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The following are instances of enteric fever among natives. The report of
Surgeon McCalman of an outbreak in the 1st Grenadiers Native Infantry at
Ahmedabad in 1878 is particularly interesting and instructive as pointing to
a source of disease which used to be common in Native Infantry lines. I have
ascertained from the weekly returns in the Surgeon General's office, referred to
by Dr. McCalman, that there were in all five admissions from enteric fever, all of
which took place in the week ending 12th April 1878, two of which proved fatal.
The first death occurred about the end of the second week of the disease, and is
thus noticed :—
"A death has occurred in hospital from enteric fever. Towards the end there was
great oppression from stuffing of the bronchial tubes, coma vigil and retention of urine,
the latter being highly albuminous when drawn off. A post-mortem revealed recent pleuritic
adhesions on both sides with infarction of the bases of the lungs, reddening and tumefaction
of mucous membrane of bronchi (large and small) and sero-sanguinolent infiltration of the
pulmonary tissue ; enormous enlargement and tumefaction of bronchial and mesenteric glands.
Patches of Peyer surrounded by an arterial halo and raised 2 or 3 lines above general sur-
face. In the upper part of the ileum they resembled fleshy growths, oval or circular, with
thickened edges and an umbilicated centre. Towards the cæcum they have a reticulated
or pitted appearance from rupture or ulceration of the follicles ; the ulceration is superficial.
Spleen much enlarged and of a dark livid colour. Pyramidal structure of kidneys much
congested and capsule partly adherent."
In the following week Dr. McCalman made the following remark :—
" There has been one death in hospital from enteric fever. A post-mortem showed much
the same pathological appearances as were observed in the preceding case."
"No. 96 of 1882.
FROM
THe CIVIL SURGEON,
RATNÁGIRI ;
To
THE SECRETARY TO THE SURGEON GENERAL
WITH THE GOVERNMENT OF BOMBAY.
Ratnágiri Civil Hospital, October 1882.
SIr,
With reference to your Circular No. 4587 of ,1882 I have the honour to state that in
the early part of 1878 when in medical charge of the 1st (Grenadiers) Regiment Native
Infantry at Ahmedabad several cases of undoubted enteric fever came under my observa-
tion in the Regimental Hospital.
I have tried to obtain extracts from the weekly reports bearing on these cases to-
gether with the original diaries, but Dr. Dane informs me that all such records were lost
when the Regiment was on field service in Afghanistan. However the weekly returns for
the early months of 1878 are, I presume, obtainable in the Surgeon General's office, and they
contain the remarks which I would now epitomise.
The number of cases among the sepoys was about half a dozen and they were all in
hospital at the same time. The initial symptoms observed were great prostration, muscular
tremor, headache, epistaxis, a very frequent and feeble pulse, and an abnormally high temper-
ature (101—104°) showing a distinct morning fall and evening rise. The temperature chart
in this respect was very pathognomonic. The bowels were loose and the motions a light
orange colour. Gurgling in the right iliac region could always be elicited. The disease was
associated with a low form of broncho-pneumonia which set in towards the second week.
This, together with the extreme weakness, was always the most urgent source of the danger
and it proved fatal in two cases.
The post-mortem appearances, especially in one instance, were particularly character-
istic, showing very extensive ulceration of Peyer's patches, catarrhal inflammation of the
ileuni, very decided splenic congestion, and tumefaction and infarction of the mesenteric
glands.
The cases which ultimately recovered were treated with half drachm doses of turpentine
emulsified with liquor potassse. The good effects of the drug were clear and unmistakeable.
The dry brown tongue rapidly became moist and clean. The diarrhoea was kept in perfect
check ; appetite improved and the skin lost its dry pungency. Deafness as a symptom was
very general, and in one case it persisted till convalescence was nearly completely established