slight disorders of the bowels being invariably the first indication we have of these diseases, especially cholera.
it goes ;
It is true that enteric fever would haust the
against due
to
poison
susceptibility
seem to ex-
and protect the system
future attack, but I take it that this is the fact that the glands, for which the a
has
special affinity,
destroyed
are
more or
less, and there is therefore less chance of their
being
A second attack
attacked.
sometimes
occur.
I have
seen
can
such
and does
a case.
as a rule very there has of where for infection, potent powers it has been of an been judging, opportunity
The
poison
found that
posed ON ENTERIC FEVER. By Surgeon W. E. Saunders,
( Continued from page III.?Nature What is the
the
of
is due to
Poison.
poison, and the poisonous infecting principle,
nature of the
properties of the gives rise
which
to the disease
enteric
call
we
fever ? The
only by the they produce, and developed by different contagia
specific contagia
of disease which
symptoms
the reactions differ in infective to
a
term
known
are
several respects. Thus poisons render the body
second attack of the
zymotic
class of
insusceptible The
applied to diseases of fever, typhus, small-pox,
has been
this kind, viz., scarlet and the like. On the other hand
another class
their
of infective tion
one
disease.
same
poisons provoke directly they enter the body,
quent diseases do
not
secure
specific
reac-
and the
conse-
future
immunity
;
erysipelas, pyaemia, septicaemia, and ague are of this class, and are termed septic diseases. There is
zymotic
no
real
incubation
period
as
in
the
class.*
Now it is fever and
presently
to
this
cholera show
latter
class
really belong,
reasons
for this view.
that enteric I
shall
The
reac-
and
tive process first manifests itself at the point and locality where the virus is inserted or alights, and spreads from this focus gathering force as *
See Dr. D, ber 23, 1878.
Southey's Lecture
on
Hygiene.
a
small percentage of those
ex-
or
an
septic diseases encapsulation or separa-
deferred reaction in
accidental
body, and may thus be mistaken for an incubating state. The quantity of virus inserted makes absolutely no difference to the sum total of the reaction or specific symptoms provoked in the instance of zymotic disease; whereas both the form and quantity of the specific poisons materially influence the course and gravity of the reaction induced in the case of septic poisons. Each of the disease poisons may have considerable differences in their vitality, and require different modes of destruction ; some requiring oxygen, some to be deprived of oxygen, some tion from the
68.)
Specific
only
has not
to its influence are attacked.
A latent a.m.d.
moreover
Lancet, Novem-
moisture, some cold, and so on.
must be
dried,
some
acids, heat,
The
vitality of poisons varies much with the zymotic class. In the case of small-pox the poison may be dried, and if neither frozen nor over-heated, it will certainly retain its infecting property for years. So also with the poisons of scarlet and yellow fevers, typhus and plague. Neither the cholera nor enteric fever poisons appear to be destructible in any quantity of cold water ; nevertheless the enteric poison has such limited power of propagating itself that the poison must be in large dose or long breathed or taken into the stomach to produce the disease *
(Jenner).*
Sir W. Jenner, Lancet, February 20, 1875.
THE INDIAN MEDICAL GAZETTE.
94
quantity of enteric poison, and the period and length of time during which it is taken, modify the result, for we have a very powerful The
destroyer in the acid secretions of the stomach
;
but if the
during
poison passes beyond the stomach period of fast, then the quantity will
a
make but little difference. There is
no
development
need to resort to the outside
the
rather shows that it tends to
theory of body, experience rapid decay ; of
it may possibly remain dormant and its vitality under certain conditions.
course
retain
[April, 1883.
years since, and in some cases by the products of inflammation from a previous case, in which case the low organisms found may be the some
poison destroyers as has frequently been suggested. Lately Dr. Brantlecht of Brunswick has repeatedly found a species of bacillus, which he believes to be pathogenic, in the water used for drinking by the inhabitants of the affected disactual
Bacilli have also been found
tricts.
in the in-
testinal and mesenteric glands in enteric fever. Dr. Brantlecht
strongly
insists
on
the
specific
nature of the bacillus he has discovered.
