148
The ileum presented a dark semi-gangrenous appearance, the colour
deepening as it approached the termination of the small intestine.
Throughout the whole of the tract softening, infiltration and
ulceration of Peyer's patches and solitary glands were found.
The liver weighed 31bs. 10 ozs. and presented on its upper surface
marks of 4 or 5 cicatrisations, the organ was much enlarged.
Both the kidneys were healthy and weighed 9 ozs. The spleen was
enlarged and the capsule presented on its surface a circular
thickened patch, about ¾ths of an inch in diameter: its weight
11 ozs. The lungs were highly congested, the pleural cavity
was partially filled up with serous fluid and presented the ap-
pearance of splenization. The bronchial glands were enlarged
and infiltrated. The weight of both the lungs was 1 lb. 12 ozs.
There was 4 ozs. of serous fluid in the cavity of the pericardium.
On opening the heart in the left ventricle a decolorized clot
was found, in other respects the organ was healthy.
E. SEXTON, Civil Surgeon,
Poona."
Other cases among natives which were diagnosed to be enteric fever have
been forwarded to me by Surgeon Major Sexton at Poona, Surgeon Thompson,
Staff Surgeon at Mhow, and Surgeon Dalai at Karachi. In the latter case
Deputy Surgeon General Pinkerton and Surgeon Major MacRury, Deputy Sani-
tary Commissioner, Sind District, concurred in the correctness of the diagnosis.
I do not print these cases as the patients recovered, and there was therefore
no opportunity of verifying the diagnosis by a post-mortem examination.
I find the following notice of a fatal case in the Jail Hospital, Ratnágiri, by
Surgeon McCalman, who is now Civil Surgeon there. He says :—
" A case of undoubted enteric fever was admitted into this jail hospital on the 4th
December 1880, and ended fatally on the 8th January 1881 from perforation of the bowel
and general peritonitis.
" The diary of Dhondya Goynah, male, aged 36, was afterwards sent to the Surgeon
General's Office (it cannot be traced in it.—T. G. H.), and the diseased portion of the intestine
retained as a pathological specimen. At the post-mortem the ileum was found gangrenous at
its junction with the colon. The base of an ulcer, about the size of a shilling, had sloughed
out. Perforation of another smaller ulcer had also taken place. There have been patches of
recent inflammation in the lower part of the small bowel, whilst its coats generally were very
much thinner and showed atrophy of grandular structure. The mesenteric glands were
diseased. The real nature of the patient's illness was not at first recognised, as the symptoms
for the first period resembled those of malarial fever of a severe type.
I was unable to find any satisfactory explanation of its origin."
The following answers to a circular which was very kindly sent at my request
to all medical officers in the Civil Department by order of the Surgeon General
with the Government of Bombay will be read with interest. I give them in
extenso as showing that enteric fever is met with in different parts of the
Presidency among natives. Cases have also in former years been reported in
Native Kegirnents at Nasirabad and at Neemuch, and the valuable remarks by
Dr. Clark, published in my report on Nasirabad, go far to show that enteric fever
is endemic there : —
" No. 26 Of 1882.
FROM
THE MEDICAL OFFICER IN CHARGE JAIL HOSPITAL,
DHA'KWA'K.
To
THE SECRETARY TO THE SURGEON GENERAL
WITH THE GOVERNMENT OP BOMBAY.
Dhárwár, 20th September 1S82
SIr,
In reply to your Circular No. 4587 of the 31st August 1882, I have the honour to inform
you that I have not observed any case of undoubted enteric fever among the native popula-
tion within the last 10 years.