spasm and even temporary unconsciousness. Dr. Karliuski soon suspected that he had a form of enteric fever to deal
subsequent observations in his suspicious. Iu
gives
description
a
of the
with,
served the
and all his
confirm him
to
present paper of
course
he
of the
some
fatal cases and of some of those that recovered, and accompanies it with chart temperatures in each. In every case he applied the bacteriolo-
Sftq Jwltmt Jjfti|dtiral teqtti}.
gical
a "
in
communication
Contribution
present
our
the
autopses
of the ileum, and in the microscopical of the intestine and spleen he observed sections the presence of the typhoid bacillus of Eberth.
lower
TYPHOID FEVER. issue headed
with success, and in
which he had the opportunity of making, lie found the characteristic typhoid ulcers in the
JUNE 1890.
There is
test
part
The bacteriological examinations were conKnowledge of Non-typical Typhoid Fever "by Dr. Justyn Kar- ducted on plate cultures and on sterilised linski, Surgeon-Major in the Austrian Army, potatoes. A 10 per cent, beef tea peptone to
our
which should be of interest to Indian medical men. We are indebted to Dr. "Vandyke Carter for the translation of this has added
being
some
paper, to which he remarks. Dr. Karlinski
important
prefatory
stationed
Stolac in
at
with
about
Herzegovina,
care
a
set
form of intes-
investigating recognized officially as gastroenteritis endemica and popularly known as dog disease, which prevails in that district in the tinal catarrh
summer
which subsides with the
and
months,
The
of cold weather.
advent
features of this disease
are
general clinical
described
as
head-
and
used for the
continuing for four a
pulse
to 60.
tongue
coated
six
behind,
abdomen uneasy. and
to
days, accompanied by
of 100 to 110, which gradually declines The conjunctivas become injected, the
occasionally
bowels
Severe
are
costive,
and
occipital headache
delirium
are
also
present.
Defervescence by crisis then ensues and with it smart diarrhoea, the patient becoming very weak and for work for a further unfit remaining
period
of three weeks
or
longer.
Variations
are,
however, extremely frequent, the fever being sometimes rather less pronounced, and lasting only two days or less, though convalescence is still as long delayed ; epistaxes and intestinal hamiorr-
hage
may occur,
also
post
febrile
delirium,
the
on
growth
on
plate
was
potatoes.
It
finally was
tested
observed
that the characteristic growth is not detected until the 9th day of illness at the earliest. Dr. Karlinski further noted that iu nearly 90 of the cases the patient gave a per cent, history He thinks that possibly a of recent ague. prior attack is the cause of a
aguish
or
bacilli
by their
course
104? F.
number
typhoid
higher, unpreceded by rigors,
or
per cent, of sugar added was and by making a
plate cultures,
Dr. Karlinski was enabled to the eliminate many transient putrid bacteria in the stools and to cultivate Eberth's present bacillus iu a pure state. The growth of the
large
tranache, anorexia, constipation, malaise, sient chilliness, a sudden rise of temperature to 103?
with 1
gelatine
non-typical
of
subsequent typhoid, the human orbecoming partially protected as it were ganism by
the earlier infection.
In connection of
non-typical
with this
enteric
important question or typho-malarial
fever,
interesting report on entero-malarial by Dr. J. T. Kinyoun appears iu the Marine Hospital Bureau's Abstract of Sauitary Reports which we give elsewhere, from the Neio
fever,
an
fever
York Medical Journal.
Dr.
Kinyoun
in the
establish he reports examined the blood and of Plasmodium Malaruie, the the presence of examination the also made a to
cases
bacteriological
the presence of Eberth's bacillus. The cases reported are few, but so far as they that the results o-o, Dr. Kinyoun is of opinion
stools
to detect
June
1890.]
TYPHOID FEVER.
firstly, malarial and enteric antagonistic to one another ;
tend to show that, fevers
not
are
that
secondly,
differential
a
diagnosis between impossible ; and
the two diseases is sometimes that there exists
thirdly,
tion which
be
can
In India where exists
mixed form of infec-
diagnosticated by
and
bacteriological
a
means
of
a
microscopical
examination. marked difference of opinion
a
to the amount of
as
prevalence of enteric fevers, these Dr, Karlinski and Dr. Kinyoun
from
the
improved methods and but here in India the old statistical methods which led to so much confudetail,
sion and to
so
applied to fevers and with the same unsatisfactory result. Medical men treating report
the disease believed it to be enteric a
Commission
observations of
came to
can
be sure, first of
all,
what disease
we are
really
dealing with, and in this connection for the purposes of diagnosis we would recommend in all doubtful cases the methods adopted by the two abovementioned observers. Lately a Commission was appointed in India to enquire into the recent epidemics of enteric fever in Lucknow This Commission has issued its
and Meerut.