At
poison must have ordinary temperatures it grows in springvvater one phase of its existence in the ground, but I very slowly, but the growth of the bacillus is shall enter into this question when relating the checked if the solution which he uses to influence of the soil together with Pettenkofer's quickly cultivate it be in the slightest degree acidulated. views. the bacillus in a special solution, All the acute specific diseases are contagious, By cultivating of phosphate of ammonia dissolved consisting i.e., from some part of the sick something is in springvvater, it forms white flakes at the botgiven off, which can, when properly applied, The microscope shows each flake to be a excite the same disease in another, and which tom. tangled mass of threads, more or less jointed, can excite no other disease. (Sir W. Jenner.) Some think that the enteric
at
Unfortunately
present
is
little
very
something is, or the condithis render tions which something potent. The doctrine in Germany appears to be that of the invariable specific origin of enteric fever ; and the general assumption is that no admittedly contagious disease ever originates in any other way than by contact with the emanations from known of what this
proved,
that in the
authorities
The
some
far
so
some
of
from
our
best
probability is in origin of enteric
spontaneous
instances.
majority a
of
opinion
of observers
the view that there is
produces
is still
the balance of
favour of the fever in
doctrine
The
the sick.
particular
a
in favour of
are
special poison
disease and
no
which
other, and
there is much evidence to support the idea. It seems, however, that it has been carried too far, and
true
blood
poisons, yet wholly physiological phenomena come into
although
as
regards
with diseases of the intestinal different
play,
which renders it difficult
tract
to
come
to
a
conclusion. It is caused
quite possible that enteric by a fungus as suggested
fever may be in Germany
which
break into small
soon
appear to dissolve into like rows of pearls.* The 1.
two
rolls, and these
aggregations
chief theories of infection
The germ
theory
or
theory
of
of spores are :?
contagium
vivuvi. The
glandular theory of Dr. Richardson. The first is probably true of the zymotic diseases chiefly infectious diseases, which run their course with such regularity, must own special causes, and the thing we call virus is to all^ intents and purposes a seed." (Prof. Tyndall.) Dr. Richardson's theory is probably true of the septic diseases. It is supported by striking experiments, and assumes that the contagium 2.
"
is the diseased secretion of
one
01*
other of the
body, which possesses the property glands secretions in a previously kindred of altering the healthy person by catalytic action. If the first of the
granted that a morbid secretion can in any way or degree induce a similar morbid action in another body, there is no reason for denying that the process might in time attain the most virulent step be
infectiv;eness. *
B.M.
Journal., July
16, 1881.
SAUNDERS ON ENTERIC FEVER.
1883.]
April,
highly probable, as Dr. B. Saunderson's experiments show, that septic animal poisons gather virulence or poisonous energy by every separate living organism they pass throughNow it is
This
that Dr. Thorne
to be the view
seems
Thorne takes. The
zymotic contagia,
tory of disease extends, de
originated
novo
;*
far back
so
appear to have
never
like has
the his-
as
always produced
like ; and whenever any outbreak of disease has been investigated with sufficient care, its introduction has been traced to person
or
respect
to
show that
some
infected
clothing. It is not so however with the septic poisons ; for experiments out of apparently harmless materials,
and with the fulfilment of certain essential
con-
ditions, septic poisons of well-established virulence
be
can
One of the conditions
developed.
appears to be the addition of bacteria germs, which are always derived from pre-existing bacteria
The
present in the air.
ever
question
has
ventilated of late years in London, and Dr. B. Saunderson has done much towards enlarging our knowledge on the subject. It been
freely
does
proved for certain they merely scavengers, the poison by feeding thereon.
not
appear
whether move
latter er
are
however and
not
In the
should expect to find them in
case we
numbers where most
poison
IV.?Origin
de
re-
great-
existed. novo.
poison arise de novo, or must directly traceable to a previous
Can the enteric each case
be
case
?
This
is
that has
very complex question, and one given rise to much discussion of late a
years, and has met
the support of
some
of our
ablest authorities. In
material from an
it is
England
some
previous
for it appears rather a disease to start anew. to
that the infective case
almost essential element in its
by
occur
*
no
in Prof.
sanitary satisfactory.
be
There
state
moreover no sewers,
are
tation of the disease for
be admitted to
must
can
and
no
impor-
be traced with every
than any other circumstance bears out this view is, that
facility
so
doing
;
and what
it will son
occur every year almost to the day.
