TYPHOID FEVER IN JOUNPORE JAIL. By James
Civil
Cleghokn, M.D.,
(Concluded from page
Surgeon, Jounpore. 30 J
Case No. III.?Mussummut Pattia, Brahmini, aged 20 years, admitted into Hawalat on 29th May. She attended court on 29th May, and sixteen days in June, the last day being the
was
26th, when she wag sentenced. She was a strumous, sickly looking woman, and bad an eruption of acne on her face. Soon after her admission as a prisoner, she suffered from diarrhoea, and on 11th July she became attacked with ague, from which she recovered on 17th July. She was re-admitted into hospital on 25th July, suffering from fever. Diarrhoea supervened, and became profuse and persistent, continuing so, with occasional interruptions, till death; the motions were pea-soupy in colour and consistence, and were occasionally passed iu bed. She became delirious at night, and quite deaf at the end of the first week. Ten days before her death she suffered from bronchial catarrh. The abdomen did not become swollen, and there was no pain in the right iliac fossa. Her expression from the first wore the listless and care worn look so characteristic of typhoid. Careful examination was made daily, both in this and the previous cases, for a specific eruption, but none was discovered.
The following is
Temperature
a
record of her daily temperature
13
12
a
w
:?
in Case No. 3.
s
a 1 f4
a
p4
a : w
a
h
a
h
a
h
a'
h
a'
w
a* !
w
101 100
M.
100-6
100-7
101*3
101-5
101-2
100-3
102-4
103 2
100 8
101-8
1027
102-1
E.
103-5
102-7
103-5
102*9
102 5
103-3
104-2
104*8
102*7
102*6
103*7
104*2
Temperature
in Case No.
3?(Continued.)
103*4
103
103*6
A post-mortem examination was made on the evening of the of her death. The body was somewhat emaciated. Breasts flat with chest. No rigor mortis present. No specific eruption on the body. There was a layer of fat, three quarters of an inch thick, in abdominal wall. In the four feet of ileum, next
day
August.
the ileo-ccccal valve, seven Peyer's patches were found in a To prevent repetition, I may more or less ulcerated condition. state now that all the ulcers were situated on the surface of
101 103 102
the gut, opposite the attachment of the mesentery, and that their long diameter, with the exception to be noted, corresponded to the longitudinal axis of the gut. The first patch was one foot from the ileo-ccccal valve ; it was
101 100
67 M.
E.
101
103-1
102'2
100-4
100-5
100'8
104-6
104-3
very clearly defined, of an oval form, and measured one inch in its long diameter. Its lower half was ulcerated; the edges of the ulcer were irregular, and its surface had the appearance of wash leather. The upper half of the patch was of a purple colour, and the individual vesicles were engorged and prominent. The .surrounding mucous membrane was of a slate-gray colour.
Three inches higher up the bowel
was an
oval shaped ulcer,
March 1,
1872.]
NOTES ON THE NATIVE ARMY OF INDIA.?BY R. IT. STEVENS.
measuring three quarters of an inch in its long diameter, and placed across the gut. Its edges were well defined, and its base formed of peritoneum. There was no congestion of surrounding vessels. The third patch was three inches above "the latter, it was well defined, and in its lower portion was a circular ulcer, half an inch in diameter, with irregular edges. The upper portion of the patch was swollen and congested. The fourth was five inches higher up; it was well marked and congested, with prominent gland vesicles, the apex of which In the centre of the patch was a deep was of a light colour. circular ulcer, the size of a split pea. Five inches higher was an oval ulcer, measuring three quarters of an inch in its long diameter; its edges were well defined, and its surface had
a
wash leather appearance.
higher was a well-defined, regularly-shaped oval ulcer, measuring three quarters of an inch in its long diameter ; its surface had a pitted appearance. In the centre of the seventh patch was a deep circular shaped ulcer, rather larger than a pea. The vesicles of the patch were swollen and prominent. The remaining Peyers' patches were beautifully defined, each of the vesicles being prominent, and of a pale colour. There was little or no congestion of the mucous membrane Four inches
of the small intestine. The mucous membrane of the ileo-ccecal
valve, and a portion of ileum and colon adjoining were thickened, of a dark slate colour, and the surface had a velvety appearance. The mucous membi-ane of the sigmoid flexure was thickened and congested, and in parts ulceration appeared about to commence.