report which,
from
Very able and
a
statistical point of view, is
interesting production,
but
a
which
(t very little further information than it gives appears possible that the curious fluctuations in prevalence, to a considerable extent, at all
us
events, may be
accounted for
imperfect diagnosis,
and
as
that the increase of
ascribed to remittent and continued fevers during the hot weather should really be credited to enteric
fever, and that of the latter the latter part of the rains mainly remittent and simple continued
during
ascribed
to
that
appointed
of the
prevalence
enquire
to
fever,
and
into
the
of this enteric fever
the conclusion based
statistics
on
alone,
great part of it is not enteric fever, and that there are no causes to be enquired into. This Commission as well have had its might a
sittings
in
Calcutta,
or
for that matter, in
the
India Office at home. We do not say that the Commission is wrong in its conclusions, but we
emphatically means
state
that it is not
by
statistical
appear in this report that the to the prevalence of enteric fever in
such
as
question as Lucknow and
Meerut
will be set at rest,
or
or
in other parts of India that the causes of that
ascertained.
fever will be thus methods of enquiry
pursued
in
But
those and
England
elsewhere at the time of the prevalence of the disease and on the spot, and with the application of the result of all the most recent scientific tests, a func-
prevalence
disease
many conflicting theories with spread of cholera are now in this
to the
regard
cause
suggestive to investigators. Before we enter into the causes of diseases, we must
of
adoption
attention to
fever and its relation to malarial are most
173
tion which
one
nently qualified
of the Commissioners to carry out,
together
was
emi-
with the
cliuical features of the malady, will alone decide
issue, and give any clue to the prevalence of the disease in question. the
causes
of
After the
thorough application of these means the utilizathis is so, but there is nothing tion of the statistical method will be of value. to be found in the report or in the methods of recommend to all Indian We would
fever."
Possibly
investigation adopted by
the Commission to
than accentuate a suspicion, which tained before the Commission was
was
strongly
more
enter-
appointed.
If
we
followed
may be allowed to say so, the a model which seems to be too
adopted relies
on
in India,
in
that it
report has commonly almost wholly
of disease the statistical
method, by itself, is radically wrong, misleadto the scientific advanceing, and not adapted ments of the
place
recent advance has day. "Whatever
in
scientific medicine has resulted
men
treating
in the those en^a^ed O O
and
specially
fever
cases
large
stations of Lucknow
to
adoption, when possible, of the bacteriological, microscopical, and chemical tests and
Meerut,
the
for the elucidation of this important problem which we feel assured will alone yield satis-
statistics to prove that which it is factory to ascertain or prove by statistics.
impossible For the investigation
taken
medical
results and such
and valued
as
will be
by their co-workers in
respected
Europe.
subsequent observations in his suspicious. Iu
gives
description
a
of the
with,
served the
and all his
confirm him
to
present paper of
course
he
of the
some
fatal cases and of some of those that recovered, and accompanies it with chart temperatures in each. In every case he applied the bacteriolo-
Sftq Jwltmt Jjfti|dtiral teqtti}.
gical
a "
in
communication
Contribution
present
our
the
autopses
of the ileum, and in the microscopical of the intestine and spleen he observed sections the presence of the typhoid bacillus of Eberth.
lower
TYPHOID FEVER. issue headed
with success, and in
which he had the opportunity of making, lie found the characteristic typhoid ulcers in the
JUNE 1890.
There is
test
part
The bacteriological examinations were conKnowledge of Non-typical Typhoid Fever "by Dr. Justyn Kar- ducted on plate cultures and on sterilised linski, Surgeon-Major in the Austrian Army, potatoes. A 10 per cent, beef tea peptone to
our
which should be of interest to Indian medical men. We are indebted to Dr. "Vandyke Carter for the translation of this has added
being
some
paper, to which he remarks. Dr. Karlinski
important
prefatory
stationed
Stolac in
at
with
about
Herzegovina,
care
a
set
form of intes-
investigating recognized officially as gastroenteritis endemica and popularly known as dog disease, which prevails in that district in the tinal catarrh
summer
which subsides with the
and
months,
The
of cold weather.
advent
features of this disease
are
general clinical
described
as
head-
and
used for the
continuing for four a
pulse
to 60.
tongue
coated
six
behind,
abdomen uneasy. and
to
days, accompanied by
of 100 to 110, which gradually declines The conjunctivas become injected, the
occasionally
bowels
Severe
are
costive,
and
occipital headache
delirium
are
also
present.
Defervescence by crisis then ensues and with it smart diarrhoea, the patient becoming very weak and for work for a further unfit remaining
period
of three weeks
or
longer.
Variations
are,
however, extremely frequent, the fever being sometimes rather less pronounced, and lasting only two days or less, though convalescence is still as long delayed ; epistaxes and intestinal hamiorr-
hage
may occur,
also
post
febrile
delirium,
the
on
growth
on
plate
was
potatoes.