exactly
more
at the
same sea-
What is meant
by a de novo origin ? To conorganism is developed out of crude material witnout a pre-existing organism, is of
tend that
an
course more
organism,
or
than absurd ; but to say that an cell, or plant should develop, under
certain conditions,
properties,
is
quite
and it may be another thing.
new
poisonous
It is in this way that diseases may be said Dr. Thorne Thorne has shewn to arise de novo.
poisons may acquire more virulent properties by transmission through the systems of several individuals; or, as it is termed, the progressive development of disease poisons. A very good example is found in venereal diseases, for it is well known that they become far how disease
more
virulent at seaport towns than elsewhere. once introduced will of course
Enteric fever
spread under certain unhygienic conditions as in England ; but many cases appear where these conditions cannot be discovered after long and careful investigations, without the many difficulties experienced in European towns and villages, each having apparently the same independent origin. I shall now bring forward two instances where enteric fever developed gradually, and are I think very ample proof of its de novo origin. The examples occurred during the Zulu campaign in 1879, one at Etshowe and the other at Helfmakaar.
probable
and diffusion ; not so,
It is
where the
95
has become
In the former instance it is pretty well known that all communication was cut off for several
development
months
however, in hot countries, common
thing
for the
exceptional for the disease place free from the disease, and
; and
enteric fever could not have been
imported except true enteric
cases
with the
force,
in which
case
should have occurred from the
commencement, within
a
fortinght
of
taking up
means
their
a
the contrary we find the disease gradually developing itself until a decided and characteris-
Tyndall?Lect. Royal Inst., 1S70.
but
position.
on
Such, however,
was
not the case,
THE INDIAN MEDICAL GAZETTE.
96
[April, 188;
occurred, the number of cases increasing very rapidly afterwards, as the overcrowding of men and animals together in a small confined space slowly but steadily undermined their health and diminished their power of resisting
these
disease.
although the strength was greater. Whether the fungus poisoning was really the starting point or not, it appears to be a very good example of the origin of enteric fever de novo. Much the same thing happened at Etshowe.
tic
case
As the Helfmakaar outbreak
point
happened
of time, I will describe it first.
outbreaks back up the view
more
first in
The two
definitely
when
taken
together and the cases are compared, although the Etshowe outbreak was the best example. Towards the end of January after the Isandlevhana disaster, when the troops were for the
men?as many as arrival?but the numbers
altogether were
to
after
These
cases
increased in
gan
Drift), at first very amenable to treatment but rapidly becoming less so, and attended with great languor. The medical officer in charge described a typical case under the following symptoms :?loss of appetite, giddiness, sickness, diarrhoea, with bilious watery motions, without pain, often as many as 12 in the 24 hours, and rapid prostration. The temperature ranged about 102? to 103? F. with well marked remissions in the morning, thick mucous secretions about the fauces, which were congested and attended with a troublesome cough. The pulse full and strong, about 90 beats per minute ; tongue normal or slightly furred ; sometimes
was
there
loss of
was
about the 10th mus
with
sleep and delirium at night day. There was generally tenes-
mucus
and blood in the
stools.
weeks, and was followed of loss flesh, debility, and nervous by great prostration requiring change of air. Many such occurred, and were at first called bilious remittent fever, but afterwards it became
cases
evident
that
they
were
really
enteric
fever.
Owing to the effluvia from the rotten mealies (used for fortifying their position and thus exposed to the rain and sun) and other foul odours, it became necessary to abandon the fort for a more healthy position. Some time afterwards,
the arrival of the de-
large numbers of admitted into hospital from
tachment at Utrecht, cases were
on
were
There
fever, prior at Utrecht
about
occur was
cut
off.
and numbers
severity developed.
was
but few true
At first
enteric cases, but
they being nearly doubled each week after the first cases appeared. Although not living in so unsanitary a state rapidly increased,
as at
the
number
Helfmakaar, the troops
were
crowded
un-
avoidably in a small space. The ground in the vicinity of the troops was highly polluted by oxen picketted within the fort, and the stench at night is described as being overpowering by the late Dr. Wilson, who
present and gave
was
Numerous were
due
cases
of
doubt
no
me
these notes.
dysentery occurred,
to
the
same
causes
and
that
the outbreak of enteric fever, viz., crowding together of a large number of men
aggravated the
small space, and the insanitary state which always accompanies such conditions.
and animals in The
The
attack lasted about three
enteric
Cases of diarrhoea attended with fever, which
there
Rorke's
few weeks.
