NOTES, WITH OBSERVATIONS, ON A CASE OP ENTERIC FEVER IN A NATIVE.
By Surgeon-Major J. R. Johnson', 5th Goorlilia Regiment, Civil Surgeon, Huzara District, Abbottabad.
and
Carefully recorded circumstantial details of the symptoms and pathological phenomena presented by enteric Tever in native3 of India are still so rarely seen in the medical literature of the day, that I venture to hope the following case may bo interesting
to the
Its
profession.
daily history
is
slightly abridged
from that recorded in the case-book of the 5th Goorkha RegiLike many similar cases observed in the British army, its ment. true nature was not even suspected until three days after the patient's admission to hospital. The case possesses features of a diagnostic point of view, but is chiefly affording an admirable illustration of one of the frequent causes of the relapses which are so characteristic
great interest in valuable most
as
of enteric fever. Regiment No.
1623, Sepoy
Surubjeet Khawas,
a
sturdy
young Goorkha recruit, aged 19 years, enlisted at Goruckpore on the 17th February 1874, and joined head-quarters at Abbottabad with a draft of recently entertained recruits on the 23rd April 1874. Had good health and performed ordinary duty when he came to hospital and stated that he until 14th
July,
been ill with fever and diarrhoea in the barracks for four or five days. His case did not attract attention, and was looked upon and returned as one of ordinary intermittent fever until the morning of the 18th, when, being suddenly recalled to of several the station, I saw him for the first time. A
had
days' low continued fever
and
history
diarrhoea, coupled
with the patient's led me to suspect the real nature of the age and appearance, disease. I therefore commenced thermometric observations, and gave instructions to leave the motions kept for inspection. Unfortunately I was again obliged to leave the station on
professional
buisness
on
the
urgent
18th,
and could not get back until
the INDIAN MEDICAL GAZETTE.
34
night of the 20th. The fragmentary history of the case for this period was as follows :? July 18^/t.?Evening temperature 103?. 19th.?Morning temperature 103? ; pulse 100; evening temperature 104^ ; passed three loose motions during day. '20th.?Morning temperature 102? ; evening temperature 103?; fluid motion.
one
:2\st, morning visit.?Seems weak and prostrate, but is bright; tongue broad and flabby, creamy white in centre ; no chest symptoms; liver natural in size ; spleen extends downwards
project much towards median line; abdomen generally rather prominent and hard, slight pain on deep pressure in right iliac region; pulse nearly
to
level of
umbilicus,
but does not
100; temperature 103?. Evening visit.?Passed two loose yellow motions since morning; temperature 103?. 22nd, morning visit.?Slept fairly ; lias no appetite and vomited
taking, milk; abdomen in same state, pain being always present on deep pressure in right iliac fossa ; passed one loose yellow motion during night; pulse 100 ; temperature 102,2?; urine abundant, high coloured, sp.gr. 1010, contains a once
after
trace of albumen.
Evening visit.?Partook freely one
of milk and had
a
fair
day;
fluid motion ; temperature 104?.
23rcl, morning visit.?Slept fairly and passed one fluid motion during night; tongue moist and cleaner, no spots ; no vomiting ; perspires freely at intervals ; abdomen a little distended ; pain distinct in right iliac region, but no gurgling can be detected; pulse 100 ; temperature 102 3?. Evening visit.?Drank milk well and had a good day; one fluid motion ; temperature 102,4?. 24tli, morning visit.?Seems better,
slept well, and partook of nourishment; bowels not moved during the night; tongue coating thick and white; abdomen in same state; pulse 96; temperature 101"4?. Evening visit.?No motions; temperature 102'3?. 25th, morning visit.?No material change; bowels still confined; slight pain on pressure in right iliac fossa; drinks milk and sleeps well; pulse 96 ; temperature 102 23?. Evening visit.?Not noted ; no motions. 26th, morning visit.?In same state ; slept well; no motions; temperature 102 2?. visit.?No motions; temperature 103'3?. 21tli, morning visit.?Is cheerful and feels .better, but does not look so well; colour leaden and anteinic; is perfectly
Evening
and so far has shown no indication of delirium ; tongue is also cleaner; hands and legs tremble when he attempts to move them ; no spots visible; there is some dulness on percussion, and feeble respiration with small moist rales on
sensible,
aspect of
thorax.
Does not
of
right complain chest, posterior Abdomen still rather disbut coughs loosely now and again. tended, and spleen prominent. He says that pain is decidedly Urine still shows a perceptible but very less in iliac region. faint trace of albumen.