It
finally was
tested
observed
that the characteristic growth is not detected until the 9th day of illness at the earliest. Dr. Karlinski further noted that iu nearly 90 of the cases the patient gave a per cent, history He thinks that possibly a of recent ague. prior attack is the cause of a
aguish
or
bacilli
by their
course
104? F.
number
typhoid
higher, unpreceded by rigors,
or
per cent, of sugar added was and by making a
plate cultures,
Dr. Karlinski was enabled to the eliminate many transient putrid bacteria in the stools and to cultivate Eberth's present bacillus iu a pure state. The growth of the
large
tranache, anorexia, constipation, malaise, sient chilliness, a sudden rise of temperature to 103?
with 1
gelatine
non-typical
of
subsequent typhoid, the human orbecoming partially protected as it were ganism by
the earlier infection.
In connection of
non-typical
with this
enteric
important question or typho-malarial
fever,
interesting report on entero-malarial by Dr. J. T. Kinyoun appears iu the Marine Hospital Bureau's Abstract of Sauitary Reports which we give elsewhere, from the Neio
fever,
an
fever
York Medical Journal.
Dr.
Kinyoun
in the
establish he reports examined the blood and of Plasmodium Malaruie, the the presence of examination the also made a to
cases
bacteriological
the presence of Eberth's bacillus. The cases reported are few, but so far as they that the results o-o, Dr. Kinyoun is of opinion
stools
to detect
June
1890.]
TYPHOID FEVER.
firstly, malarial and enteric antagonistic to one another ;
tend to show that, fevers
not
are
that
secondly,
differential
a
diagnosis between impossible ; and
the two diseases is sometimes that there exists
thirdly,
tion which
be
can
In India where exists
mixed form of infec-
diagnosticated by
and
bacteriological
a
means
of
a
microscopical
examination. marked difference of opinion
a
to the amount of
as
prevalence of enteric fevers, these Dr, Karlinski and Dr. Kinyoun
from
the
improved methods and but here in India the old statistical methods which led to so much confudetail,
sion and to
so
applied to fevers and with the same unsatisfactory result. Medical men treating report
the disease believed it to be enteric a
Commission
observations of
came to
can
be sure, first of
all,
what disease
we are
really
dealing with, and in this connection for the purposes of diagnosis we would recommend in all doubtful cases the methods adopted by the two abovementioned observers. Lately a Commission was appointed in India to enquire into the recent epidemics of enteric fever in Lucknow This Commission has issued its
and Meerut.
report which,
from
Very able and
a
statistical point of view, is
interesting production,
but
a
which
(t very little further information than it gives appears possible that the curious fluctuations in prevalence, to a considerable extent, at all
us
events, may be
accounted for
imperfect diagnosis,
and
as
that the increase of
ascribed to remittent and continued fevers during the hot weather should really be credited to enteric
fever, and that of the latter the latter part of the rains mainly remittent and simple continued
during
ascribed
to
that
appointed
of the
prevalence
enquire
to
fever,
and
into
the
of this enteric fever
the conclusion based
statistics
on
alone,
great part of it is not enteric fever, and that there are no causes to be enquired into. This Commission as well have had its might a
sittings
in
Calcutta,
or
for that matter, in
the
India Office at home. We do not say that the Commission is wrong in its conclusions, but we
emphatically means
state
that it is not
by
statistical
appear in this report that the to the prevalence of enteric fever in
such
as
question as Lucknow and
Meerut
will be set at rest,
or
or
in other parts of India that the causes of that
ascertained.
fever will be thus methods of enquiry
pursued
in
But
those and
England
elsewhere at the time of the prevalence of the disease and on the spot, and with the application of the result of all the most recent scientific tests, a func-
prevalence
disease
many conflicting theories with spread of cholera are now in this
to the
regard
cause
suggestive to investigators. Before we enter into the causes of diseases, we must
of
adoption
attention to
fever and its relation to malarial are most
173
tion which
one
nently qualified
of the Commissioners to carry out,
together
was
emi-
with the
cliuical features of the malady, will alone decide
issue, and give any clue to the prevalence of the disease in question. the
causes
of
After the
thorough application of these means the utilizathis is so, but there is nothing tion of the statistical method will be of value. to be found in the report or in the methods of recommend to all Indian We would
fever."
Possibly
investigation adopted by
the Commission to
than accentuate a suspicion, which tained before the Commission was
was
strongly
more
enter-
appointed.
If
we
followed
may be allowed to say so, the a model which seems to be too
adopted relies
on
in India,
in
that it
report has commonly almost wholly
of disease the statistical
method, by itself, is radically wrong, misleadto the scientific advanceing, and not adapted ments of the
place
recent advance has day. "Whatever
in
scientific medicine has resulted
men
treating
in the those en^a^ed O O
and
specially
fever
cases
large
stations of Lucknow
to
adoption, when possible, of the bacteriological, microscopical, and chemical tests and
Meerut,
the
for the elucidation of this important problem which we feel assured will alone yield satis-
statistics to prove that which it is factory to ascertain or prove by statistics.
impossible For the investigation
taken
medical
results and such
and valued
as
will be
by their co-workers in
respected
Europe.