a
lasted up to 14 days, began to two weeks after communication until true enteric fever
(near
day after their decreased, and
arrival of this detachment
most
part shut up in small forts, diarrhoea beto prevail amongst the troops at Helfmakaar
soon
admissions for
no
the
ceased
10 one
records of temperature will show at Etshowe and Helfmakaar may
following
that the be
a
cases
looked upon as the same disease. at Etshowe occurred before
practically The first
typical
case
accompanied by The second
case
appeared,
and
was
pea-soup stools and diarrhoea. recorded here seemed to be a
link between the first and
had
enteric fever
or
case
undefined
attack,
the true enteric fever which afterwards
appeared. There
many
were
before
typical observed, and I
enteric
them forward
among
of this disease
cases
of enteric
think I
am
proof during war
as a
of each of the types were fever
cases
justified
of the de time.
in
bringing origin
novo
April,
WADDELL ON HYDROFLUORIC ACID AND THE FLUORIDES.
1883.]
Etshowe Cases.
Helfmakaar Cases.
1st
Case.
Typical
Case.
March.
I
Febry.
2nd Case
104
2
102-4
103-8
104*4
100 1
103-4
103
103 "2
102
o
1032
102
4
102 2
101
10
12
100-4
I02'S
IOI -2
102-6
100
I02'4
ioi'4
100 *4
99.6
102-3 1018
I febry.
103
100
>3 |
99
14
!
*
15
|
9S
4
!I
102-6
102
103 4
101-3
IOO"2
102'4
103-4
99'2
8
1026
101
99 "4
Conval'es-cent.
100-4
16 17 18
Conval escent.
102
99'8
ioo'S
99-4
1001
98 Conval-
19
When
6
102-8
100 2
|
7
103 102
ioi*8
.
11
-4
103
100
J |
104
99'3
101
9
102-8
typical
cases
of enteric
fever
occur
preceding, the chances are that the disease has been imported ; but if, as in the above instances, the typical cases only appear after many such slight cases which gradually approach the typical enteric attacks, then I consider the outbreak is due to a new development of the disease?an origin de without these abortive attacks
novo
|
in fact.
(To
be
continued.)
97
it goes ;
It is true that enteric fever would haust the
against due
to
poison
susceptibility
seem to ex-
and protect the system
future attack, but I take it that this is the fact that the glands, for which the a
has
special affinity,
destroyed
are
more or
less, and there is therefore less chance of their
being
A second attack
attacked.
sometimes
occur.
I have
seen
can
such
and does
a case.
as a rule very there has of where for infection, potent powers it has been of an been judging, opportunity
The
poison
found that
posed ON ENTERIC FEVER. By Surgeon W. E. Saunders,
( Continued from page III.?Nature What is the
the
of
is due to
Poison.
poison, and the poisonous infecting principle,
nature of the
properties of the gives rise
which
to the disease
enteric
call
we
fever ? The
only by the they produce, and developed by different contagia
specific contagia
of disease which
symptoms
the reactions differ in infective to
a
term
known
are
several respects. Thus poisons render the body
second attack of the
zymotic
class of
insusceptible The
applied to diseases of fever, typhus, small-pox,
has been
this kind, viz., scarlet and the like. On the other hand
another class
their
of infective tion
one
disease.
same
poisons provoke directly they enter the body,
quent diseases do
not
secure
specific
reac-
and the
conse-
future
immunity
;
erysipelas, pyaemia, septicaemia, and ague are of this class, and are termed septic diseases. There is
zymotic
no
real
incubation
period
as
in
the
class.*
Now it is fever and
presently
to
this
cholera show
latter
class
really belong,
reasons
for this view.
that enteric I
shall
The
reac-
and
tive process first manifests itself at the point and locality where the virus is inserted or alights, and spreads from this focus gathering force as *
See Dr. D, ber 23, 1878.
Southey's Lecture
on
Hygiene.
a
small percentage of those
ex-
or
an
septic diseases encapsulation or separa-
deferred reaction in
accidental
body, and may thus be mistaken for an incubating state. The quantity of virus inserted makes absolutely no difference to the sum total of the reaction or specific symptoms provoked in the instance of zymotic disease; whereas both the form and quantity of the specific poisons materially influence the course and gravity of the reaction induced in the case of septic poisons. Each of the disease poisons may have considerable differences in their vitality, and require different modes of destruction ; some requiring oxygen, some to be deprived of oxygen, some tion from the
68.)