The mesenteric glands were enlarged, the spleen was norThe liver weighed three pounds; its texture was hard
mal.
and anccmic. These are not, I suspect, the first eases of typhoid fever I have met with in my Indian practice. The above cases show that the eruption cannot be relied on in diagnosis; and from the difficulty of obtaining exact information from native patients, and the frequency of febrile and bowel complaints in this country, I think that the only means of forming a correct diagnosis of typhoid fever during life, is by the use of the thermometer.
When death
occurs
the post-mortem appear-
sufficiently indicative of the disease. The peculiar lock of typhoid patients and the feeling of exhaustion are highly characteristic, and when these present themselves, early, in a case of fever or diarrhoea, the thermometer ought to be employed. ances
are
I cannot trace any connection in the occurrence of these cases, and the dry-earth system of conservancy. The gnmlahs containing the faeces and dry earth are removed from the latrines, and conveyed outside the jail immediately after the visit of the prisoners, and the gumlahs are, when necessary, removed during the day. In Case No. 1, the disease appeared while he was in attendance at kutcherry, and No. Ill suffered from diarrhoea immediately
morning
after sentence. "Was this diarrhoea typhoid? No serious case of fever or diarrhoea had been admitted into hospital for months previous to the appearance of the three cases recorded. There must be considerable doubt in the mind of the reader to the true character of the fever in No. II. If typhoid, he no doubt contracted it while in attendance on No. I.
as
Deaths in the Province of Oudh.?The death-rate for October 1871 was,?per 1,000?cholera 0"32, small-pox 004, fevers 137, bowel complaints 0 05, injuries 004, all other There were 70 deaths from suicide causes 0 08; total 1*90. (37 males and 33 females); 30 from wounds (L7 males and from accident 13 females); 268 (131 males and 137 females); from snake-bite and wild animals (30 males and 68 females).
Population, 11,223,746.
55
Civil
Cleghokn, M.D.,
(Concluded from page
Surgeon, Jounpore. 30 J
Case No. III.?Mussummut Pattia, Brahmini, aged 20 years, admitted into Hawalat on 29th May. She attended court on 29th May, and sixteen days in June, the last day being the
was
26th, when she wag sentenced. She was a strumous, sickly looking woman, and bad an eruption of acne on her face. Soon after her admission as a prisoner, she suffered from diarrhoea, and on 11th July she became attacked with ague, from which she recovered on 17th July. She was re-admitted into hospital on 25th July, suffering from fever. Diarrhoea supervened, and became profuse and persistent, continuing so, with occasional interruptions, till death; the motions were pea-soupy in colour and consistence, and were occasionally passed iu bed. She became delirious at night, and quite deaf at the end of the first week. Ten days before her death she suffered from bronchial catarrh. The abdomen did not become swollen, and there was no pain in the right iliac fossa. Her expression from the first wore the listless and care worn look so characteristic of typhoid. Careful examination was made daily, both in this and the previous cases, for a specific eruption, but none was discovered.
The following is
Temperature
a
record of her daily temperature
13
12
a
w
:?
in Case No. 3.
s
a 1 f4
a
p4
a : w
a
h
a
h
a
h
a'
h
a'
w
a* !
w
101 100
M.
100-6
100-7
101*3
101-5
101-2
100-3
102-4
103 2
100 8
101-8
1027
102-1
E.
103-5
102-7
103-5
102*9
102 5
103-3
104-2
104*8
102*7
102*6
103*7
104*2
Temperature
in Case No.
3?(Continued.)
103*4
103
103*6
A post-mortem examination was made on the evening of the of her death. The body was somewhat emaciated. Breasts flat with chest. No rigor mortis present. No specific eruption on the body. There was a layer of fat, three quarters of an inch thick, in abdominal wall. In the four feet of ileum, next
day
August.
the ileo-ccccal valve, seven Peyer's patches were found in a To prevent repetition, I may more or less ulcerated condition. state now that all the ulcers were situated on the surface of
101 103 102
the gut, opposite the attachment of the mesentery, and that their long diameter, with the exception to be noted, corresponded to the longitudinal axis of the gut. The first patch was one foot from the ileo-ccccal valve ; it was
101 100
67 M.
E.
