particularly
at its lower third, as well as in the majority in the large intestine ; the exceptional case had no very significant lesion in the ileum or any other portion of the small intestine, but the disease was chiefly situated in the large gut. Authors on morbid anatomy do describe cases of enteric fever where the lesion is in this portion of the alimentary canal, whilst the ileum presents but little alteration ; but such cases are rare, and very likely to mislead one as to determining the true nature of the disease. The mesenteric glands were invariably affected. The following are brief notes of the post mortem appearances of some of the cases which terminated fatally. 1. Private J- McMahon, aat. 25. Post mortem examination 5 hours after death. Body fairly well nourished ; rigor mortis strong. Head ?Brain and membranes generally vascular ; ventricular fluid bloody about 3 ij each, otherwise normal. Thorax.?Heart, muscular tissue pale and flabby, cavities contained soft dark clots and dark fluid blood ; lungs both congested, chiefly at their bases and posterior
of
cases
margins.
Abdomen.?Mucous membrane of stomach congested, of the duodenum and jejunum, of a rosy pink color, but of the ileum intensely congested, chiefly at lower end ; twenty-two ulcers were counted of various sizes and in different stages, the majority of the ulcers consisting of Peyerian patches, a few only of the solitary follicles, whilst many of the latter structures were enlarged, looking like peas studding the surface of the ileum and portion of the jejunum ; there was a general thinning of the coats of the small intestines, and in two spots approaching perforation. .Mucous membrane of large
gut congested throughout its course with a few of its solitary follicles prominent and infarcted ; mesenteric
POST
MORTEM
NOTES
FEVER
ENTERIC
THE
DURING
ON
WHICH
LATE
CASES
OF
OCCURRED
EPIDEMIC
AT
BAREILLY. By J. R. Passed
Massey, Hospital Apprentice.
During the recent epidemic of enteric fever in the 2/2nd Eegiment at Bareilly 32 cases occurred, out of which 18 proved fatal. Cause.?The apparent cause of the disease (though there may have been other undetected influences at the effect of the climate on the men of the
work)
was
regiment, who being quite young, and coming out to India quite recentto the disease. The regiment arrived ly > in this station from Malta early in March, and rlie disease set in in April. As regards the water supply there is no
prove that the disease was due to any of contamination ; and as to the sanitary condition of the station and barracks reports are favorable. to be one is of the station The supposed healthiest stations in theN. W. P. and Oude. The ages of the victims were 27. between 17 and Symptoms and treatment. The symptoms in the of cases were those usually observed and deevidence to
specific
cause
majority
scribed, but in two cases they were_ very obscure, death ensuing in from twenty-four to thirty-sis hours after admission into the hospital ; post mortem examination only revealed the true nature of the disease. The treatment adopted was chiefly rest, stimulants, generous diet and good nursing, besides palliatives for urgent distressing symptoms. Turpentine oil with yolk of egg and quinine were also resorted to. Morbid Anatomy.?It is to the appearances revealed by post mortem examination that I would particularly invite attention. In every case, save one, the internal lesions observed were chiefly situated hi the ileum, and
glands enlarged, softened and hyperamic; liver enlarged and fatty ; spleen enlarged and engorged ; kidneys both deeply congested. 2. Private II. Wareham, fet. 19, P. M. exam. 6 hours after death.
Body fairly nourished
; rigor mortis well developed. Head.?Brain and membranes vascular, about 2 oz. of sero-sanguinolent. fluid in cavity of arachnoid. Thorax.?Heart soft and flabby, pericardial sac contained about an ounce of clear fluid ; lungs both slightly adherent at apices to chest walls, and congested. Abdomen? Mucous membrane of stomach congested at the pylorus, and extending through the whole of duodenum. The lower two feet of the ileum congested, and presenting two patches of commencing ulceration, one about the size of a rupee and the other an eight anna piece ; solitary glands prominent and enlarged. In the coecum half a dozen small superficial recent ulcers are seen, as well as congestion of its mucous membrane ; mesenteric glands enlarged and hard ; liver congested ; spleen, enlarged and softened from engorgement ;
kidneys congested.
