a dliiiHOi! o| iosptat fpctiq. OF INDIA* TYPHOID FEVER IN A NATIVE Camb., &c., d.p.h., Hendley, Harold BY Surgeon-Captain
Dliarmsala.
Cases of enteric fever in Natives
ot
inaia
in which
post-mortem examinations have undoubtedly proved the character of the disease are sufficiently rare to justifj^ me in troubling f.hft Oonaress with notes on a single case which Read at the Indian Medical Congress, December
1894.
108
?
INDIAN MEDICAL GAZETTE.
ifc has been my fortune to have under my care during the last few days. Tidhu, a Chamar, became an inmate of the Dharmsala Jail on the 28th November 1894. He was looking seedy and out of sorts and was at once by my order admitted to Hospital. His temperature was only just above normal, his tongue covered with a whitish fur, and he suffered from constipation. Castor oil was given. From this and until the 6th day the patient was treated for remittent fever. Chart of temperature is affixed. On that day the bowels were again constipated and pill hydrarg. followed by mag. sulph. was given. On the 8tli day he passed three motions, which Hospital Assistant Mahomed Jan (to whom I am principally indebted for thfese notes) saw and thought had the appearance of typhoid stools. From this onwards the stools were disinfected, and rice, the only solid food he was taking, was discontinued. The 10th day he passed two motions and his tongue was covered with a creamy white fur with the exception of the tip and edges. The 11th day the patient became much worse, unconscious and delirious; marked gurgling was elicited in the right iliac No spots characteristic of enteric fever fossa. could be made out on the surface of the abdomen and chest. The lips and gums were covered with sordes, the pulse weak and rapid, the breathing rather shallow, and the stools thin and whitish in appearance. The 13th day the pulse had improved, the general condition was more promising, but towards evening the temperature rose to 104?. The 14th day the patient was much weaker and passed urine unconsciously. The 15th day the pulse had slightly improved his condition, otherThe 16th day bowels not wise unchanged. was steadier. The 17th day but moved, pulse a large motion during the night and seempassed ed better. Towards the evening his pulse became irregular and unequal, and he appeared to be sinking. The 18th day he died at 6 a.m. I made the post-mortem examination on the same day with the following result:?Body emaciated; no marks of injury on the surface; recent abrasions are present in the skin over the sacrum. Rigor mortis in all the limbs. Pericardium, slightly adherent to chest wall in front, contains one ounce of serious fluid. Heart, cavities empty; wall of right ventricle much thinned, but muscalar tissue fairly firm. Lungs contain large quantity of blood; tissue
thick!j7
normal. Liver,
congested, weight 44
oz.
and
congested; tissue very Spleen enlarged dark in colour. 15 oz., very weight off easily, somewhat Kidneys, capsule peels congested. Mesenteric glands enlarged generally and in-
friable,
flamed. Small intestine contains a quantity of partially digested food in the upper portion and lower
[March
1895.
down fluid fseces. In the last 4 feet the mucous membrane is congested in patches and scattered here and there from this to the ileo-coecal valve are well-marked ulcers, with their long axes parallel with the length of the intestine, and situated on the sites of Peyer's patches and solitary glands. They vary in size from that of a pea to 2 inches in length and | inch in breadth. In appearance the ulcers are as if gnawed, from the surface of the mucous membrane and from the muscular wall beneath, ancl in a few the periThe mucous toneal covering alone remains. membrane bordering the ulcers is somewhat undermined. Near the ileo-ccecal valve the ulcers become more numerous and confluent. Large intestine contains a large amount of semi-fluid feces. The first foot presents a number of hemorrhagic infarcts with small rounded sloughs about the size of dill seeds in their centres.
The brain is markedly injected, but otherwise normal. Portions of the intestines with the ulcers described have been forwarded with this paper for the inspection of members of the Congress. At first the case certainly seemed to be one of malarial fever and was returned as such, but from the 9th day suspicions of its character were aroused and the post-ynortem examination placed It should be stated, that the this beyond doubt. to have come from a diswas known prisoner tinctly malarious part of the district lying near the Beas. At present it is not known whether other cases of a similar nature have occurred, but enquiries are being made. < r
Dliarmsala.
