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In this fever, however, which is best known as 'remittent', there is great gastric irritation
in many cases with vomiting and complete anorexia. These symptoms are not general in
' enteric'; in fact there is often a craving for food in the latter. Pains in the limbs and body
are frequently met with in 'remittent' and are of a most distressing character, the patient
groaning with pain tumbles about, trying one position after another without relief.
Prostration is common to both diseases ; it is however more marked in 'enteric' and
takes more the appearance of hstlessness than in the case of 'remittent', in which the patient
is usually peevish and restless with rapid and shallow breathing, due very often entirely to
the severity of the fever, especially during the exacerbation. The eyes not unfrequently
are suffused, in other cases they have a jaundiced tinge showing hepatic disturbance. It is
quite possible that from the fact of these two diseases having so many important points in
common, it has happened that cases of 'enteric' fever have been returned as 'remittent'.
I cannot express a definite opinion as to whether there is any connection between infantile
'remittent' fever and 'enteric'. I believe there is, more especially amongst European
children in India.
J. C. H. PEACOCKE, Surgeon, I. M. D.,
Civil Surgeon, in Medical Charge, Jail Hospital,
Shikárpur.
Jail Hospital, Shikárpur,
24th October
1882."
The following extract from the carefully written and instructive review
of the practice of the Jamsetjee Jeejeebhoy Hospital for the year 1882 by
Surgeon-Major Waters, 3rd Physician and Registrar, J. J. Hospital, and Professor
of Pathology, G. M. C., will be read with interest :—
" A certain proportion of the remittent fever cases (it would be difficult to say how
many) presented some characteristics which though in several respects not those either of
remittent or typhoid, yet partook of both with not a little uniformity. To this class
of cases the term typho-remittent has been for some time applied with a fair show of
reason; but I think, with all due respect to those who have given the designation to the
combination of symptoms under notice, that for the present such a term should only be
accepted in its symptomatological significance, for we may be on the eve of recognizing a
febrile affection as distinct in its pathological bearing from the two diseases with which for
the moment it is nosologically allied as these are from one another. It would be equally
unsafe to call it Bombay fever, though, no doubt, it has only been spoken of in this city.
In thermometric range this typho-remittent fever most resembles remittent fever, but in
the duration of the febrile state it corresponds more to typhoid. The cerebral symp-
toms are most akin to those of typhoid, but the peculiar bowel complaint associated with
the grave enteric condition is not a feature of typho-remittent fever. A tympanitic condi-
tion of the abdomen is not infrequently observed in typho-remittent, but the typhoid
rash hardly ever. The presence or absence of a rash however is of little moment as point-
ing towards typhoid or remittent, for the rose-coloured rash is frequently absent in cases
of undoubted typhoid fever as seen in India among Europeans, and I myself have often
noticed a very well pronounced crop of reddish spots on the skin in grave cases of remit-
tent fever. As regards the treatment of the anomalous phase of febrile disease above
sketched, the fact is full of significance that the most liberal use of quinine though
temporarily reducing the temperature (and that not always), has no permanently salutary
effect.
"No case of true enteric fever was treated in the hospital during the year although
the disease was unquestionably found among the European troops stationed at Colába; and
from the reliable testimony I have received from medical practitioners I have no doubt
that the disease also prevailed to a small extent among natives in this city. With regard
to the view, now not a little canvassed, that typhoid fever in India is but a form of paludal
remittent fever, I have to state that I made post-mortem examinations in 15 cases which
had proved fatal from remittent fever, and in no single instance did I find the Peyerian
lesion which is the pathological characteristic of typhoid.
"The last year's experience of the pathological work and registration of this large
hospital incline me to the belief that typhoid fever in Bombay is quite distinct from re-
mittent, but that as compared with the latter it is a very rare disease."
Further investigation is, perhaps, required to confirm Dr. Waters' opinion
that enteric fever only prevails to a small extent among the native population in
Bombay ; at all events the interesting cases published by Dr. Pinkerton of patients
admitted into the European General Hospital show that it is by no means a rare
disease among Europeans.
It so happens that in not one of the cases in 1882 among the European
troops at Colába was the disease contracted in Bombay; but the following cases