94
SKETCH OF THE MEDICAL HISTORY OF THE NATIVE ARMY OF BOMBAY.
Born visible ; in others vomiting and general malaise, but in all cases there was a remarkable
uniformity in some of the symptoms of dengue ; for instance, the eruption was never wholly
absent, nor was the foul, creamy, clammy tongue, with complete loss of taste. Albumen in the
urine, more or less, was invariably present, especially on the subsidence of the eruption ; and
anorexia, frontal headache, and suffused conjunctiva were observed in every case. Every form of
treatment was adopted with pretty much the same results—colchicum
T
and belladonna with chlorate of potass was of decided benefit, but the
eliminative treatment succeeded best in my hands. Unlike other epidemics, the latter cases
of dengue presented a much more severe type than the first-hyperpyrexia and delirium:being
very common and in some instances very alarming. Aconite and conium in these . cases. acted
most favourably. In two or three marked instances of severe pulmonary apoplexy, consequent
on dengue, 8 and 10 drop doses of nitrite of amyl, repeated every two , hours, worked like a
charm ; the pulmonary and systemic capillaries, under its influence, became steadily relaxed
and remained so ; the venous circulation became much freer, so much so as to reduce the
lividity of the countenance; and the heart's action was in consequence considerably reduced,
and the hyperpyrexia proportionately lessened. The internal administration (guttatim) well
diluted, is much more satisfactory than by inhalation—it merely requires proper dilution..
An undoubted case of typhoid fever occurred in a sepoy of the regiment. He had been
ailing for several days from general malaise and a confused head-
Typhoid fever in a ache before he came to hospital. He was admitted and treated. for a
native.
day or two with diaphoretics (sudorifics) and a mild aperient of rhu-
barb and calomel but without benefit ; his countenance looked heavy, dull, and oppressed,
and the fever was continued ; the tongue was of a deep yellowish-brown colour, moist and
somewhat clammy ; pulse 98, and steady; the bowels were irregular—loose one day and consti-
pated the next—and the motions were very fœtid and dark in colour ; the temperature of his
body by the clinical thermometer indicated 103°3 on the 2nd morning of his admission
and about the 8th day after his first feeling ill ; on the 3rd morning the temperature was 104°1
and at night it descended to 103°. On the 4th morning after admission, the thermometer
registered 104°6 and at night it descended to 103 0 3, and after a motion, the bowels being
loose and altered in character, it fell to 103° : the 5th morning the temperature was the
same, but the bowels became more loose and putty-like, or of a light ochre or pea-soup
colour ; the abdomen became hard and tympanitic, flat, and bulged out on each side. No
pain was evinced on pressure, except on a small circumscribed spot over the cœcum with a
considerable amount of gurgling, both audible and perceptible by the hand, as if flatus and
fluid in fermentation existed. On the 8th day the clinical thermometer rose to 105°2., and at
night descended to 103°7, and the patient had slight delirium and a dull semi-comatose ap-
pearance. On the 9th day after admission several spots appeared over
Temperature.
the abdomen and on the inside of the arms, and one on the throat—
small papulœ and with a circumscribed irritable appearance around them. They 'disappeared
for a moment on pressure, but re-appeared on removing the finger: These faded away during
the course of the day and others, four or five, came out on other adjacent parts of the body on
the 10th day. These disappeared on the 12th day, and were succeeded by one or two others on
the 13th day, and on this day several motions were passed, of a dirty pink colour, as if unifor-
-mily mixed with a little bright arterial or red capillary blood, evidently from rupture or
ulceration of the vessels of the highly inflamed, agminated, or solitary glands of the small
intestines. After these motions, the thermometer indicated a reduced temperature of nearly
3°, having descended to 102°8 in the morning and 101°3 in the evening. The tongue at this
period was red, glazed, and dry—redder at the tips and margins— and the pulse weak but
steady at 110°. Wine, strong mutton-broth, &c., were given every two hours. These
symptoms, alternately better and worse, continued until the 11th day after admission, when
the temperature descended to 101°4 in the morning and 100°2 in the afternoon ; the motions
became somewhat healthier in character, the pulse 100 to 104, the tongue and skin became
moister, and everything appeared satisfactory but a wheezing and slight difficulty of breathing
set in. On examination the base of each lung, chiefly at their posterior aspect, were found
to be congested or engorged, as if from gravitation of the blood from the continual recumbent'
position. Dry cupping at different times relieved this symptom, and the patient progressed
satisfactorily, until the 16th day after admission, when diarrhœa, set in and the motions were
ochrey and very offensive, the thermometer (in the axilla) indicated an increase of temperature
t o 0 1 1 0 6°5 , a n d a t n i g h t i t d e s c e n d e d t o 1 0 4°7 . S l i g h t h e m o r r h a g e a g a i n o c c u r r e d f r o m t h e
vessels of the agminated glands (peyers). Ulceration had set in with symptoms of perforation of
the intestines ; hiccup, increased pulse, slight delirium, &c. ; the bowels were now very frequently
moved, the motions were tinged with blood, and were very putrid and offensive ; the tongue
became dry; hard, glazed, and brown, in the centre fiss0ured, and red at the tip and margins,,
and the pulse increased to 140—wiry and hard. The thermometer registered over 106° in the
morning and 1050. 1 in the evening, when he became comatose and died the following . day.