3. Private B. Smyth, tet. 27. P.M. exam. 11| hours after death. Body well nourished but discolored, chiefly at dependent portions ; rigor mortis strong. Head.?Congestion of brain and membranes well marked. Thorax.?Heart healthy ; lungs both engorged, the left especially so, and filled with frothy mucus. Abdomen.?Mucous membrane of stomach and intestinal tract of an unhealthy ashy grey color, twenty-five ulcers in various stages of development and destruction along the course of the small gut (majority in the ileum), some of the ulcerated patches x 1?) ; solitary glands enlarged very extensive and prominent ; localized" deep congestion of mucous membrane of ?mall intestine at irregular intervals. Mucous coat of large intestine throughout uniformly congested, a portion of bowel in the vicinity of ileocoecal valve sphacelated from intense acute destruc-
November 1,
A MIRROR OF HOSPITAL PRACTICE.
1878.]
305
tion; mesenteric glands enlarged and hyperaamic liver normal ; spleen enlarged and darkly congested ; kidneys, both congested. 4. Private P. Westgate, sat 21. P.M. exam. 4 hours after death. Body fairly well nourished ; cadaveric
Abdomen.?Stomach posteriorly congested, duodenum also irregularly congested in patches of about half an inch in extent; mucous membrane of the jejunum likewise injected irregularly. In the ileum Peyerian patches considerably diseased and found in various stages of de-
Head.?Brain and membranes congested ; ventricular fluid tinged pink. Thorax.?Both lungs congested, chiefly the lower lobe of the right lung ; heart healthy. Abdomen.?Stomach healthy, large clusters of ulceration
solitary glands also enlarged and elevated, cending colon presented some large patches of
?
rigidity
parently just supervening.
and
thickening
in the
ileum,
near
struction, in one or two places threatening perforation, ap- and surrounded by an areola of inflammation ; a few-
follicles of the small intestine very much enlarged, and in many instances ulcerated ; Peyer's patches in various stages of ulceration, and in some places almost amounting to perforation; liver enlarged and fatty ; spleen enlarged and congested ; both kidneys deeply congested ; mesenteric glands enlarged and hypersemic. 5. Private J. J. Whiting, set. 19. P. M. exam. 5| hours after death Bodi/ well nourished ; rigor mortis strong. Head.?Considerable effusion on surface of brain, the brain and membranes liyperaamic, about 3* of pink fluid in each lateral ventricle. Heart healthy, about an ounce of clear pinkThorax ish serum in pericardial sac ; lungs, both congested. Abdomen?Stomach, duodenum and jejunum healthy. The tract of the ileum is studded with six ulcers of different sizes and in various stages, a number of small ulcers coalescing are seen at the ileo-coecal valve ; mucous membrane of large gut deeply congested in irregular patches ; solitary glands enlarged and prominent along the course of both small and large intestines ; mesenteric glands enlarged, hardened and hypertemic ; liver healthy; spleen enlarged and softened from engorgement; kidneys con6. Private A. death.
Smith,
rest of the large gut healthy ; softened and enlarged ; liver healthy ;
tion, the
highly
spleen,
nor-
mal in size but congested ; kidneys healthy. 8. Private Q. Wells, sat. 19. P. M exam. 6 hours after
and at the ileo-coecal death.
valve, with extensive destruction of tissue, the solitary
gested.
the ascongesmesenteric glands
set. 22. P. M. exam. 4 hours after
Body poorly strong.
nourished
Head.?-About 2
on
opening cavity
and
pallid
;
rigor
mortis
of sero-sanguinolent fluid escaped of cranium ; brain and membranes
oz.
