iliac fossa; there was slight diarrhoea*. I took an interest in the case, aud used to see the patient twice, sometimes thrice every day with my friend. Her temperature was uniform throughout the second week of her illness; it being 104"5? in the morning aud 105'5? Ft., in the evening. Her pupils were contracted, and she was delirious, hut could give correct answers to some sharp questions. The treatment adopted in this case was ammonia and bark with On the 15th day of her illsoup and brandy. ness her temperature was 105'5? Ft., and the respiration more hurried than usual. We examined her lungs and could detect fine crepitations over the left base. There was tenderness over the liver, but no enlargement; the spleen was slightly enlarged. On the 19tii day of her illness she had ineliena and lost a good deal of blood; her temperature fell from 105? Ft. to 101? Ft., but by judicious administration of food and nourishment, the capillary circulation In course of the day she could be restored. had several bloody stools. Turpeutiue was given internally to stop the haemorrhage, but to no effect. The next day the prescription was altered, and sulphuric acid with gallic acid and ergot succeeded better. The melaena was altogether checked; her temperature from this day never went higher than 103? Ft. in the evening. Her expectoration was rusty, but the cough was not so troublesome. She was most carefully watched by her friends, and a competent nurse from the hospital used to watch her during the night. On the night of the 20th day her crisis commenced ; her body was covered with perspiration; her temperature fell down to 96? Ft.; respiration 24, tranquil ; countenance much brighter than before ; her lungs commenced to get free; the nights were comfortable ; her appetite returned; and she could be pronounced fairly convalescent after the 34th day of her illness. There was no eruption on her body. During the period of her convalescence, she had slight periostitis of the left tibia which for some time retarded the progress of her recovery. 2. Bhogeruthy Thacoor, at. 37, living at 51, Banstolla Street, was placed under my treatment for fever and frontal headache. His temperature in the morning of the third day was 102? F., and during evening 104? F. ; pulse 120, full On and bounding; tongue furred and sticky. the 5th day his evening temperature 105? F., aud on the following morning it was 103? F. From this date up to the lltli day his temperature was uniform, being 103? F. in the morning, and 105? F. in the evening; his nights were disturbed, and lie was always delirious, but could correctly recite solnhes from shastras ;
right
% Dflirvor of Hospital fractia. ENTERIC FEVER IN CALCUTTA. By KAILAS CnUNDRA BOSE, L.M.S. 1. B?, a girl, at. 13, of respectable parentfever in the beginning of age, was taken ill with She was very delicate in her last August. health, and was subject to periodical attacks of fever. The onset of the attack was a slight febrile state of her body with slight frontal headache. She could walk in her room, although feeling tired and vexed on slight exertion. Her friends did not anticipate the seriousness of the On the disease in the first week of her illness. 8th day of the disease alarming symptoms The commenced to make their appearance. temperature went high, the patient became delirious, her face was pale, tongue dry, prostration rapid, she could not move in her bed. My friend, Dr. Tariny Churn Paul, who was the physician to the family, kindly allowed me to examine the patient. The temperature was taken, and it was found to be 105? Ft.; pulse 120, soft and compressible; her respiration was 40 ; but nothing abnormal could be detected in her lungs. There was pain and gurgling over the
* The stools were of light colour and very offensive ; her uriue scanty, high coloured, and slightly albuminous.
16
THE INDIAN MEDICAL GAZETTE.
