150
The first one occurred in an elderly Pársi priest He was engaged in a law suit with
another person, and had therefore frequently to go to Baroda and reside there for several
days. The place where he used to put up was in the neighbourhood of open drains and cess-
pits. On his last visit to that place he was attacked with fever of a continued type. About
seven days afterwards his bowels becoming loose and the fever high, he was obliged to
return to Navsári. When I visited him I found the temperature to be very high. The
bowels were said to be opened about six or eight times in twenty-four hours, and the evacua-
tions resembled pea-soup in appearance. There was distinct gurgling and tenderness in the
right iliac region. The pulse was of a spare volume, soft, very frequent. The intellect was
clear and there was no delirium. Some amount of headache, which was said to be very
severe in the beginning, and deafness were present. The spleen was enlarged and felt
several inches below the margin of the false ribs. A distinct and regular rise of temperature
in the evening and the fall to the extent of about a degree in the morning was observed
continuously for about 4 or 5 days after I visited him first, when it became stationary and
remained so for several days. The liver then began to be enlarged and was distinctly felt
beneath the margin of the false ribs. Notwithstanding the administration of suitable re-
medies, the diarrhœa after a slight abatement for about a couple of days, again became
worse. The tenderness which was confined to the right iliac region became more extensive,
and the tongue became dry and very florid at the tip and edges. At about the middle of the
third week there was great prostration with delirium. Sordes collected about the lips and
gums, the abdomen was distended, tender, and tympanitic, the extremities cold, and he died
about twenty-five days after the commencement of his illness. In this case no connection
could be traced with the dejecta of a person who had previously suffered from typhoid fever
but the disease was owing, as above stated, to the inhalation of effluvia from drains and
cesspits. There was no eruption.
The second case occurred in a boy of about 10 years of age. It was very clear not only as
regards the symptoms that were present but also as regards the cause of the disease. It
happened that he accidentally fell in an open cesspit adjoining a house, and involuntarily
swallowed some of its contents. About ten days afterwards he was attacked with severe
frontal headache and fever of a continued type. In a few days the characteristic evening
exacerbation and the slight decrease of temperature in the morning were observed. An
eruption of rose-coloured spots appeared on the chest and abdomen, and afterwards on the
extremities in crops. Diarrhoea of a mild character set in at about the end of the first week.
the stools having the peculiar pea-soup character. Deafness and latterly a good deal of pros-
tration with some amount of delirium were also observed. At about the end of the third
week the symptoms began to subside, and he recovered gradually in the course of about a
fortnight more.
The third one occurred in a Pársi girl, aged about 16 years. When I visited her, which
was about six days after the commencement of her illness, the temperature was high. There
was a regular rise and fall in the evening and morning respectively as was observed in nay
subsequent visits. At the end of the first week she was attacked with diarrhoea with gurg-
ling in the right iliac region. The eruption appeared a couple of days afterwards. It was
composed of rose-coloured spots, but not very copious. She became day by day very weak.
The tongue became dry and furred. There were no sordes about the lips and gums. The
temperature after remaining high for some days began to subside at about the end of the
third week, when distinct remissions were observed. The diarrhœa was checked at about
the end of the second week. The patient gradually recovered. In this case the cause of the
disease could not be satisfactorily ascertained.
With reference to the last para. of the above-mentioned circular I beg to state that there
seems to be some connection between infantile remittent and enteric fevers. In the rainy
season here the people instead of allowing the refuse water which contains urine also to flow
into the cesspits, close them in order to prevent them from being filled up by the rains,
consequently it flows out into the streets. Noxious emanations are thereby given off which
pollute the atmosphere. At this period infantile remittent fever prevails here. It is for the
most part continued, the remissions are not well marked, and takes a long course of about
four or five weeks. There is good deal of prostration, diarrhoea in not a few cases, delirium
and in the later stages partial unconsciousness. An eruption of rose-coloured spots is also
observed in some instances. Deafness is also present in many cases. Very rarely such
cases prove fatal. From their cause, the period of the year when they prevail, their long
duration and symptoms, there is reason to believe that such cases are more of the nature of
enteric than any other fever.
I have no reason to suppose that in cases that have been returned as remittent fever
with or without complications it would have been more accurately ascribed to enteric fever.
I have the honour to be,
Sir,
Your most obedient Servant,
JAMSETJEE BYRAMJEE,
Assistant Surgeon, Victoria Dispensary, Navsári."