congested. Thorax.?Heart, about an ounce of clear serum in pericardial sac; right ventricle very pale, thin and flabby, ventricle on the contrary slightly hypertrophied, but pale : lungs both congested, chiefly at bases and posterior margins. Abdomen.?Stomach congested on its posterior wall; duodenum pale and unhealthy looking, with a tendency to softening; jejunum in much the same condition, until near its junction with the ileum, where all the glands are elevated, and stray patches ulcerated. The ileum is diseased throughout its wnole extent, patches of Peyer were extensively ulcerated, in many instances with ragged, elevated edges, surrounded by dark areolae of
there was no perforation ; all the solitary also diseased, much elevated, and several of them ulcerated; the mucous membrane was congested throughout and somewhat softened ; colon much congested, of a dark purple color, dotted all over with prominent yellowish-white solitary glands, there was a great tendency to softening and apparently effusion into the
congestion; glands were
sub-mucous tissue, the rest of the large gut remarkable except that it contained a
presented quantity Body fairly nourished; rigor mortis strong; pupils of clotted blood ; mesenteric glands enlarged and softdilated. ened ; liver healthy ; spleen greatly enlarged, engorged, Head.?Brain and membranes congested, about 3ss of soft and very dark in colour ; kidneys both congested. blood-stained serum in each lateral ventricle. Private D. England, jet. 20. P. M. exam. 7 hours 9. Thorax. ?Heart healthy ; lungs, both pale and anasmic, after death. structurally healthy. Body poorly nourished ; rigor mortis strong; pupils A bdomen.?Stomach healthy, duodenal mucous memdilated. bile stained brane injected in irregular spots, jejunum Head.?Brain and membranes congested. and pallid. In the ileum the solitary glands prominent, | Thorax.?Hearn small and flabby ; lungs both engorged of mucous membrane vascular, patches Peyer consider- at their bases, otherwise quite healthy. ably diseased, enlarged, elevated, softened, and in difAbdomen?Mucous membrane of duodenum and ferent stages of ulceration. At the ileo-coecal valve there stomach of a dark purple color, that of the ileum generally is a patch of thickened ulceration about four inches in inflamed with patches of ulceration along its tract ; coalescence of the 2 or 3 formed by extent, evidently Peyer's patches and solitary follicles enlarged and proulcerated patches of Peyer in this situation ; the ulcera- minent with surrounding liyperannic zones, no ulceration ; the mucous extended tion does not appear to have beyond mucous lining of the large gut highly vascular ; liver membrane of the coat in any instance. The mucous and intensely engorged ; kidspleen healthy; enlarged large gut throughout exhibits much vascularity and neys congested. dark patches of congestion ; solitary glands prominent, 10. Private H. Fisher, rot. 20. P. M. exam. 12 hours but not ulcerated ; mesenteric glands enlarged, hyafter death. perasmic and softened ; liver enlarged, pale, soft, and Body poorly nourished ; rigor mortis well developed fatty ; spleen enlarged and congested; kidneys, both Head.?Dura mater aind other meninges of a dark pink and slightly enlarged congested. color, brain substance firm and hypencmic 7. Private J. Smeaton, ajt. 20. P. M. exam, about five Thorax.?Heart soft. pale, and flabb3r, about 5iv of pale hours after death. serum in pericardial sac. Right lung adherent pink somewhat emaciated ; rigor mortis well markBody at the apex by fine cobweb like^ bands, both posteriorly ed. lungs congested chiefly at bases and posterior margins. Head ?Arachnoid slightly opaque in places ; about an Abdomen.?Stomach, mucous membrane at pylorus ounce of serous fluid escaped on removing the brain ; exhibits a small patch of blood staining, that of duonothing
brain substance hyperasmic Thorax.?Heart normal, about an
of clear fluid in pericardial ; lungs congested, rusty frothy fluid escaping on section, the left adherent to chest wall and diaphragm firmly, and studded at apex with small tubercles (grey granulations), the right contained more tubercular deposit and a small cavity at apex. sac
both
much
ounce
denum and jejunum of a rosy pink color. The mucous membrane of the ileum shows a congested condition, with its solitary follicles enlarged from a pin's head to a split pea, a few of these ulcerated at the lower third. The Peyerian patches show prominence, infarction, softening and coalescence ; higher up in the ileum the
306
THE INDIAN MEDICAL GAZETTE.