110
his tongue and teeth were covered with sordes and were quite black; he had pain and distinct gurgling on pressure over the right iliac fossa. On the morning of the 12th day he had obstinate diarrhoea, and the stools were all of ochre colour and very offensive. Aromatic chalk powder and bismuth could only arrest it for a few hours; his pulse, which was hitherto good, commenced to be soft and weak; his temperature still keeping 104"6o F. during evening; his tongue denuded of its epithehis teeth, when brushed with lial layer; common salt, would look clean for that day only ; the next morning they were sure to be covered with sordes. On the 16th day his temwas 104? F. in the morning ; pulse 130, perature soft and compressible; respiration 40; acute bronchitis; great restlessness; tossing his head, and always putting it down from the pillow ; his delirium, which was violent before, now became low and muttering. Bark and ammonia, with brandy and serpentary, were continued. He had a separate bottle of cough mixture, which was at intervals. He had retention of urine, given and the bladder had to be relieved by catheter ; his water was scanty and of deep purple colour. On the 19th day lie had acute parotitis, which prevented him from opening his mouth, his morning and evening temperature being 105? F. On the morning of the 20th day, his friends came running with the report that the patient was very restless and complained of much pain over the abdomen. I went and saw the patient moaning under severe pain over the abdomen; it was found to be tympanitic and tender to the touch ; his body cold and clammy with perspiration ; pulse flickering ; temperature 96? F. ; his eyes half shut; teeth black,, and tongue shortened. On telling him to protrude it, lie would attempt, but could not move it; his breathing laboured ; and, notwithstanding the efforts of his friends to bring him round under hot bottles and stimulants, he died on the same
evening.
In this case there was no rose-coloured spots the abdomen and chest. His spleen was
over
slightly enlarged.
3. Premsook, oet. 13, a Marwaree lad, living in No. 146, Cotton Street, was laid up with lever on the second week of December 1887. He had slight frontal headache, pain over the loins and back, furred tongue, sleeplessness, anorexia, and great prostration from the very I was called in to commencement of the illness. see the fifth on the day of his illness. patient His pulse was 120; temperature 104? F. ; tongue thickly coated ; respiration 32 ; pupils normal ;
bowels constipated
slight cough ; pain on presiliac fossa. Bark and ammonia, with digitalis and chlorate of potash, were prescribed. The next morning his temperature was 105? F. Passed a very bad night; one stool sure over
the
right
;
[April,
1888.
offensive; intense headache; the prescription altered; the patient continued to be in one state for four days. There was no difference in
very was
not
his temperature, it being 103? F. in the morning, and 105? F. in the evening. On the 12th day, I was suddenly called in to see the patient at dead of night. I found the patient delirious, picking at the bed-clothes; pulse weak; temperature 105? F.; three or four stools within the short space of three hours ; tongue dry, and teeth covered with sordes. I took out ammonia from the mixture, and ordered aromatic chalk powder with bismuth after each stool, nitromuriatic acid, with brandy and serpentary, every two hours. The next morning the patient complained of severe colic over the right iliac fossa; on pressing over the part distinct gurgling and hardness could be felt. There were a few rose spots over the abdomen ; the spleen was moderately enlarged and tender oil pressure. From this day up to the 19th date of his illness, the fever continued in one state ; the morning temperature being 103? F., and the evening 105? F. On the 23rd day he had a critical sweatiug ; his extremities were cold ; pulse intermittent; respiration 18 ; but his countenance less anxious, and his tongue not so dry as before. Hot bottles and free use of alcoholic stimulants soon brought round the patient. This is the fifth week of the fever, and the patient, I am happy to be able to say, is progres-
sing
very In this
favourably.
distinct rose-coloured spots were the abdomen ; the pain over the right iliac fossa was so great that constant fomentation and extract of belladonna could give only The pain lasted throughout temporary relief. the second and early part of the third week. The patient has become a little deaf, although no quinine has been used. 4. Dookhia, Brahmin, cet. 36, living in premises No. 147, Cotton Street, came under my treatment on the morning of the 9th day of his fever. His temperature was 104,6? F.; pulse 130, soft and compressible ; respiration 32, sonorous and sibilant; rhonci over the chest and back; abdomen tympanitic, and shrinks under pressure over the right iliac fossa; tongue dry and thickly coated at the centre, but red and clean at the edges. There were few purpuric spots over the abdomen. In the evening of the same day his temperature was 105*5? F. ; lie was very violent during the night, and could not catch a wink of sleep. The next morning his temperature was 103*5? F.; there was improvement in other symptoms; prostration greater than on the previous day; had several stools of sickening odour, thin, of pea soup colour with In the some flaky matter floating on the surface. evening, his temperature was found to be 105*6? F., the night was painful; had several stools passed on the bed-clothes. The next day his seen
on
*1
case
April, 1888.]
