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

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