patches are nearly in the same condition, but exhibit no coalescence, the patches affected vary from 20 to 24 in number; mucous membrane of large gut generally congested, solitary follicles enlarged and softened ; liver enlarged, pale and fatty ; spleen enlarged ; Malphigian softening ; kidneys bodies prominent, commencing healthy. 11. * Private W. West, se>t. 27; died on the 27 th day of the disease. Post mortem 8| hours after death. Body poorly nourished ; rigor mortis fairly well developed. ffead.?Meninges and brain substance healthy. Thorax.?Heart normal. Both lungs collapsed anteriorly and congested at b;tses and posterior margins, right
to chest wall at apex. Abdomen ?Stomach, duodenum and jejunum of a rosy pink color. The mucous membrane of the ileum congested throughout, no prominence or ulceration of the glandular structures, but at the ileo-coecal valve a few small superficial and recent ulcers are seen evidently coalescing. Innumerable small isolated ulcers with thin and irregular margins and undefined bases, from the size of a shilling downwards, are seen along the whole tract of the large intestine from the ileo-coecal valve to the rectal orifice ; in some places these ulcers threaten perforation. There are no sloughs or thickening of the coats of the gut in the vicinity of these ulcers ; mesenteric glands enlarged, hardened and hypercemic ; liver enlarged and fatty ; spleen enlarged, deeply engorged and presents a few embolic infarctions wedge-shaped, firm, and almost " entirely decolorized : these blocks" vary from the size of a hopse-bean; kidneys both an unshelled almond to
lung adherent
slightly congested Remarks.?In nearly all the cases recorded, there has been congestion of nearly all the organs, and especially the spleen, which organ has been found in every case, except one to be enlarged and congested, weighing from ] 0 to 30 ounces ; next in order have been the lungs and contents of cranium, as also the kidneys; the livers presented nothing remarkable. The lesion in the ileocoecal valve in the last case was most probably a continuation of the disease from the large into the smail gut. Dr. J. F. P. McUonnell, Professor of Pathology at the medical College, Calcutta, used to tell his class students in his lectures that the typhoid lesion may originate in, and be entirely confined to, the large gut, but that more commonly it was an extension of the disease from the small into the large intestine. In the case in question there seemed to be no ulceration in the ileum, except only a few small
superficial recent ulcers in the ileo-coecal valve, whereas in the large gut the ulcers seemed to be of long standing which is evident from their physical appearances, and this leads me to be of opinion that the disease most probably must have originated in the large intestine, and subsequently extended to the small intestine. The lesion in the large gut at first sight appeared to be examination, the shape, margin, dysenteric, but on closer base, &c., indicated the characteristic appearances of the 1 he post mortem lesions in the rest typhoid ulceration. are not detailed here were much the of the cases that same as in those given. interest in connection with the [These notes will be read with remarks recorded in our last issue. There can be no doubt that a very remarkable constitute detailed and cases such as are above well defined description of fever strongly simulating or identical with enteric fever. If this identity is established, it will be necesreceived definitions of enteric sary either to widen the commonly so far as etiology is concerned, or to postulate a very strong and general prevalence of faecal contamination of Indian stations and a very peculiar and striking susceptibility to its influence on the part of young soldiers newly arrived in India?Ed., I. M.G.] * This is the exceptional case. I have forwarded a specimen of the lesion in the large gut to Dr. J. F. P. McConnell, the Curator of the Medical College Museum, Calcutta.
