PART IV.

MEDICAL MISCELLANY.

]~eports, Transactions, and Scientific Intelligence.

T R A N S A C T I O N S OF T H E M E D I C A L SOCIETY OF T H E

COLLEGE OF P H Y S I C I A N S .

SESSION ]880-81.

GEORGE JOIt~STO.~, M.D., President.

ALEXANDER •IXON MONTGOMERY, M.K.Q.C.P., Honorary Secretary.

Wednesday, March 2, 1881.

The Vice-President, DR. WALTER G. S)~ITtI, in tile Chair.

A case of Enteric ]:ever, with Complications. By CECIL J. L. BcsnE, M.B., Univ. Dubl. ; Surgeon Army Medical Department.

Tn~ case I have the honour to bring under your notice this evening is one of no small interest, opening up as it does the question as to whether what we call " m a l a r i a " is in any degree transmissible between indivi- duals, and whether a subject previously healthy, and who has never been exposed to the influences, climatic and otherwise, from which the malarious contamination commonly arises, can be so influenced by the presence and contact of other individuals who have been so exposed as to produce a visible effect on his health.

I t is a well-known fact, and one of which I have myself had ample experience, that in malarious districts a peculiar and most characteristic odour may be distinguished at certain times, generally after sunset and during the night, and also very generally associated with a misty fog.

This odour is peculiar to malarial distr icts; and although, in our present state of uncertainty with regard to the exact definition of what we call malaria, I would be unwill ing to state that the smell is that of malaria, yet all who have had long experience jn the treatment of these diseases are aware that a similar odour may be distinguished from the person and in the excreta of such patients, more especially in the sweat, and occasionally in the fmces.

Wi th regard to the latter excretion, gentlemen, I may state, that I am

Transactions of the Medical Societal. 351

myself liable to occasional attacks of malarial fever, which I contracted in Burmah in 1873 ; and that although I have a regular cold~ succeeded by a hot fit, yet I never sweat, the poison in my case being eliminated by the bowels apparently, as I always recover after passing one or two copious evacuations possessing a strongly malarious odour. I t is not more than five or six weeks ago since I had such an attack, following a slight chill.

The case I now lay before you is one of enteric fever, presenting certain symptoms of a typho-malarial character, in addition to its ordinary symptoms. The case is as follows : -

Lance-Corporal Bourne, of the 80th regiment, aged twenty-three years, two years' service, a native of Staffordshire, who states he always enjoyed good health, and who has never been abroad in his life, and since enlist- ment only served at the depSt of his regiment and at the Curragh Camp, previous to coming to Dublin, was admitted into hospital from the Royal Barracks on the 20th December, 1880, complaining of continual rigors, vertigo, and sickness of stomach. His face was dusky and flushed, eyes suffused, skin dry and hot, great nervous irritability, and subsultus tendinum. Temperatur% 104"8 ~ F. ; pulse, 110. Marked bronchophony over posterior aspect of right lung ; tongue dry and glazed ; complained much of thirst ; severe frontal headache ; also pain in occipital and lumbar regions. He vomited several times before admission, and frequently for the next two or three days. The boweis were very loose~ and the stools were watery and of a yellow ochrey appearance.

Evening visit.--Temperature~ 105 ~ F. The case went on, with very high temperature, with continued rigors

and gradual consolidation of right lung and posterior and inferior portion of left, up to the night of the 23rd December; the tongue during this time presenting the pathognomonic appearance of enteric fever, being red and beefy at the sides, pointed~ very foul in the centre ; the bowels loose ; f~eces fluid and of 'a yellow ochrey appearance. Delirium at night ; great subsultus tendinum, insomnia, muttering to himself~ and all the appearance of intense poisoning of the nervous centres. On that day both lungs being much engorged, his chest was enveloped in a succession of jacket poultices~ and he was treated with half-drachm doses of spts. terebinthin~% suspended in white of egg, every fourth hour. His evening temperature, on that date, was 102"3~ He was delirious all night, and attempting to get out of bed; towards morning he passed a great quantity of urine (amount not measured) densely loaded with lithates.

On the morning of the 24th there was complete defervescenc~ of the feve ; temperature normal; pulse, 84; skin acting freely; respiration restored in front and posteriorly down to the superior margin of seventh rib. He had taken altogether about four drachms of turpentine. The temperature from this date gradually crept up with the regular rise and

352 Transactions of the Medical Society.

fall of enteric fever, till tile period of convalescence set i n - - t h e symptoms being those of an ordinary case of enteric fever; but the stranges~ feature in the case is, that during the period of convalescence the patient has been liable to frequent remlssions, with tile regular rigors, succeeded by the hot stage and sweating of true malarial fever, for which I found it necessary to treat him with quinine.

Now it will doubtless strike many here that the early high tempera- tm'e was tile result of the pneumonia with which the disease was complicated, and that the rapid resolution was followed by a corresI)ondiug fall of temI)erature. In reply to such a natural remark~ I mllst refer you to what Professor Aitken says, in page 608, Vol. I., of his 7th E d i t i o n - - namely, " A case after tlle first day whose temperature has been normal once in the first week, is not a case of enteric fever." Yet here the temperature fell to normal on the fourth day; and, during my experience of typho-malarial fevers in South Afriea~ 1 have frequently seen temperatures fall from 105 ~ F.~ and higher, to below normal in a few hours without the administration of quinine.

By a curious coincidence I am now able to lay before you the temperature chart of another soldier, at present suffering from enteric fever at the Royal Infirmary, who did serve previously in South Africa~ and who has a malarious taint, in which you will remark precisely the same early rise and fall of temperature without having had the puhnonary complication.

i must also beg you to allow me to quote from a paper on "Maltese Fever~" in the Arm.y Medical Report for 1866, by Dr. Boileau, now one of the Assistant Professors at Netley : -

Extract from Dr..13oileau's Paper.--" Generally 24 hours ill ; generally quite well ~ yesterday morning ;' frontal headache, vertigo, rigors, vomit- ing~ general pains, eyes suffused, occasionally purging, sometimes pul- monary complication. On 3rd day, often aggravation of symptoms and frequently highest temperature reached. On 4th day, generally amend- ment. On evening of admission, temperature generally over 102 ~ sometimes up to 105 ~ On 3rd day, morning temperature falls generally one degree. On 2nd and 3rd evenings~ highest temperature rarely under 103 ~ F." In the cast under my own observation, the man's regiment had only just returned from the Cape, after ten years' service in I tong-Kong, Straits Settlements, Natal, &c., and it would almost seem as though the malarious poison~ which appears in a certain degree to be reproduced in the system of those tainted on each febrile remission, had been passed on to him~ by contact or otherwise, from his comrades, the greater number of whom are old soldiers of long tropical service. I believe my friend, Surgeon-Major Jackson~ who has made a special study of fevers of a typho-malarial character, has had experience of cases in which a somewhat similar history existed.