Specific
only
has not
to its influence are attacked.
A latent a.m.d.
moreover
Lancet, Novem-
moisture, some cold, and so on.
must be
dried,
some
acids, heat,
The
vitality of poisons varies much with the zymotic class. In the case of small-pox the poison may be dried, and if neither frozen nor over-heated, it will certainly retain its infecting property for years. So also with the poisons of scarlet and yellow fevers, typhus and plague. Neither the cholera nor enteric fever poisons appear to be destructible in any quantity of cold water ; nevertheless the enteric poison has such limited power of propagating itself that the poison must be in large dose or long breathed or taken into the stomach to produce the disease *
(Jenner).*
Sir W. Jenner, Lancet, February 20, 1875.
THE INDIAN MEDICAL GAZETTE.
94
quantity of enteric poison, and the period and length of time during which it is taken, modify the result, for we have a very powerful The
destroyer in the acid secretions of the stomach
;
but if the
during
poison passes beyond the stomach period of fast, then the quantity will
a
make but little difference. There is
no
development
need to resort to the outside
the
rather shows that it tends to
theory of body, experience rapid decay ; of
it may possibly remain dormant and its vitality under certain conditions.
course
retain
[April, 1883.
years since, and in some cases by the products of inflammation from a previous case, in which case the low organisms found may be the some
poison destroyers as has frequently been suggested. Lately Dr. Brantlecht of Brunswick has repeatedly found a species of bacillus, which he believes to be pathogenic, in the water used for drinking by the inhabitants of the affected disactual
Bacilli have also been found
tricts.
in the in-
testinal and mesenteric glands in enteric fever. Dr. Brantlecht
strongly
insists
on
the
specific
nature of the bacillus he has discovered.
At
poison must have ordinary temperatures it grows in springvvater one phase of its existence in the ground, but I very slowly, but the growth of the bacillus is shall enter into this question when relating the checked if the solution which he uses to influence of the soil together with Pettenkofer's quickly cultivate it be in the slightest degree acidulated. views. the bacillus in a special solution, All the acute specific diseases are contagious, By cultivating of phosphate of ammonia dissolved consisting i.e., from some part of the sick something is in springvvater, it forms white flakes at the botgiven off, which can, when properly applied, The microscope shows each flake to be a excite the same disease in another, and which tom. tangled mass of threads, more or less jointed, can excite no other disease. (Sir W. Jenner.) Some think that the enteric
at
Unfortunately
present
is
little
very
something is, or the condithis render tions which something potent. The doctrine in Germany appears to be that of the invariable specific origin of enteric fever ; and the general assumption is that no admittedly contagious disease ever originates in any other way than by contact with the emanations from known of what this
proved,
that in the
authorities
The
some
far
so
some
of
from
our
best
probability is in origin of enteric
spontaneous
instances.
majority a
of
opinion
of observers
the view that there is
produces
is still
the balance of
favour of the fever in
doctrine
The
the sick.
particular
a
in favour of
are
special poison
disease and
no
which
other, and
there is much evidence to support the idea. It seems, however, that it has been carried too far, and
true
blood
poisons, yet wholly physiological phenomena come into
although
as
regards
with diseases of the intestinal different
play,
which renders it difficult
tract
to
come
to
a
conclusion. It is caused
quite possible that enteric by a fungus as suggested
fever may be in Germany
which
break into small
soon
appear to dissolve into like rows of pearls.* The 1.
two
rolls, and these
aggregations
chief theories of infection
The germ
theory
or
theory
of
of spores are :?
contagium
vivuvi. The
glandular theory of Dr. Richardson. The first is probably true of the zymotic diseases chiefly infectious diseases, which run their course with such regularity, must own special causes, and the thing we call virus is to all^ intents and purposes a seed." (Prof. Tyndall.) Dr. Richardson's theory is probably true of the septic diseases. It is supported by striking experiments, and assumes that the contagium 2.
"
is the diseased secretion of
one
01*
other of the
body, which possesses the property glands secretions in a previously kindred of altering the healthy person by catalytic action. If the first of the
granted that a morbid secretion can in any way or degree induce a similar morbid action in another body, there is no reason for denying that the process might in time attain the most virulent step be
infectiv;eness. *
B.M.