/
[November 1,
1878.
at its lower third, as well as in the majority in the large intestine ; the exceptional case had no very significant lesion in the ileum or any other portion of the small intestine, but the disease was chiefly situated in the large gut. Authors on morbid anatomy do describe cases of enteric fever where the lesion is in this portion of the alimentary canal, whilst the ileum presents but little alteration ; but such cases are rare, and very likely to mislead one as to determining the true nature of the disease. The mesenteric glands were invariably affected. The following are brief notes of the post mortem appearances of some of the cases which terminated fatally. 1. Private J- McMahon, aat. 25. Post mortem examination 5 hours after death. Body fairly well nourished ; rigor mortis strong. Head ?Brain and membranes generally vascular ; ventricular fluid bloody about 3 ij each, otherwise normal. Thorax.?Heart, muscular tissue pale and flabby, cavities contained soft dark clots and dark fluid blood ; lungs both congested, chiefly at their bases and posterior
of
cases
margins.
Abdomen.?Mucous membrane of stomach congested, of the duodenum and jejunum, of a rosy pink color, but of the ileum intensely congested, chiefly at lower end ; twenty-two ulcers were counted of various sizes and in different stages, the majority of the ulcers consisting of Peyerian patches, a few only of the solitary follicles, whilst many of the latter structures were enlarged, looking like peas studding the surface of the ileum and portion of the jejunum ; there was a general thinning of the coats of the small intestines, and in two spots approaching perforation. .Mucous membrane of large
gut congested throughout its course with a few of its solitary follicles prominent and infarcted ; mesenteric
POST
MORTEM
NOTES
FEVER
ENTERIC
THE
DURING
ON
WHICH
LATE
CASES
OF
OCCURRED
EPIDEMIC
AT
BAREILLY. By J. R. Passed
Massey, Hospital Apprentice.
During the recent epidemic of enteric fever in the 2/2nd Eegiment at Bareilly 32 cases occurred, out of which 18 proved fatal. Cause.?The apparent cause of the disease (though there may have been other undetected influences at the effect of the climate on the men of the
work)
was
regiment, who being quite young, and coming out to India quite recentto the disease. The regiment arrived ly > in this station from Malta early in March, and rlie disease set in in April. As regards the water supply there is no
prove that the disease was due to any of contamination ; and as to the sanitary condition of the station and barracks reports are favorable. to be one is of the station The supposed healthiest stations in theN. W. P. and Oude. The ages of the victims were 27. between 17 and Symptoms and treatment. The symptoms in the of cases were those usually observed and deevidence to
specific
cause
majority
scribed, but in two cases they were_ very obscure, death ensuing in from twenty-four to thirty-sis hours after admission into the hospital ; post mortem examination only revealed the true nature of the disease. The treatment adopted was chiefly rest, stimulants, generous diet and good nursing, besides palliatives for urgent distressing symptoms. Turpentine oil with yolk of egg and quinine were also resorted to. Morbid Anatomy.?It is to the appearances revealed by post mortem examination that I would particularly invite attention. In every case, save one, the internal lesions observed were chiefly situated hi the ileum, and
glands enlarged, softened and hyperamic; liver enlarged and fatty ; spleen enlarged and engorged ; kidneys both deeply congested. 2. Private II. Wareham, fet. 19, P. M. exam. 6 hours after death.
Body fairly nourished
; rigor mortis well developed. Head.?Brain and membranes vascular, about 2 oz. of sero-sanguinolent. fluid in cavity of arachnoid. Thorax.?Heart soft and flabby, pericardial sac contained about an ounce of clear fluid ; lungs both slightly adherent at apices to chest walls, and congested. Abdomen? Mucous membrane of stomach congested at the pylorus, and extending through the whole of duodenum. The lower two feet of the ileum congested, and presenting two patches of commencing ulceration, one about the size of a rupee and the other an eight anna piece ; solitary glands prominent and enlarged. In the coecum half a dozen small superficial recent ulcers are seen, as well as congestion of its mucous membrane ; mesenteric glands enlarged and hard ; liver congested ; spleen, enlarged and softened from engorgement ;
kidneys congested.
