta, and it is well to note this opinion expressed before the new drainage works have sometimes find a similar condition in low pneumonia, pyaemia, extended to the northern portion of the town; otherwise it is dysentery, meningitis, renal disease, abscess of the liver and in fact in all forms of disease in which a continued high temperature not improbable we shall be told, bye and bye, that our system of (indicating excessive combustion of the tissues) has occurred. under-ground drains has been the cause of the increasing numDr. Fothergill quotes from Tweedie as to the outward indications ber of cases of typhoid fever amongst us. of this typhoid state :?" It is announced by the decline of the previous more acute symptoms; by the pulse becoming more rapid and soft; the tongue dry and brown, tremulous, and protruded with difficulty; by the incrustation of the teeth with sordes; by the increasing intellectual disorder, indicated by the more constant low muttering delirium, and the greater insensibility and deafness; and by the condition of the muscular tremor and subsultus tendinum, and in some cases irregularity or intermission of the pulse, by the patient lying sunk on his back, or sliding to the foot of the bed, the muscles being unable to support the body even in the horizontal position." Our experience certainly coincides with that of DaCosta, for there is no blunder I
of the blood
heing the case,
more
common
than to misconstrue the above described condition
typhoid fever, and yet it is quite possible for a patient to run through an attack of enteric fever without a single one of these symptoms declaring themselves ?, but if the temperature of the patient's body is excessive or remains at a high point for many days, then the typhoid state, so graphically sketched by Dr. Tweedie, sets in; its symptoms are in fact superadded to those which are characteristic of typhoid fever, resulting probably from the cause which has excited the fever, but fortunately only developed in severe cases of the disease. "We have felt it necessary to make these remarks before entering directly on the subject of enteric fever in Bengal, for unless the distinction between the typhoid condition, and the symptoms to which enteric fever gives rise be carefully borne in mind, it is impossible to
into
comprehend
the nature of the latter affection. It is in fact in the
typhoid fever that we can best form a diagnosis Subsequently, as Murchison remarks, "it is not that uraemia from renal disease is apt to be missurprising taken for typhus ; indeed, it is sometimes impossible to distinand the same remark applies to interguish the two diseases mittent and typhoid fevers Patients suffering from either disease may pass into a typhoid condition, and it is then most difficult to determine what the primary affection has been ; but in the earlier stages of the diseases it is equally impossible to confound them, provided, of course, that a careful use is made of the thermometer?an instrument without which, we need hardly ?ay, the medical practitioner cf the present day is as much abroad, as a mariner would be without his quadrant; the latter might steer by aid of his compass for a time, but would be considered a sorry mariner now-a-days unless he made use of other appliances for navigating his vessel.
earlier stages of of the case.
'
It is not many years since it
enteric fever
was a
was asserted that typhoid or disease unknown in Bengal, but if any linger-
ing doubts exist on this point, they must have been dispelled by the records of cases such as those published in this journal by Dr. T. O'Farrell, which apply to Europeans, and the disease is no less certainly present among the native population of Bengal. With reference to the metropolis, it is difficult to determine if typhoid fever is at present on the increase, but it is quite certain that very many more cases are recognised as such
