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Pain over the right iliac region is just the same. Three small spots were noticed over
the chest and abdomen. They were not rose-coloured but rather dusky and faded on pressure.
This crop disappeared on about the 3rd or 4th day.
5th April.—Bowels were not moved yesterday. He was very restless during the day.
6th April.—Bowels moved twice last night. Temperature continued high. Three more
spots were noticed this morning just below the left costal cartilage ; tongue is moist and
quite clean. Digitalis was omitted.
7th April.—Slept well last night; bowels moved four times during 24 hours.
8th April.—Slept well last night; bowels moved three times during day and not at all
at night. Pulse 112. Temperature continues high.
9th April.—Slept well last night. Temperature has gone down to 102°. Pulse 128.
10th April.—Bowels moved four times. Tenderness over the right iliac fossa continues
just the same. Stools are all throughout copious and yellow in colour, consequently the
quantity of urine passed was very small. No albumen in urine.
11th April.—Bowels moved five times during 24 hours. Urine measured 30 ozs. Pulse
118. At 11-30 P.M. he passed motion in bed, and also at 3 A.M. next day.
12th April.—Passed a very restless night. Temperature stood to 103° and 104°. Passed
large clots of blood in bed and fæcal matter. First time distinct gurgling was noticed in
the right iliac fossa. Turpentine and other astringents were ordered with stimulants if
necessary.
13th April.—There were three involuntary motions passed in bed, brown in colour. He
complains of pain in the abdomen. Pulse very weak and frequent.
14th April.—Had three scanty motions containing very little blood. There was low
muttering delirium. Pulse weak and frequent. Ordered acetate of lead mixture.
loth April.—Bowels not moved at all. Passed urine in bed. Temperature at 9 P.M
100 2°, at 11 P.M. 99 6°, from which time he began to sink.
Died at 3 A.M. next morning.
Post-mortem Appearances.
Brain was not examined. Lungs.—Right lung weighed 12 ozs. and was congested
posteriorly. Left lung weighed 10 ozs. and was found congested. Heart weighed 3 ozs.
and its walls were thin and attenuated, valves were normal, and there were clots of blood in
its cavities. Liver was fatty and weighed 3½ lbs. Spleen was normal and weighed 9 ozs.
Kidneys.—Right kidney weighed 6 ozs. and cortical portion was found congested. Left
kidney weighed 5 ozs. and was also congested. Intestines.—Ulceration extended within 2
feet 8 inches of the lower portion of the ileum. Commencing from below upwards where
ileum passes into cæcum there were four large ulcers, about the size of a rupee, just at the
lower end. There was a tendency in two of these ulcers to run into two other ulcers.
The margin of these ulcers was very prominent, and the surface covered with slough, yellow
in colour. The ulceration seemed to extend as far as the muscular coat. Further up there
was a very large ulcer, about the size of a lime. In appearance it resembled the other ulcer,
Half an inch further up there was a very small ulcer. Inch and a half on the top of this
there was a circular ulcer about the size of half a rupee. Two inches further up there were
two small ulcers with reddened surface, and from which it was most likely that hœmorrhage
took place. At a distance of about an inch or half an inch there were three more ulcers,
circular in shape (solitary glands). Proceeding upward we came to an ulcer, oval in shape
(Peyer's patch). Between this oval ulcer and another there were three circular ulcers.
The last Peyer's patch was only prominent and there was no ulceration in it. It was very
prominent, rising above the surface to the extent of about three or four lines. Lastly, there
was one circular ulcer at the end. In all there were 24 ulcers, 15 large and 9 small ones.
No entozoa were found in the intestines.
The specimen has been preserved in spirit.
Remarks.—I must say that it was very difficult to trace the cause of the disease even
after thorough inquiry.
There are two wells in the lines from which drinking water is drawn by the men; one
is for Mochis and the other for the rest. There is nothing to show that the patient had
drunk water from any other source but this well. This is the first case of enteric
fever that has occurred in the Regiment ever since they have come down from the Front in
1881. I am not in a position to say whether typhoid fever is prevalent in the bazar
amongst the people. There is a small river close to the lines where these bázár people and
men in the lines go for bathing purposes, where also clothes are washed. This river
water is also used by the bazar people for drinking purposes, but not by the men in the
lines. This patient used to bathe in the river almost every day, but I do not believe that he