THE THERAPEUTICS OF HEADACHE.
temperature was 102?; F., pulse still beating 130; 110 chauge in other respects. The follow-
ing morning I was compelled to give him a little opium to check diarrhoea. His temperature 103? F. in the morniug, and 105? ill the evening; his urine was scanty, of high colour, and slightly albuminous; thirst urgent; tongue dry and glazed ; teeth covered with sordes; diarrhoea slightly checked. The next day I saw him, during
the afternoon his temperature was then found to be 104 8? F. Fresh spots were visible on his abdomen and chest; they were few in number. He did not make any improvement until the evening of tlie 23rd day when a critical perspiration broke out, reducing the tempo rature from 105? F. to 99? F. ; his tongue became moist; his mind clear; could sleep The next morning his during the night. urine more free than was 97? temperature before; the colour of his stool was changed; appetite fair; and wants to take some solid food. In the evening, his temperature was found to be 101? F. On the morning 0f the 28th day of his illness, I left the patient to the care of his friends. My favourite prescription in this case was nitro-muriatic acid with brandy and serpentary. As the patient was ol strict Hindu habits, milk and barley were his only nourishment.
Ill
right
% Dflirvor of Hospital fractia. ENTERIC FEVER IN CALCUTTA. By KAILAS CnUNDRA BOSE, L.M.S. 1. B?, a girl, at. 13, of respectable parentfever in the beginning of age, was taken ill with She was very delicate in her last August. health, and was subject to periodical attacks of fever. The onset of the attack was a slight febrile state of her body with slight frontal headache. She could walk in her room, although feeling tired and vexed on slight exertion. Her friends did not anticipate the seriousness of the On the disease in the first week of her illness. 8th day of the disease alarming symptoms The commenced to make their appearance. temperature went high, the patient became delirious, her face was pale, tongue dry, prostration rapid, she could not move in her bed. My friend, Dr. Tariny Churn Paul, who was the physician to the family, kindly allowed me to examine the patient. The temperature was taken, and it was found to be 105? Ft.; pulse 120, soft and compressible; her respiration was 40 ; but nothing abnormal could be detected in her lungs. There was pain and gurgling over the
* The stools were of light colour and very offensive ; her uriue scanty, high coloured, and slightly albuminous.
16
THE INDIAN MEDICAL GAZETTE.
110
his tongue and teeth were covered with sordes and were quite black; he had pain and distinct gurgling on pressure over the right iliac fossa. On the morning of the 12th day he had obstinate diarrhoea, and the stools were all of ochre colour and very offensive. Aromatic chalk powder and bismuth could only arrest it for a few hours; his pulse, which was hitherto good, commenced to be soft and weak; his temperature still keeping 104"6o F. during evening; his tongue denuded of its epithehis teeth, when brushed with lial layer; common salt, would look clean for that day only ; the next morning they were sure to be covered with sordes. On the 16th day his temwas 104? F. in the morning ; pulse 130, perature soft and compressible; respiration 40; acute bronchitis; great restlessness; tossing his head, and always putting it down from the pillow ; his delirium, which was violent before, now became low and muttering. Bark and ammonia, with brandy and serpentary, were continued. He had a separate bottle of cough mixture, which was at intervals. He had retention of urine, given and the bladder had to be relieved by catheter ; his water was scanty and of deep purple colour. On the 19th day lie had acute parotitis, which prevented him from opening his mouth, his morning and evening temperature being 105? F. On the morning of the 20th day, his friends came running with the report that the patient was very restless and complained of much pain over the abdomen. I went and saw the patient moaning under severe pain over the abdomen; it was found to be tympanitic and tender to the touch ; his body cold and clammy with perspiration ; pulse flickering ; temperature 96? F. ; his eyes half shut; teeth black,, and tongue shortened. On telling him to protrude it, lie would attempt, but could not move it; his breathing laboured ; and, notwithstanding the efforts of his friends to bring him round under hot bottles and stimulants, he died on the same
evening.
In this case there was no rose-coloured spots the abdomen and chest. His spleen was
over
slightly enlarged.