Journal., July
16, 1881.
SAUNDERS ON ENTERIC FEVER.
1883.]
April,
highly probable, as Dr. B. Saunderson's experiments show, that septic animal poisons gather virulence or poisonous energy by every separate living organism they pass throughNow it is
This
that Dr. Thorne
to be the view
seems
Thorne takes. The
zymotic contagia,
tory of disease extends, de
originated
novo
;*
far back
so
appear to have
never
like has
the his-
as
always produced
like ; and whenever any outbreak of disease has been investigated with sufficient care, its introduction has been traced to person
or
respect
to
show that
some
infected
clothing. It is not so however with the septic poisons ; for experiments out of apparently harmless materials,
and with the fulfilment of certain essential
con-
ditions, septic poisons of well-established virulence
be
can
One of the conditions
developed.
appears to be the addition of bacteria germs, which are always derived from pre-existing bacteria
The
present in the air.
ever
question
has
ventilated of late years in London, and Dr. B. Saunderson has done much towards enlarging our knowledge on the subject. It been
freely
does
proved for certain they merely scavengers, the poison by feeding thereon.
not
appear
whether move
latter er
are
however and
not
In the
should expect to find them in
case we
numbers where most
poison
IV.?Origin
de
re-
great-
existed. novo.
poison arise de novo, or must directly traceable to a previous
Can the enteric each case
be
case
?
This
is
that has
very complex question, and one given rise to much discussion of late a
years, and has met
the support of
some
of our
ablest authorities. In
material from an
it is
England
some
previous
for it appears rather a disease to start anew. to
that the infective case
almost essential element in its
by
occur
*
no
in Prof.
sanitary satisfactory.
be
There
state
moreover no sewers,
are
tation of the disease for
be admitted to
must
can
and
no
impor-
be traced with every
than any other circumstance bears out this view is, that
facility
so
doing
;
and what
it will son
occur every year almost to the day.
exactly
more
at the
same sea-
What is meant
by a de novo origin ? To conorganism is developed out of crude material witnout a pre-existing organism, is of
tend that
an
course more
organism,
or
than absurd ; but to say that an cell, or plant should develop, under
certain conditions,
properties,
is
quite
and it may be another thing.
new
poisonous
It is in this way that diseases may be said Dr. Thorne Thorne has shewn to arise de novo.
poisons may acquire more virulent properties by transmission through the systems of several individuals; or, as it is termed, the progressive development of disease poisons. A very good example is found in venereal diseases, for it is well known that they become far how disease
more
virulent at seaport towns than elsewhere. once introduced will of course
Enteric fever
spread under certain unhygienic conditions as in England ; but many cases appear where these conditions cannot be discovered after long and careful investigations, without the many difficulties experienced in European towns and villages, each having apparently the same independent origin. I shall now bring forward two instances where enteric fever developed gradually, and are I think very ample proof of its de novo origin. The examples occurred during the Zulu campaign in 1879, one at Etshowe and the other at Helfmakaar.
probable
and diffusion ; not so,
It is
where the
95
has become
In the former instance it is pretty well known that all communication was cut off for several
development
months
however, in hot countries, common
thing
for the
exceptional for the disease place free from the disease, and
; and
enteric fever could not have been
imported except true enteric
cases
with the
force,
in which
case
should have occurred from the
commencement, within
a
fortinght
of
taking up
means
their
a
the contrary we find the disease gradually developing itself until a decided and characteris-
Tyndall?Lect. Royal Inst., 1S70.
but
position.
on
Such, however,
was
not the case,
THE INDIAN MEDICAL GAZETTE.
96
[April, 188;
occurred, the number of cases increasing very rapidly afterwards, as the overcrowding of men and animals together in a small confined space slowly but steadily undermined their health and diminished their power of resisting
these
disease.
although the strength was greater. Whether the fungus poisoning was really the starting point or not, it appears to be a very good example of the origin of enteric fever de novo. Much the same thing happened at Etshowe.
tic
case
As the Helfmakaar outbreak
point
happened
of time, I will describe it first.