3. Private B. Smyth, tet. 27. P.M. exam. 11| hours after death. Body well nourished but discolored, chiefly at dependent portions ; rigor mortis strong. Head.?Congestion of brain and membranes well marked. Thorax.?Heart healthy ; lungs both engorged, the left especially so, and filled with frothy mucus. Abdomen.?Mucous membrane of stomach and intestinal tract of an unhealthy ashy grey color, twenty-five ulcers in various stages of development and destruction along the course of the small gut (majority in the ileum), some of the ulcerated patches x 1?) ; solitary glands enlarged very extensive and prominent ; localized" deep congestion of mucous membrane of ?mall intestine at irregular intervals. Mucous coat of large intestine throughout uniformly congested, a portion of bowel in the vicinity of ileocoecal valve sphacelated from intense acute destruc-
November 1,
A MIRROR OF HOSPITAL PRACTICE.
1878.]
305
tion; mesenteric glands enlarged and hyperaamic liver normal ; spleen enlarged and darkly congested ; kidneys, both congested. 4. Private P. Westgate, sat 21. P.M. exam. 4 hours after death. Body fairly well nourished ; cadaveric
Abdomen.?Stomach posteriorly congested, duodenum also irregularly congested in patches of about half an inch in extent; mucous membrane of the jejunum likewise injected irregularly. In the ileum Peyerian patches considerably diseased and found in various stages of de-
Head.?Brain and membranes congested ; ventricular fluid tinged pink. Thorax.?Both lungs congested, chiefly the lower lobe of the right lung ; heart healthy. Abdomen.?Stomach healthy, large clusters of ulceration
solitary glands also enlarged and elevated, cending colon presented some large patches of
?
rigidity
parently just supervening.
and
thickening
in the
ileum,
near
struction, in one or two places threatening perforation, ap- and surrounded by an areola of inflammation ; a few-
follicles of the small intestine very much enlarged, and in many instances ulcerated ; Peyer's patches in various stages of ulceration, and in some places almost amounting to perforation; liver enlarged and fatty ; spleen enlarged and congested ; both kidneys deeply congested ; mesenteric glands enlarged and hypersemic. 5. Private J. J. Whiting, set. 19. P. M. exam. 5| hours after death Bodi/ well nourished ; rigor mortis strong. Head.?Considerable effusion on surface of brain, the brain and membranes liyperaamic, about 3* of pink fluid in each lateral ventricle. Heart healthy, about an ounce of clear pinkThorax ish serum in pericardial sac ; lungs, both congested. Abdomen?Stomach, duodenum and jejunum healthy. The tract of the ileum is studded with six ulcers of different sizes and in various stages, a number of small ulcers coalescing are seen at the ileo-coecal valve ; mucous membrane of large gut deeply congested in irregular patches ; solitary glands enlarged and prominent along the course of both small and large intestines ; mesenteric glands enlarged, hardened and hypertemic ; liver healthy; spleen enlarged and softened from engorgement; kidneys con6. Private A. death.
Smith,
rest of the large gut healthy ; softened and enlarged ; liver healthy ;
tion, the
highly
spleen,
nor-
mal in size but congested ; kidneys healthy. 8. Private Q. Wells, sat. 19. P. M exam. 6 hours after
and at the ileo-coecal death.
valve, with extensive destruction of tissue, the solitary
gested.
the ascongesmesenteric glands
set. 22. P. M. exam. 4 hours after
Body poorly strong.
nourished
Head.?-About 2
on
opening cavity
and
pallid
;
rigor
mortis
of sero-sanguinolent fluid escaped of cranium ; brain and membranes
oz.