3. Premsook, oet. 13, a Marwaree lad, living in No. 146, Cotton Street, was laid up with lever on the second week of December 1887. He had slight frontal headache, pain over the loins and back, furred tongue, sleeplessness, anorexia, and great prostration from the very I was called in to commencement of the illness. see the fifth on the day of his illness. patient His pulse was 120; temperature 104? F. ; tongue thickly coated ; respiration 32 ; pupils normal ;
bowels constipated
slight cough ; pain on presiliac fossa. Bark and ammonia, with digitalis and chlorate of potash, were prescribed. The next morning his temperature was 105? F. Passed a very bad night; one stool sure over
the
right
;
[April,
1888.
offensive; intense headache; the prescription altered; the patient continued to be in one state for four days. There was no difference in
very was
not
his temperature, it being 103? F. in the morning, and 105? F. in the evening. On the 12th day, I was suddenly called in to see the patient at dead of night. I found the patient delirious, picking at the bed-clothes; pulse weak; temperature 105? F.; three or four stools within the short space of three hours ; tongue dry, and teeth covered with sordes. I took out ammonia from the mixture, and ordered aromatic chalk powder with bismuth after each stool, nitromuriatic acid, with brandy and serpentary, every two hours. The next morning the patient complained of severe colic over the right iliac fossa; on pressing over the part distinct gurgling and hardness could be felt. There were a few rose spots over the abdomen ; the spleen was moderately enlarged and tender oil pressure. From this day up to the 19th date of his illness, the fever continued in one state ; the morning temperature being 103? F., and the evening 105? F. On the 23rd day he had a critical sweatiug ; his extremities were cold ; pulse intermittent; respiration 18 ; but his countenance less anxious, and his tongue not so dry as before. Hot bottles and free use of alcoholic stimulants soon brought round the patient. This is the fifth week of the fever, and the patient, I am happy to be able to say, is progres-
sing
very In this
favourably.
distinct rose-coloured spots were the abdomen ; the pain over the right iliac fossa was so great that constant fomentation and extract of belladonna could give only The pain lasted throughout temporary relief. the second and early part of the third week. The patient has become a little deaf, although no quinine has been used. 4. Dookhia, Brahmin, cet. 36, living in premises No. 147, Cotton Street, came under my treatment on the morning of the 9th day of his fever. His temperature was 104,6? F.; pulse 130, soft and compressible ; respiration 32, sonorous and sibilant; rhonci over the chest and back; abdomen tympanitic, and shrinks under pressure over the right iliac fossa; tongue dry and thickly coated at the centre, but red and clean at the edges. There were few purpuric spots over the abdomen. In the evening of the same day his temperature was 105*5? F. ; lie was very violent during the night, and could not catch a wink of sleep. The next morning his temperature was 103*5? F.; there was improvement in other symptoms; prostration greater than on the previous day; had several stools of sickening odour, thin, of pea soup colour with In the some flaky matter floating on the surface. evening, his temperature was found to be 105*6? F., the night was painful; had several stools passed on the bed-clothes. The next day his seen
on
*1
case
April, 1888.]
THE THERAPEUTICS OF HEADACHE.
temperature was 102?; F., pulse still beating 130; 110 chauge in other respects. The follow-
ing morning I was compelled to give him a little opium to check diarrhoea. His temperature 103? F. in the morniug, and 105? ill the evening; his urine was scanty, of high colour, and slightly albuminous; thirst urgent; tongue dry and glazed ; teeth covered with sordes; diarrhoea slightly checked. The next day I saw him, during
the afternoon his temperature was then found to be 104 8? F. Fresh spots were visible on his abdomen and chest; they were few in number. He did not make any improvement until the evening of tlie 23rd day when a critical perspiration broke out, reducing the tempo rature from 105? F. to 99? F. ; his tongue became moist; his mind clear; could sleep The next morning his during the night. urine more free than was 97? temperature before; the colour of his stool was changed; appetite fair; and wants to take some solid food. In the evening, his temperature was found to be 101? F. On the morning 0f the 28th day of his illness, I left the patient to the care of his friends. My favourite prescription in this case was nitro-muriatic acid with brandy and serpentary. As the patient was ol strict Hindu habits, milk and barley were his only nourishment.
Ill
