Report on typhoid or enteric fever in relation to British troops in the Madras command / by C. A. Gordon.

  • Gordon, C. A.
Date:
1878
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Licence: Public Domain Mark

Credit: Report on typhoid or enteric fever in relation to British troops in the Madras command / by C. A. Gordon. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    many solitary glands in the csecum and ascending colon ulcerated or contained morbid deposit; large intestine contained a few ounces of blood, mesenteric glands enlarged. In the 1st stage Peyer’s patches are indurated and raised, the mucous membrane over them grey purplish, softened, peritoneum corresponding much infected ; they may be soft or hard. The solitary glands at the lower end of the ileum are often affected, as are Peyer’s patches; they were found diseased in 12 out of 46 cases; their appearance may be that of pustules of small-pox. In the 2nd stage ulceration of Peyer’s patches may begin in two ways; by softening or by sloughing. In the latter case the sloughs are yellowish brown, spongy, infiltrated with bile or with blood. In the 3rd stage these ulcers have their seat in the lower third of the small intestine, their number and size increase towards the ileo-coecal valve. Close to the csecum, ulcers may unite so as to form a mass several inches in length ; their form is elliptical, circular, or irregular. The elliptical ulcers do not form a zone encircling the intestine a.s with the tuber- cular ulcer, but their long diameter corresponds to its longitudinal axis. An elongated ulcer running transversely may result from a union of several small ones. In the 4th stage cicatrization takes place. When perforation takes place the opening is always round; one or two openings of this kind may be seen at the base of an ulcer. The number of diseased Peyer’s patches may vary from two or three to forty; at the upper part of the ileum the transition between the diseased and healthy patches is usually rather abrupt; the diseased process is always further advanced the lower we go; an extensive mass of disease is usually found Peculiar to enteric fever. , ,1 j i* ii -i • ,• i . ,1 at the lower end oi the ileum terminating abruptly at the valve. These appearances, presented by the solitary glands and Peyer’s patches are constant in, and peculiar to, enteric fever. The solitary glands of the colon are enlarged or ulcerated like those of the ileum in one-third the cases that prove fatal. The disease may be confined to the c33cum and ascending colon, or may reach to the sigmoid flexure ; the ulcers are usually round and small; they may be an inch and a half long, and then their diameter is transverse. Other authors observe, however, that in exceptional cases the disease is more extensive in the large intestine than in the small, and a case is recorded in which it was restricted to the large bowel. The lesions of dysentery occasionally co-exist with those of enteric fever. The mesenteric glands are generally enlarged. The spleen is almost t b ailit boid always hypertrophied. Dr. Harley considers that the distinc- yp ub an yp ou. ^ion between the typhous processes and the dysenteric in the large intestine is purely artificial. In a case related the large intestine was the more extensively ulcerated, and the ulcers in both small and large intestine were Cbolc ^ undistinguishable from dysenteric ulcers. A protracted attack of cholera bears a close resemblance to enteric fever, and the intestinal lesions of the two diseases are undistinguishable from each other. There are both mineral and vegetable substances which when intro- Minerai and vegetable dUced into the stomach produce symptoms and morbid changes substances. . . A . «/ 1 o which, if not identical with those of enteric fever, are at least hard to distinguish from them; poisonous mushrooms produce such effects, so do colchicum and cicuta virosa. Lesions of dysentery. There can be little doubt that the usual symptoms and post-mortem appearances , of enteric fever may arise during the progress of several other In several diseases. d ° 1 ° , . n acute diseases, as a consequence oi a general inflammatory condition. According to Dr. Twining eliptical ulcers are always opposite to the attachment of the mesentery, in fatal cases of endemic remittent fever. Dr. Joseph Bell observes that in the epidemics of typhus described by M. Reveille Paresse the . ms o ,inions glands of Peyer were found inflamed. Forget and Cruvellhier found the same conditions constantly present in the epidemic of typhus in 1814. Dr. Bell quotes various other authorities to the same effect; and with reference thereto observes, that in typhus, the same conditions of Peyer’s glands