congested. Thorax.?Heart, about an ounce of clear serum in pericardial sac; right ventricle very pale, thin and flabby, ventricle on the contrary slightly hypertrophied, but pale : lungs both congested, chiefly at bases and posterior margins. Abdomen.?Stomach congested on its posterior wall; duodenum pale and unhealthy looking, with a tendency to softening; jejunum in much the same condition, until near its junction with the ileum, where all the glands are elevated, and stray patches ulcerated. The ileum is diseased throughout its wnole extent, patches of Peyer were extensively ulcerated, in many instances with ragged, elevated edges, surrounded by dark areolae of
there was no perforation ; all the solitary also diseased, much elevated, and several of them ulcerated; the mucous membrane was congested throughout and somewhat softened ; colon much congested, of a dark purple color, dotted all over with prominent yellowish-white solitary glands, there was a great tendency to softening and apparently effusion into the
congestion; glands were
sub-mucous tissue, the rest of the large gut remarkable except that it contained a
presented quantity Body fairly nourished; rigor mortis strong; pupils of clotted blood ; mesenteric glands enlarged and softdilated. ened ; liver healthy ; spleen greatly enlarged, engorged, Head.?Brain and membranes congested, about 3ss of soft and very dark in colour ; kidneys both congested. blood-stained serum in each lateral ventricle. Private D. England, jet. 20. P. M. exam. 7 hours 9. Thorax. ?Heart healthy ; lungs, both pale and anasmic, after death. structurally healthy. Body poorly nourished ; rigor mortis strong; pupils A bdomen.?Stomach healthy, duodenal mucous memdilated. bile stained brane injected in irregular spots, jejunum Head.?Brain and membranes congested. and pallid. In the ileum the solitary glands prominent, | Thorax.?Hearn small and flabby ; lungs both engorged of mucous membrane vascular, patches Peyer consider- at their bases, otherwise quite healthy. ably diseased, enlarged, elevated, softened, and in difAbdomen?Mucous membrane of duodenum and ferent stages of ulceration. At the ileo-coecal valve there stomach of a dark purple color, that of the ileum generally is a patch of thickened ulceration about four inches in inflamed with patches of ulceration along its tract ; coalescence of the 2 or 3 formed by extent, evidently Peyer's patches and solitary follicles enlarged and proulcerated patches of Peyer in this situation ; the ulcera- minent with surrounding liyperannic zones, no ulceration ; the mucous extended tion does not appear to have beyond mucous lining of the large gut highly vascular ; liver membrane of the coat in any instance. The mucous and intensely engorged ; kidspleen healthy; enlarged large gut throughout exhibits much vascularity and neys congested. dark patches of congestion ; solitary glands prominent, 10. Private H. Fisher, rot. 20. P. M. exam. 12 hours but not ulcerated ; mesenteric glands enlarged, hyafter death. perasmic and softened ; liver enlarged, pale, soft, and Body poorly nourished ; rigor mortis well developed fatty ; spleen enlarged and congested; kidneys, both Head.?Dura mater aind other meninges of a dark pink and slightly enlarged congested. color, brain substance firm and hypencmic 7. Private J. Smeaton, ajt. 20. P. M. exam, about five Thorax.?Heart soft. pale, and flabb3r, about 5iv of pale hours after death. serum in pericardial sac. Right lung adherent pink somewhat emaciated ; rigor mortis well markBody at the apex by fine cobweb like^ bands, both posteriorly ed. lungs congested chiefly at bases and posterior margins. Head ?Arachnoid slightly opaque in places ; about an Abdomen.?Stomach, mucous membrane at pylorus ounce of serous fluid escaped on removing the brain ; exhibits a small patch of blood staining, that of duonothing
brain substance hyperasmic Thorax.?Heart normal, about an
of clear fluid in pericardial ; lungs congested, rusty frothy fluid escaping on section, the left adherent to chest wall and diaphragm firmly, and studded at apex with small tubercles (grey granulations), the right contained more tubercular deposit and a small cavity at apex. sac
both
much
ounce
denum and jejunum of a rosy pink color. The mucous membrane of the ileum shows a congested condition, with its solitary follicles enlarged from a pin's head to a split pea, a few of these ulcerated at the lower third. The Peyerian patches show prominence, infarction, softening and coalescence ; higher up in the ileum the
306
THE INDIAN MEDICAL GAZETTE.