Pulse 104; temperature 102?; bowels not having acted for three
days,
a
simple
water enema
ordered.
visit.?Bowels moved once copiously after enema; motion yellow in colour and semi-fluid; temperature 27th, evening
102?.
28th, morning visit.?Slept well and
moist and white
in
centre; 100; temperature 101-2?.
cough
seems
less ;
brighter; tongue respirations 28;
pulse Evening visit.?Progress satisfactory; passed one semi-consisteat yellow motion since morning; temperature 102?. 29
cough ; abdomen a little distended. Pain and slight gurgling in iliac region; passed one fluid motion unconsciously during the night; respirations 32 ; pulse 120; temperature 102'3?. 4th, evening visit.?Vomited once after milk and soda water, and complains of nausea ; passed one fluid motion in bed ; tongue dry, and fissured at sides, and coated in centre and base; pulse 128; temperature 104?; opium suppository at bed time. 5th, morning visit,?Slept fairly, quite free from delirium; very prostrate. Three doubtful looking papules on chest and abdomen;* fluid motions are now passed unconsciously; tongue unchanged ; sordes forming on teeth ; abdomen flaccid ; paiu is less in iliac region ; respirations 32; pulse weak, 124; temperature no
102-2?.
Evening visit.?No improvement; symptoms of exhaustion increasing ; stools and urine passed unconsciously ; pulse weak, too frequent to be counted; respirations spasmodic; temperature 104?. ?
These afterwards proved to bo small boils probably due to poultices.
Pebbuaby 1, 1875.] NOTES ON A CASE 0? ENTERIC FEVER.?BY J. Gth, morning visit.? Slept during night; aspect brighter ; tongue more coated, and deposition of sordes greater than yesterday. Abdomen dull on percussion and less flaccid ; no pain in iliac fossa; urine of low specific gravity 1000, and decidedly albuminous; passed two stools, one unconsciously, the other contained a round worm, and was green and watery; pulse 120; temperature 103?. 6th, evening visit.?Pulse more frequent and weaker ; half the tongue coated with thick yellow fur, the other half being crusted with black dry sordes ; one fluid motion passed unconsciously since morning; temperature 104'2?. 7 th, morning visit.?Slept during night; no delirium; passed ?ne motion in bed; pulse and respiration less frequent than on Previous evening ; tongue cleaner, greater portion of sordes having disappeared, but its dorsum is still dry ; gurgling in iliac region, but no plain complained of; temperature 102'2?. Evening visit.?Somewhat improved; pulse and respiration lnereased in frequency since morning; bowels not moved; no r?se papules ; tongue moister and cleaner ; temperature 103'3? St7>f morning visit.?Looks exhausted ; passed one motion ; tongue again dry and covered with black sordes, large accumulation of sordes on teeth ; temperature 102'2?.
Evening visit.?Tongue dry
and
two watery motions during day
temperature 9 th,
;
rough,
free from
sordes;
neither pain nor delirium ;
103?. visit.?Countenance less anxious ;
morning
Pressure in iliac region ;
no
pain
on
watery motion during night; urine free from albumen ; temperature 102?. Evening visit.?Temperature 103?. ltith, morning visit.?Slept badly ; bowels moved three times, Motions green and watery; complains of no pain; exhaustion extreme ; slight gurgling in right iliac fossa ; tongue and teeth still covered with dark sordes; respiration easy; pulse quick and weak ;
Evening
temperature
passed
one
green
100'4?.
better; tongue dry and rough, but free from sordes; no motion during day; pulse soft and weak, reduced in frequency ; temperature 102?. 11 th, morning visit.?Continues to improve; bowels not Moved; no pain or gurgling in iliao region; slept well; tongue dry in centre and coated with yellow fur; sordes absent ; urine is passed naturally ; temperature 100'4?. Evening visit.?Passed one watery motion since morning; visit.?Seems
temperature
101'3?.
morning visit.?Slept well; respirations easy and natural; pulse soft, reduced in frequency; tongue moist and covered with slight yellowish fur; abdomen contracted; no pain or gurgling in iliac region; no appearance of rose papules; Passed one watery stool in bed during night; temperature 100-3O, Evening visit.?No motion ; tongue dry in centre and slightly c?ated, no sordes ; pulse soft and weak, 120 ; temperature 101-4?. 13M, morning visit.?Much better; slept well; bowels not moved ; tongue moist and slightly furred ; temperature 100?. 12 th,
Evening
visit.?No motion ; temperature 100?. visit.?Had one watery motion this
14
By Surgeon-Major J. R. Johnson', 5th Goorlilia Regiment, Civil Surgeon, Huzara District, Abbottabad.
