153
On admission he complained of cough, fever, and pain in the right side; some days
afterwards of diarrhœa, pain in the right iliac fossa, severe fever, cough worse with much
expectoration.
He died on the 12th May 1882, or 34 days after admission.
Notes.
The symptoms observed were continued fever of a remittent type, the evening tempera-
ture being higher than the morning; pain in right iliac region with diarrhoea; edges of
tongue red, centre furred, becoming dry and dark towards death; sordes on teeth and gums ;
lips parched, stupor, incoherence, and low delirium passing on to a comatose condition.
Some pulmonary complications pneumonic in character.
No spots were found on the body although looked for ; there was no hœmorrhage from
the bowels observed.
I find in my remarks for May last that although no spots were found 'the symptoms
were unmistakeable'.
No post-mortem was permitted by the deceased's friends.
II.
2nd Prisoner, No. 779, Hondoo valad Billoo. Caste—Mussalman. Male ; age 36 years-
Entered Jail—3rd January 1882. Occupation in Jail—Gardening. Admitted into Hospital
—8th May 1882.
This man had been but a short time in jail when he was admitted into hospital for
fever, headache, epistaxis, and pains in the limbs; this was in March 1882. He was dis-
charged convalescent on the 26th April 1882.
Re-admitted on the 8th May 1882.
Suffering from fever, diarrhœa, and burning in the stomach. The peculiar fever,
diarrhoea, iliac pain and tenderness, delirium, semi-conscious condition with wasting, pros-
tration, sordes and anorexia were all present in this case as in the former. No spots were
observed though looked for. No hoemorrhage from the bowels was observed.
I find the same remark attached to this case as was made about Dossoo—' the
symptoms were, however, unmistakeable,' although no spots were found. He died on the
22nd May 1882, or 15 days after admission.
No post-mortem was permitted by the deceased's friends.
Remarks.
In these cases there was no evidence to show any communication between the deceased
and the dejecta of any person who had previously suffered from ' enteric fever' ; indeed, so
far as I know, these appear to be isolated cases, no case of enteric having, so far as I am
aware, been previously reported from the jail. It is equally difficult to say whether the
sanitary condition of the jail or the prisoners' occupation had anything to do with inducing
the disease.
The water they drank was the same as that taken by other prisoners, and milk is only
allowed to the sick in hospital.
The question now remains as to whether its appearance was due to malaria or climatic
influences.
We find both cases occurring about the same time, one patient being admitted on the
9th April and the other on the 8th May, no other cases being reported before or after.
This would be strong presumptive proof of the influence of season had the cases been
more numerous; but the number reported being so small, it would be impossible to base a
positive statement on them without some other local corroborative evidence. It is most
unfortunate that autopsies were not possible in these cases.
I have observed a continued form of fever in Sind, which in many of its features and
symptoms resembles ' enteric':—
(a.) There is an evening exacerbation of temperature.
(6.) Diarrhœa, stools light, yellowish coloured and watery.
(c.) Delirium, slight semi-conscious condition.
(d.) Tongue red at edges, white fur in centre, in bad cases becoming brown and dry.
(e.) Pulmonary complications disappearing as the fever subsides, which it generally does
in favourable cases in about ten days.
(f.) There may be even abdominal pain ; but the duration of the attack is as a rule
much shorter, when not fatal, than that of ' enteric'; and convalescence is rapid.
B 357—394