86
Plague simulating, Enteric Fever.
Register No. 469, Sister E, age 45, European, ill since 2nd May, when she had
a rigor at noon whilst at work in the Plague Hospital where she has been doing duty
for nearly 6 weeks. She had to give up her work owing to giddiness, trembling, chil-
liness, headache, repeated vomiting of bilious matter, and prostration. The same
symptoms were repeated on 3rd instant, especially vomiting, so that she could not
retain her food, and she felt sleepless and was very restless and depressed. On the 4th
diarrhœa of a thin, yellowish foetid, watery character came on, and she had six such
motions in the 24 hours with much griping and gurgling. She was slightly delirrous,
had fever, and repeated vomiting, and nausea was constantly present. She was kept
under observation at Mahim Hospital and sent to Parel under suspicion of deve-
loping plague.
On admission on the 5th, her temperature was 104.6° F. ; pulse 144; respiration
36 ; tongue covered with a light yellowish brown fur, moist, tip and edges clean. Skin
hot and clammy. Bad odour from breath and peculiar heavy earthy smell from bed-
clothes when they are turned down. Headache, frontal or vertical in seat, complained of
very much. Patient is drowsy, wants to sleep, but cannot. Heart and lungs normal.
Liver and spleen normal. No eruptions, wounds, or buboes. Bowels moved three times
to-day, thin, yellowish, and very bad smelling. Complete anorexia; vomiting abated
under treatment. Patient looks and feels ill. Eyes not injected, abdomen tympanitic,
and tender, and gurgling detected in various parts not confined to the iliac fossa.
Pulse large, soft, and compressible. Decubitus dorsal. Diaphoretic mixture, stimulants
and quinine prescribed and the patient kept in a separate ward und er observation. On
6th, temperature 104° F., pulse 120, respiration 30 ; slept fairly well with a
sedative draught. Headache less, very prostrate, tongue large, soft, teeth-indented
and covered with dry yellowish-brown fur except at edges, which are red and clean.
Bowels moved three times ; motions as before in appearance. Dorsal decubitus and
sinking down in the bed ; no delirium. Enteric spots looked for, but not seen ; the
same evening temperature 102° F., pulse 130, respiration 30 ; prostrate, and com-
plains of aching lumbar pain and pains in the limbs. On 7th, temperature 99° F.,
pulse 120, respiration 30 ; slept well ; bowels moved six times. Camphorodyne and
intestinal antiseptics given, and diet as in Enteric being continued ; no other change
in her condition noticeable. General appearance of " typhoid state." On 8th, tem-
perature 103° F., pulse 120—132, respiration 24 ; nothing abnormal in chest ;
skin moist ; tongue furred, headache less, slept a little, but had delirium between
sleeping and waking periods. Bowels moved three times during the night
distinctly yellowish and suggestive of enteric motions, very foetid, acid in
reaction ; complete anorexia, and some incoherence present. Fumbling and picking at
bed-clothes.
This evening tenderness is felt at the inner end of Paupart's ligament in the left
groin, and she groans when pressed in the left groin. No buboes felt however in this
groin or elsewhere ; a vesicle has appeared on the right loin. Its contents have been exa-
mined for plague bacilli with negative results, and repeated attempts by skilled Bacteri-
ologists of the German Plague Mission have failed to demonstrate plague bacilli in the
blood of this patient. On 9th, temperature 101.6º F., pulse 144, respiration 36 at
8 a.m., and she is very prostrate. Tongue more furred in the centre ; no headache ; three
motions as before ; liver not enlarged nor tender ; abdomen distended and tender all
over ; eyes not injected ; pupils normal. Face has a heavy apathetic look ; delirium at
times and marked incoherence in speech ; feels tongue heavy ; sighs, groans, sinks
clown in the bed. No typhoid spots. An enlarged hard linear 3' X 2' ring of inflamed
gland tissue felt along both Paupart's ligaments near the inner side of each groin,
slightly above the level of the groin and partly extending over the abdomen.