outbreaks back up the view
more
first in
The two
definitely
when
taken
together and the cases are compared, although the Etshowe outbreak was the best example. Towards the end of January after the Isandlevhana disaster, when the troops were for the
men?as many as arrival?but the numbers
altogether were
to
after
These
cases
increased in
gan
Drift), at first very amenable to treatment but rapidly becoming less so, and attended with great languor. The medical officer in charge described a typical case under the following symptoms :?loss of appetite, giddiness, sickness, diarrhoea, with bilious watery motions, without pain, often as many as 12 in the 24 hours, and rapid prostration. The temperature ranged about 102? to 103? F. with well marked remissions in the morning, thick mucous secretions about the fauces, which were congested and attended with a troublesome cough. The pulse full and strong, about 90 beats per minute ; tongue normal or slightly furred ; sometimes
was
there
loss of
was
about the 10th mus
with
sleep and delirium at night day. There was generally tenes-
mucus
and blood in the
stools.
weeks, and was followed of loss flesh, debility, and nervous by great prostration requiring change of air. Many such occurred, and were at first called bilious remittent fever, but afterwards it became
cases
evident
that
they
were
really
enteric
fever.
Owing to the effluvia from the rotten mealies (used for fortifying their position and thus exposed to the rain and sun) and other foul odours, it became necessary to abandon the fort for a more healthy position. Some time afterwards,
the arrival of the de-
large numbers of admitted into hospital from
tachment at Utrecht, cases were
on
were
There
fever, prior at Utrecht
about
occur was
cut
off.
and numbers
severity developed.
was
but few true
At first
enteric cases, but
they being nearly doubled each week after the first cases appeared. Although not living in so unsanitary a state rapidly increased,
as at
the
number
Helfmakaar, the troops
were
crowded
un-
avoidably in a small space. The ground in the vicinity of the troops was highly polluted by oxen picketted within the fort, and the stench at night is described as being overpowering by the late Dr. Wilson, who
present and gave
was
Numerous were
due
cases
of
doubt
no
me
these notes.
dysentery occurred,
to
the
same
causes
and
that
the outbreak of enteric fever, viz., crowding together of a large number of men
aggravated the
small space, and the insanitary state which always accompanies such conditions.
and animals in The
The
attack lasted about three
enteric
Cases of diarrhoea attended with fever, which
there
Rorke's
few weeks.
a
lasted up to 14 days, began to two weeks after communication until true enteric fever
(near
day after their decreased, and
arrival of this detachment
most
part shut up in small forts, diarrhoea beto prevail amongst the troops at Helfmakaar
soon
admissions for
no
the
ceased
10 one
records of temperature will show at Etshowe and Helfmakaar may
following
that the be
a
cases
looked upon as the same disease. at Etshowe occurred before
practically The first
typical
case
accompanied by The second
case
appeared,
and
was
pea-soup stools and diarrhoea. recorded here seemed to be a
link between the first and
had
enteric fever
or
case
undefined
attack,
the true enteric fever which afterwards
appeared. There
many
were
before
typical observed, and I
enteric
them forward
among
of this disease
cases
of enteric
think I
am
proof during war
as a
of each of the types were fever
cases
justified
of the de time.
in
bringing origin
novo
April,
WADDELL ON HYDROFLUORIC ACID AND THE FLUORIDES.
1883.]
Etshowe Cases.
Helfmakaar Cases.
1st
Case.
Typical
Case.
March.
I
Febry.
2nd Case
104
2
102-4
103-8
104*4
100 1
103-4
103
103 "2
102
o
1032
102
4
102 2
101
10
12
100-4
I02'S
IOI -2
102-6
100
I02'4
ioi'4
100 *4
99.6
102-3 1018
I febry.
103
100
>3 |
99
14
!
*
15
|
9S
4
!I
102-6
102
103 4
101-3
IOO"2
102'4
103-4
99'2
8
1026
101
99 "4
Conval'es-cent.
100-4
16 17 18
Conval escent.
102
99'8
ioo'S
99-4
1001
98 Conval-
19
When
6
102-8
100 2
|
7
103 102
ioi*8
.
11
-4
103
100
J |
104
99'3
101
9
102-8
typical
cases
of enteric
fever
occur
preceding, the chances are that the disease has been imported ; but if, as in the above instances, the typical cases only appear after many such slight cases which gradually approach the typical enteric attacks, then I consider the outbreak is due to a new development of the disease?an origin de without these abortive attacks
novo
|
in fact.
(To
be
continued.)
97