and
Carefully recorded circumstantial details of the symptoms and pathological phenomena presented by enteric Tever in native3 of India are still so rarely seen in the medical literature of the day, that I venture to hope the following case may bo interesting
to the
Its
profession.
daily history
is
slightly abridged
from that recorded in the case-book of the 5th Goorkha RegiLike many similar cases observed in the British army, its ment. true nature was not even suspected until three days after the patient's admission to hospital. The case possesses features of a diagnostic point of view, but is chiefly affording an admirable illustration of one of the frequent causes of the relapses which are so characteristic
great interest in valuable most
as
of enteric fever. Regiment No.
1623, Sepoy
Surubjeet Khawas,
a
sturdy
young Goorkha recruit, aged 19 years, enlisted at Goruckpore on the 17th February 1874, and joined head-quarters at Abbottabad with a draft of recently entertained recruits on the 23rd April 1874. Had good health and performed ordinary duty when he came to hospital and stated that he until 14th
July,
been ill with fever and diarrhoea in the barracks for four or five days. His case did not attract attention, and was looked upon and returned as one of ordinary intermittent fever until the morning of the 18th, when, being suddenly recalled to of several the station, I saw him for the first time. A
had
days' low continued fever
and
history
diarrhoea, coupled
with the patient's led me to suspect the real nature of the age and appearance, disease. I therefore commenced thermometric observations, and gave instructions to leave the motions kept for inspection. Unfortunately I was again obliged to leave the station on
professional
buisness
on
the
urgent
18th,
and could not get back until
the INDIAN MEDICAL GAZETTE.
34
night of the 20th. The fragmentary history of the case for this period was as follows :? July 18^/t.?Evening temperature 103?. 19th.?Morning temperature 103? ; pulse 100; evening temperature 104^ ; passed three loose motions during day. '20th.?Morning temperature 102? ; evening temperature 103?; fluid motion.
one
:2\st, morning visit.?Seems weak and prostrate, but is bright; tongue broad and flabby, creamy white in centre ; no chest symptoms; liver natural in size ; spleen extends downwards
project much towards median line; abdomen generally rather prominent and hard, slight pain on deep pressure in right iliac region; pulse nearly
to
level of
umbilicus,
but does not
100; temperature 103?. Evening visit.?Passed two loose yellow motions since morning; temperature 103?. 22nd, morning visit.?Slept fairly ; lias no appetite and vomited
taking, milk; abdomen in same state, pain being always present on deep pressure in right iliac fossa ; passed one loose yellow motion during night; pulse 100 ; temperature 102,2?; urine abundant, high coloured, sp.gr. 1010, contains a once
after
trace of albumen.
Evening visit.?Partook freely one
of milk and had
a
fair
day;
fluid motion ; temperature 104?.
23rcl, morning visit.?Slept fairly and passed one fluid motion during night; tongue moist and cleaner, no spots ; no vomiting ; perspires freely at intervals ; abdomen a little distended ; pain distinct in right iliac region, but no gurgling can be detected; pulse 100 ; temperature 102 3?. Evening visit.?Drank milk well and had a good day; one fluid motion ; temperature 102,4?. 24tli, morning visit.?Seems better,
slept well, and partook of nourishment; bowels not moved during the night; tongue coating thick and white; abdomen in same state; pulse 96; temperature 101"4?. Evening visit.?No motions; temperature 102'3?. 25th, morning visit.?No material change; bowels still confined; slight pain on pressure in right iliac fossa; drinks milk and sleeps well; pulse 96 ; temperature 102 23?. Evening visit.?Not noted ; no motions. 26th, morning visit.?In same state ; slept well; no motions; temperature 102 2?. visit.?No motions; temperature 103'3?. 21tli, morning visit.?Is cheerful and feels .better, but does not look so well; colour leaden and anteinic; is perfectly
Evening
and so far has shown no indication of delirium ; tongue is also cleaner; hands and legs tremble when he attempts to move them ; no spots visible; there is some dulness on percussion, and feeble respiration with small moist rales on
sensible,
aspect of
thorax.
Does not
of
right complain chest, posterior Abdomen still rather disbut coughs loosely now and again. tended, and spleen prominent. He says that pain is decidedly Urine still shows a perceptible but very less in iliac region. faint trace of albumen.
