REPORT ON ENTERIC FEVER.
CHAPTER I.
As this report will be submitted to unprofessional readers, it may perhaps be
as well to give a brief description of enteric fever and to explain shortly what
are the current opinions as to its causation.
The following definition of the disease is taken from Dr. Aitken's Science
and Practice of Medicine (7th edition) :—
" A continued specific fever having an incubation period of about two weeks, with an
eruption on the skin of isolated, elevated, rose-coloured spots, chiefly on the abdomen,
appearing generally from the seventh to the fourteenth day, occurring in crops, each spot
continuing visible about three days and vanishing on pressure. Languor and feebleness are
prominent from the first, attended "by headache, abdominal pains and (early) by spontaneous
diarrhoea; but absolute prostration does not come on till late, the patient rarely taking to
bed before the seventh or tenth day. "With the advance of the disease the diarrhœa
increases, the discharges being for the most part liquid, copious, of bright yellow colour, devoid
of mucus, occasionally containing altered blood. In, reaction the discharges are alkaline, and
contain a large proportion of soluble salts with some albumen. The fever may terminate
favourably by a gradual resolution to health during the fourth week. The average duration
of the illness is about twenty-three days. Death in the majority of fatal cases occurs
towards the end of the third week. There are special symptoms sometimes associated with
the characteristic lesion of this fever, namely,—fulness, resonance and tenderness of the
abdomen; more or less tympanites, with gurgling in the iliac fossœ; and increased splenic
dullness. The specific lesions are enlargement of the spleen and the mesenteric glands
with enlargement, ulceration and sloughing of the glands of Peyer and the minute solitary
glands of the small, and sometimes also of the large, intestine.—Aitken."
One theory which is accepted by many medical men at home, on the
Continent, and in America, is that enteric fever belongs to what Lieber-
meister calls "the Miasmatic Contagious Diseases", and that it is caused by
a living particle or low organism which possesses specific characters and which
never originates spontaneously, but only from some preceding case of enteric
fever; and that without the introduction into the body of such specific living
particle, or low organism, enteric fever cannot result.
Much diversity of opinion exists as to the exact nature of morbific conta-
gia, as will be seen by the following extracts from Dr. Aitken's work:—
" With regard to the acute specific diseases there are two pathological theories to be
noticed, each of which has been the subject of much contention, namely,—the theory of a
' Contagium Yivum ; and the ' Germ Theory'—two theories so closely associated in the minds of
many persons that they sometimes seem to be regarded as identical. In reality they have
no necessary connection with each other. The expression ' Contagium Vivum'. is meant to
designate the doctrine that when a contagious disease is communicated by the atmosphere,
by personal intercourse, or in any other way, that conveyance takes place by specifically
endowed organisms, which stand in a similar relation to the disease to that in which the seed
does to the plant. For just as the seed is at once the origin and offspring of the plant,
so according to this view the. morbific contagium produces the disease and is in time pro-
duced by it. This being understood, it is evident that the term contagium vivum relates
exclusively to specific diseases and therefore mostly belongs to medicine. On the other hand,
the germ theory teaches that certain organised and living particles, of extreme if not ultra
microscopical minuteness, which are always suspended in the atmosphere are in such sense
the causes of the suppuration and other destructive changes which interfere with the healing
of a wound ; and that (1) if these organisms are excluded, the wound must enter.at once on the
processes of reparation ; and (2) that if these organisms are present, it cannot so heal ; and
consequently that the whole secret of the successful treatment of wounds consists in the
expulsion of that finest form of atmospheric dust which, whatever be the size of its par-
ticles, has been identified as well by physicists such as Professor Tyndall and by mycologists
such as Nageli with the contaminating agents in question. Hence the germ theory, as it
relates to the inflammatory and other consequences of injuries, involves questions which
almost exclusively belong to Surgery, the object of surgical treatment being to defend the
patient against the septic germ.—Burdon Sanderson."
B 357—1