patches are nearly in the same condition, but exhibit no coalescence, the patches affected vary from 20 to 24 in number; mucous membrane of large gut generally congested, solitary follicles enlarged and softened ; liver enlarged, pale and fatty ; spleen enlarged ; Malphigian softening ; kidneys bodies prominent, commencing healthy. 11. * Private W. West, se>t. 27; died on the 27 th day of the disease. Post mortem 8| hours after death. Body poorly nourished ; rigor mortis fairly well developed. ffead.?Meninges and brain substance healthy. Thorax.?Heart normal. Both lungs collapsed anteriorly and congested at b;tses and posterior margins, right
to chest wall at apex. Abdomen ?Stomach, duodenum and jejunum of a rosy pink color. The mucous membrane of the ileum congested throughout, no prominence or ulceration of the glandular structures, but at the ileo-coecal valve a few small superficial and recent ulcers are seen evidently coalescing. Innumerable small isolated ulcers with thin and irregular margins and undefined bases, from the size of a shilling downwards, are seen along the whole tract of the large intestine from the ileo-coecal valve to the rectal orifice ; in some places these ulcers threaten perforation. There are no sloughs or thickening of the coats of the gut in the vicinity of these ulcers ; mesenteric glands enlarged, hardened and hypercemic ; liver enlarged and fatty ; spleen enlarged, deeply engorged and presents a few embolic infarctions wedge-shaped, firm, and almost " entirely decolorized : these blocks" vary from the size of a hopse-bean; kidneys both an unshelled almond to
lung adherent
slightly congested Remarks.?In nearly all the cases recorded, there has been congestion of nearly all the organs, and especially the spleen, which organ has been found in every case, except one to be enlarged and congested, weighing from ] 0 to 30 ounces ; next in order have been the lungs and contents of cranium, as also the kidneys; the livers presented nothing remarkable. The lesion in the ileocoecal valve in the last case was most probably a continuation of the disease from the large into the smail gut. Dr. J. F. P. McUonnell, Professor of Pathology at the medical College, Calcutta, used to tell his class students in his lectures that the typhoid lesion may originate in, and be entirely confined to, the large gut, but that more commonly it was an extension of the disease from the small into the large intestine. In the case in question there seemed to be no ulceration in the ileum, except only a few small
superficial recent ulcers in the ileo-coecal valve, whereas in the large gut the ulcers seemed to be of long standing which is evident from their physical appearances, and this leads me to be of opinion that the disease most probably must have originated in the large intestine, and subsequently extended to the small intestine. The lesion in the large gut at first sight appeared to be examination, the shape, margin, dysenteric, but on closer base, &c., indicated the characteristic appearances of the 1 he post mortem lesions in the rest typhoid ulceration. are not detailed here were much the of the cases that same as in those given. interest in connection with the [These notes will be read with remarks recorded in our last issue. There can be no doubt that a very remarkable constitute detailed and cases such as are above well defined description of fever strongly simulating or identical with enteric fever. If this identity is established, it will be necesreceived definitions of enteric sary either to widen the commonly so far as etiology is concerned, or to postulate a very strong and general prevalence of faecal contamination of Indian stations and a very peculiar and striking susceptibility to its influence on the part of young soldiers newly arrived in India?Ed., I. M.G.] * This is the exceptional case. I have forwarded a specimen of the lesion in the large gut to Dr. J. F. P. McConnell, the Curator of the Medical College Museum, Calcutta.
/
[November 1,
1878.