Pulse 104; temperature 102?; bowels not having acted for three
days,
a
simple
water enema
ordered.
visit.?Bowels moved once copiously after enema; motion yellow in colour and semi-fluid; temperature 27th, evening
102?.
28th, morning visit.?Slept well and
moist and white
in
centre; 100; temperature 101-2?.
cough
seems
less ;
brighter; tongue respirations 28;
pulse Evening visit.?Progress satisfactory; passed one semi-consisteat yellow motion since morning; temperature 102?. 29
cough ; abdomen a little distended. Pain and slight gurgling in iliac region; passed one fluid motion unconsciously during the night; respirations 32 ; pulse 120; temperature 102'3?. 4th, evening visit.?Vomited once after milk and soda water, and complains of nausea ; passed one fluid motion in bed ; tongue dry, and fissured at sides, and coated in centre and base; pulse 128; temperature 104?; opium suppository at bed time. 5th, morning visit,?Slept fairly, quite free from delirium; very prostrate. Three doubtful looking papules on chest and abdomen;* fluid motions are now passed unconsciously; tongue unchanged ; sordes forming on teeth ; abdomen flaccid ; paiu is less in iliac region ; respirations 32; pulse weak, 124; temperature no
102-2?.
Evening visit.?No improvement; symptoms of exhaustion increasing ; stools and urine passed unconsciously ; pulse weak, too frequent to be counted; respirations spasmodic; temperature 104?. ?
These afterwards proved to bo small boils probably due to poultices.
Pebbuaby 1, 1875.] NOTES ON A CASE 0? ENTERIC FEVER.?BY J. Gth, morning visit.? Slept during night; aspect brighter ; tongue more coated, and deposition of sordes greater than yesterday. Abdomen dull on percussion and less flaccid ; no pain in iliac fossa; urine of low specific gravity 1000, and decidedly albuminous; passed two stools, one unconsciously, the other contained a round worm, and was green and watery; pulse 120; temperature 103?. 6th, evening visit.?Pulse more frequent and weaker ; half the tongue coated with thick yellow fur, the other half being crusted with black dry sordes ; one fluid motion passed unconsciously since morning; temperature 104'2?. 7 th, morning visit.?Slept during night; no delirium; passed ?ne motion in bed; pulse and respiration less frequent than on Previous evening ; tongue cleaner, greater portion of sordes having disappeared, but its dorsum is still dry ; gurgling in iliac region, but no plain complained of; temperature 102'2?. Evening visit.?Somewhat improved; pulse and respiration lnereased in frequency since morning; bowels not moved; no r?se papules ; tongue moister and cleaner ; temperature 103'3? St7>f morning visit.?Looks exhausted ; passed one motion ; tongue again dry and covered with black sordes, large accumulation of sordes on teeth ; temperature 102'2?.
Evening visit.?Tongue dry
and
two watery motions during day
temperature 9 th,
;
rough,
free from
sordes;
neither pain nor delirium ;
103?. visit.?Countenance less anxious ;
morning
Pressure in iliac region ;
no
pain
on
watery motion during night; urine free from albumen ; temperature 102?. Evening visit.?Temperature 103?. ltith, morning visit.?Slept badly ; bowels moved three times, Motions green and watery; complains of no pain; exhaustion extreme ; slight gurgling in right iliac fossa ; tongue and teeth still covered with dark sordes; respiration easy; pulse quick and weak ;
Evening
temperature
passed
one
green
100'4?.
better; tongue dry and rough, but free from sordes; no motion during day; pulse soft and weak, reduced in frequency ; temperature 102?. 11 th, morning visit.?Continues to improve; bowels not Moved; no pain or gurgling in iliao region; slept well; tongue dry in centre and coated with yellow fur; sordes absent ; urine is passed naturally ; temperature 100'4?. Evening visit.?Passed one watery motion since morning; visit.?Seems
temperature
101'3?.
morning visit.?Slept well; respirations easy and natural; pulse soft, reduced in frequency; tongue moist and covered with slight yellowish fur; abdomen contracted; no pain or gurgling in iliac region; no appearance of rose papules; Passed one watery stool in bed during night; temperature 100-3O, Evening visit.?No motion ; tongue dry in centre and slightly c?ated, no sordes ; pulse soft and weak, 120 ; temperature 101-4?. 13M, morning visit.?Much better; slept well; bowels not moved ; tongue moist and slightly furred ; temperature 100?. 12 th,
Evening
visit.?No motion ; temperature 100?. visit.?Had one watery motion this
14