101
103-1
102'2
100-4
100-5
100'8
104-6
104-3
very clearly defined, of an oval form, and measured one inch in its long diameter. Its lower half was ulcerated; the edges of the ulcer were irregular, and its surface had the appearance of wash leather. The upper half of the patch was of a purple colour, and the individual vesicles were engorged and prominent. The .surrounding mucous membrane was of a slate-gray colour.
Three inches higher up the bowel
was an
oval shaped ulcer,
March 1,
1872.]
NOTES ON THE NATIVE ARMY OF INDIA.?BY R. IT. STEVENS.
measuring three quarters of an inch in its long diameter, and placed across the gut. Its edges were well defined, and its base formed of peritoneum. There was no congestion of surrounding vessels. The third patch was three inches above "the latter, it was well defined, and in its lower portion was a circular ulcer, half an inch in diameter, with irregular edges. The upper portion of the patch was swollen and congested. The fourth was five inches higher up; it was well marked and congested, with prominent gland vesicles, the apex of which In the centre of the patch was a deep was of a light colour. circular ulcer, the size of a split pea. Five inches higher was an oval ulcer, measuring three quarters of an inch in its long diameter; its edges were well defined, and its surface had
a
wash leather appearance.
higher was a well-defined, regularly-shaped oval ulcer, measuring three quarters of an inch in its long diameter ; its surface had a pitted appearance. In the centre of the seventh patch was a deep circular shaped ulcer, rather larger than a pea. The vesicles of the patch were swollen and prominent. The remaining Peyers' patches were beautifully defined, each of the vesicles being prominent, and of a pale colour. There was little or no congestion of the mucous membrane Four inches
of the small intestine. The mucous membrane of the ileo-ccecal
valve, and a portion of ileum and colon adjoining were thickened, of a dark slate colour, and the surface had a velvety appearance. The mucous membi-ane of the sigmoid flexure was thickened and congested, and in parts ulceration appeared about to commence.
The mesenteric glands were enlarged, the spleen was norThe liver weighed three pounds; its texture was hard
mal.
and anccmic. These are not, I suspect, the first eases of typhoid fever I have met with in my Indian practice. The above cases show that the eruption cannot be relied on in diagnosis; and from the difficulty of obtaining exact information from native patients, and the frequency of febrile and bowel complaints in this country, I think that the only means of forming a correct diagnosis of typhoid fever during life, is by the use of the thermometer.
When death
occurs
the post-mortem appear-
sufficiently indicative of the disease. The peculiar lock of typhoid patients and the feeling of exhaustion are highly characteristic, and when these present themselves, early, in a case of fever or diarrhoea, the thermometer ought to be employed. ances
are
I cannot trace any connection in the occurrence of these cases, and the dry-earth system of conservancy. The gnmlahs containing the faeces and dry earth are removed from the latrines, and conveyed outside the jail immediately after the visit of the prisoners, and the gumlahs are, when necessary, removed during the day. In Case No. 1, the disease appeared while he was in attendance at kutcherry, and No. Ill suffered from diarrhoea immediately
morning
after sentence. "Was this diarrhoea typhoid? No serious case of fever or diarrhoea had been admitted into hospital for months previous to the appearance of the three cases recorded. There must be considerable doubt in the mind of the reader to the true character of the fever in No. II. If typhoid, he no doubt contracted it while in attendance on No. I.
as
Deaths in the Province of Oudh.?The death-rate for October 1871 was,?per 1,000?cholera 0"32, small-pox 004, fevers 137, bowel complaints 0 05, injuries 004, all other There were 70 deaths from suicide causes 0 08; total 1*90. (37 males and 33 females); 30 from wounds (L7 males and from accident 13 females); 268 (131 males and 137 females); from snake-bite and wild animals (30 males and 68 females).
Population, 11,223,746.
55
