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Spleen seemed quite disorganised, somewhat enlarged ; substance of it quite broken
down and pulpy like a bag of currant jelly ; the glands in the adjoining mesentery not at all
affected.
Kidneys were healthy.
Large Intestine quite healthy and contained neither pus nor blood. The lower portion
of small intestine exhibited several patches of congestion and inflammation, the ileum, about a
foot or 18 inches from the cæcum, showed a few small circular ulcers; these were very small
and shallow and not surrounded in any case by vascularity or congestion, and the bowel near
them contained neither pus nor blood ; one gland in the adjoining mesentery was found some-
what enlarged but no induration or inflammation of 'Peyer's patches was to be found, and
the nearest portion of inflamed or congested gut was at some distance higher up.
Other abdominal organs were healthy.
Head not examined.
This was an obscure case ; it was continued fever ; there were no remissions, for the
slight variations in morning and evening temperature cannot be called so. The bowels were
costive at first, and were so for the first 12 days of his illness.
There was no diarrhœa at any time and when the bowels were moved the motions were,
though fluid, dark and consisted of the beef tea and its fibre altered by gastric juices and
contained neither blood, pus, nor mucus, and were totally different from the yellow slimy stools
of enteric fever.
Moreover, there was no abdominal pain, but very slight tenderness, and that only found
on one occasion when it could be accounted for ; no fullness or tympanitis or gurgling in
abdomen and no maculœ though frequently looked for.
The state of the spleen seems to show that the fever was malarious, and the state of the
lungs would be enough in a debilitated man to account for death ; so I have left the disease
under its original heading Simple Continued Fever, adding Malarious.
(Signed) J. T. SHOrTT, Surgeon Major, A. M. D.,
On consideration disease is altered in books and returns to enteric fever as ulcers in
bowel leave it no longer doubtful.
(Signed) J. T. SHOrTT, Surgeon Major, A. M. D."
The following cases occurred in the North Staffordshire Regiment at Kará
chi, and as the correctness of the diagnosis has since been questioned, the me
dical officer who was in charge of the Regiment at the time was requested to
make any remarks he might wish regarding them. He says :—
" In reply 1 beg to state that all the cases were diagnosed by me as remittent fevers
after a most careful consideration of all the symptoms exhibited during life as well as the
appearances revealed by post mortem examination, and I may add that the Deputy Surgeon
General who saw the cases frequently as well as the other medical officers attached to the
Regiment (the latter being always present at the post mortem examinations) concurred with
me in the same opinion. After carefully perusing all the papers forwarded I still retain
the same opinion that all these cases were remittent and not enteric fevers. The cases of
Private Bagnell and Lamb, 2nd North Staffordshire Regiment, occurred during the time the
Base Hospital was established at Karáchi under the medical charge of Brigade Surgeon
Lithgow. In the latter case the post mortem appearances have not been accurately report-
ed. The man died suddenly from hœmorrhage; the whole of the large intestine (not the
liver) was found studded with innumerable small bleeding ulcers, evidently due to scurvy;
the man never suffered from dysentery while under treatment. It was this case that called
my attention that scurvy was prevailing amongst the men of the 'Regiment which was found
to be correct, and which was afterwards verified on the inspection made by Surgeon General
Fogo.
(Signed.) H. M. MACBETH, Surgeon Major, A. M. D."
I was the Deputy Surgeon General referred to and am intimately acquaint-
ed with the circumstances Dr. Macbeth relates, and although I quite allow that
the lesions found in several of the cases were such as in England would be
considered pathognomonic of enteric fever, yet for the reasons stated by
Dr. Macbeth I concurred with the view held by him and all the other medical
officers. The men of the Regiment were simply saturated with fever, and the
scurvy Dr. Macbeth speaks of was a most ugly complication. If the disease
was true enteric fever it co existed with malarial fever and also with scurvy ; but
although the possibility of its being enteric fever was often discussed at the time,
we believed that it was remittent fever with enteric complications and associated
with scurvy. The officers attending the cases, with the exception of one young
Surgeon, were old and experienced medical men, well conversant with enteric fever
as seen in Europe as well as in India, and I had then and have now no reason to
question the correctness of their diagnosis.
The notes of some of the cases are not perhaps as full as might be desired ;
but the pressure at that time on the medical officers was excessive owing to an
exceptionally full hospital.