ON ENTERIC By Surgeon W. E.
FEVER.
Saunders,
a.m.d.
(Concluded from page 24.6.) Having now entered as fully into the subject as
is
possible
briefly
sum
in
essay of this kind, I shall the conclusions arrived at as up an
280
THE INDIAN MEDICAL GAZETTE.
the result of as
it
experience of enteric fever Europe, Asia, and Africa, as well
some
in
occurs
among troops on active service in the field* I found it necessary to enter more fully into details than I should have done, had my views been at all orthodox. My endeavour has been to as
prove that the
commonly accepted
etiology and pathology of this
view
of the
fever has not been
borne out
by clinical experience, and that in reality only one phase of the disease is recognised in Europe ; and that the type usually met with in England is not the common form observed abroad. I have not introduced any cases, as they don't published in every journal at
differ from those
intervals, pretation one
but have
discussed
the inter-
merely recognised facts with which acquainted, and their relation
of
is well
everyto
one
another. Enteric fever is
a very complex disease. It be defined as a may contagious and perhaps slightly infectious continued fever, assuming
more or
hot
less of
countries, month
remittent type, especially in and lasting from about 14 days a
by disbowels, diarrhoea, but sometimes constipation ; there is generally an eruption on the skin, chiefly of the abdomen, of a rose red colour slightly raised and disappearing on pressure. This eruption comes out in crops, lasting about 3 days, and when present is pathognomonic of the disease. The fever is of a septic nature, (similar to surgical fever after injuries and operations) but due indirectly to a local specific inflammatory disease of the intestinal glands and surrounding tissues, to
a
or
order of the
more, and characterised
looseness
or
severe in the lower part of the ileum. ttr nr \rf *T Of* 1 rSDCIsL) The disease forms the great scourge of armies in the field, and with its sequel dysentery forms
most
the chief
cause
Formerly the typhus probably enteric fever,
of sickness.
fever amongst armies was and typhus itself is rare in
war
time.
In some cases of the scorbutic type, there is a profuse eruption very like that of typhus, and
apt
to be mistaken for
phoid
it, especially
as
the ty-
investigations
cause
of
spread
show' for certain,
patients Suffering only,
the great, if not the ; and probably this is to
tain extent true
a^disposition
of
discharges
from the disease
of
are
a cer-
abroad, although there has been late to assign the cause of en-
teric fever to climatic and mysterious, rather to social and personal conditions for the
than
mode of
means or
and cholera.
spread
of both enteric fever
The disease arises de
certain
novo
under
the
conditions, poison being probably a low vegetable organism existing in marsh water ; and this is probably the common mode of spread in hot countries, as well as in the case of troops in the field. malarial
I have called this the endemic
or
variety.
The disease may be communicated to healthy men by the dejecta of the sick, and in England this is the
common
mode of
spread
;
chiefly by
the passage of the intestinal discharges into the This is the water used for drinking purposes.
epidemic
or
true
variety
of enteric fever.
The scorbutic taint may be a complication of either form, but most commonly of the endemic
type, in times of
war
and in
where
vegetables arc scarce quantity, to admit tity being taken in the diet.
sufficient ed
as a
I
use
tropical
climates
and not grown in of the proper quanIt is best consider-
separate type, the scorbutic variety. the term malarial, because it is of palli-
dal
origin, origin.
but do not wish to
I have touched
011
imply
miasmatic
the various modes of dis-
semination, and shown that the medium of the drinking water is the most common mode of spread, and that a specific poison is necessary. Decomposition and foul air, although they may lower the health and predispose, yet are incapable of exciting the disease without the introduction of the specific poison. I have^endeavoured to point out that the soil takes an accidental and not essential part, and that no such law as that laid down by Professor Pettenkofer can be
places, and that his views wrongly chosen facts. It is argued that the poison is got
true of all on
the intestinal
state is more marked.
In Europe
that the bowel
[October, 1883.
glands, though
are
based
rid of
by
it is "known that
the greater the lesion'- th6,:'more
seVere the
October,
1883.]
disease.
It is
SAUNDERS ON ENTERIC frEVER,
acknowledged that the confined to youth and early these glands are most active,
also
disease is almost
manhood, when
and the relief to the system should be more evident. Yet it is not so ; the better fed should be able to resist the
quently
disease,
they
more
there
being
some
glands healthy
being
not ones
and
severe
of
afterwards, all point toward the doctrine If the
local infection.
primary
the intestinal
as
poison
was
should find all
first, glands involved, and the lower part of the ileum only. The mesenteric glands moreover we
not those at
are
enlarged,
the result of their endeavours to check the
entrance of
and then reads of the treatment
tine
or
material into the circulation
septic purely symptomatic, and the typhis a complication, due to the accumuIhe blood of peccant material, not exit should be. is th e chief
cause
of death, and
sometimes proves fatal in a few days. The great aim that Sydenham set before was
the
cure
of disease, and
although
we
him, may
.
in
must
speculative inquiry, delight permit the theories formed to interfere we
treatment ; that must be based
on
never
with our
rational
em-
piricism. We
are not
cause we nor
the
entitled to withhold remedies be-
do not understand their exact minute
changes.
in the animal economy. When good practice rests there is
on
they unsound of the
nature,
produce theory, practice
always great danger theory is overthrown. This in fact explains why we vacillate from one extreme to another, and why, to some extent, we seem to work in recurring circles; and in the course of years most valuable practical conclusions arrived at from actual experience are forbeing
excellent
certain conditions and
compli-
abandoned when the
gotten, because the theory upon which the conclusions were based has been overthrown and
are?
;
tissues. The
expectant
treatment is very
cases, but it must not be converted
enteric
as
by turpen-
are
dangerous and distressing and complications high temperature symptoms must be prevented as far as possible. To sustain the powers of the patient and 2. maintain the nutrition of the body, and also to keep the circulation from flagging. 3. To promote elimination of the products of exaggerated metamorphosis in the blood and 1.
nothing
Septicaemia
drugs
To relieve the
oid state creted
These
The indications of treatment
The fever is lation in
for
remedies
&c.
every
tention to details, and it may he said to resolve itself into simple diet and simple measures.
passage of the contents of the and cases mild at first turning out more
in the blood from the
now
digitalis,
specific
one
in-
some
speedy
bowel,
although
cations, but our treatment must be symptomatic. Success of treatment depends on a careful at-
diseased ones, and the local lesion being more is greater obstruction severe just where there to the
treatment for enteric fever ;
no
fre-
contract it.
The fact also of all the
volved,
but
There is
be unsound.
to
proved
281
We
treatment. cases
if
can
do
a
in mild
good
into the do
great deal in
try.
we
Scepticism often springs from intellectual indolence. Thucidydes reminded us of what all observation and experience too abundantly confirm, the very languid interest taken by most men in the pursuit of truth. Interest, habit custom, love of ease, dislike of change, and many other shades of sentiment or disposition, help to affect our judgment or to disincline form any judgus from taking the trouble to is No motive ment. sufficiently strong to force a doubter to honestly think out for himself, and the result is, I often fear, that the easiest view becomes the most popular. Then again it is one thing to know and acquiesce in a doctrine or theory, and another thing to act up to the belief. *j
1. ?
VI lllii
regards
As
able to
come to a
that mild attacks that way. ;? ..ji
?
-]
1
The
JJlti
on
under the
I
J J1
the sick I
i1J
r