Cases of enteric fever in Natives
ot
inaia
in which
post-mortem examinations have undoubtedly proved the character of the disease are sufficiently rare to justifj^ me in troubling f.hft Oonaress with notes on a single case which Read at the Indian Medical Congress, December
1894.
108
?
INDIAN MEDICAL GAZETTE.
ifc has been my fortune to have under my care during the last few days. Tidhu, a Chamar, became an inmate of the Dharmsala Jail on the 28th November 1894. He was looking seedy and out of sorts and was at once by my order admitted to Hospital. His temperature was only just above normal, his tongue covered with a whitish fur, and he suffered from constipation. Castor oil was given. From this and until the 6th day the patient was treated for remittent fever. Chart of temperature is affixed. On that day the bowels were again constipated and pill hydrarg. followed by mag. sulph. was given. On the 8tli day he passed three motions, which Hospital Assistant Mahomed Jan (to whom I am principally indebted for thfese notes) saw and thought had the appearance of typhoid stools. From this onwards the stools were disinfected, and rice, the only solid food he was taking, was discontinued. The 10th day he passed two motions and his tongue was covered with a creamy white fur with the exception of the tip and edges. The 11th day the patient became much worse, unconscious and delirious; marked gurgling was elicited in the right iliac No spots characteristic of enteric fever fossa. could be made out on the surface of the abdomen and chest. The lips and gums were covered with sordes, the pulse weak and rapid, the breathing rather shallow, and the stools thin and whitish in appearance. The 13th day the pulse had improved, the general condition was more promising, but towards evening the temperature rose to 104?. The 14th day the patient was much weaker and passed urine unconsciously. The 15th day the pulse had slightly improved his condition, otherThe 16th day bowels not wise unchanged. was steadier. The 17th day but moved, pulse a large motion during the night and seempassed ed better. Towards the evening his pulse became irregular and unequal, and he appeared to be sinking. The 18th day he died at 6 a.m. I made the post-mortem examination on the same day with the following result:?Body emaciated; no marks of injury on the surface; recent abrasions are present in the skin over the sacrum. Rigor mortis in all the limbs. Pericardium, slightly adherent to chest wall in front, contains one ounce of serious fluid. Heart, cavities empty; wall of right ventricle much thinned, but muscalar tissue fairly firm. Lungs contain large quantity of blood; tissue
thick!j7
normal. Liver,
congested, weight 44
oz.
and
congested; tissue very Spleen enlarged dark in colour. 15 oz., very weight off easily, somewhat Kidneys, capsule peels congested. Mesenteric glands enlarged generally and in-
friable,
flamed. Small intestine contains a quantity of partially digested food in the upper portion and lower
[March
1895.
down fluid fseces. In the last 4 feet the mucous membrane is congested in patches and scattered here and there from this to the ileo-coecal valve are well-marked ulcers, with their long axes parallel with the length of the intestine, and situated on the sites of Peyer's patches and solitary glands. They vary in size from that of a pea to 2 inches in length and | inch in breadth. In appearance the ulcers are as if gnawed, from the surface of the mucous membrane and from the muscular wall beneath, ancl in a few the periThe mucous toneal covering alone remains. membrane bordering the ulcers is somewhat undermined. Near the ileo-ccecal valve the ulcers become more numerous and confluent. Large intestine contains a large amount of semi-fluid feces. The first foot presents a number of hemorrhagic infarcts with small rounded sloughs about the size of dill seeds in their centres.
The brain is markedly injected, but otherwise normal. Portions of the intestines with the ulcers described have been forwarded with this paper for the inspection of members of the Congress. At first the case certainly seemed to be one of malarial fever and was returned as such, but from the 9th day suspicions of its character were aroused and the post-ynortem examination placed It should be stated, that the this beyond doubt. to have come from a diswas known prisoner tinctly malarious part of the district lying near the Beas. At present it is not known whether other cases of a similar nature have occurred, but enquiries are being made. < r
