T H E DU]3LI JOUI I AL OF

MED [ C A L S C I E N C E .

O C T O B E R 1, 1902.

P A R T I.

O R I G I N A L C O M M U N I C A T I O N S .

ART. XII.---Case of Continued Fever resembling Enteric due to Bacillus Enteritidis el Ggirtner2 By JA~IEs CRAIG, ~ . D . Univ. Dubl. ; Fellow and Registrar Royal College of Physicians of I re land; Physician to the 5[eath Hospital and County Dublin Infirmary.

THE subject of this communication was a man, L. G., aged twenty-two years, unmarried, and manager of a boot shop in Francis-street, Dublin. He lodged in a small house, adjacent to the South Circular-road, where his younger brother and he slept together. He was strictly temperate iu his habits, and spent his leisure time in writing political articles for a Wexford newspaper. About the middle of September, 1901, he felt out of sorts and went to his parents' home, 8 miles from the town of Wexford, in order to have a holiday and rest. On Tuesday, September 24th, while in the country, he got several attacks of shivering and felt more unwell than previously. During the next few days he vomited several times and passed liquid motions, from two to four times a day, but felt no pain anywhere. He was to have returned to his work in Dublin on Monday, September 30th, and accordingly he arrived in town on the Saturday evening before. He d4d not appear at hisAodgings either that evening or on Sunday, but on Monday morning he presented himself at the out-patient depart-

a Read before the Pathological Section of ~he Royal Academy of ~edi- cine in Ireland, on Friday, May 2nd, 1902. [For the discussion on this paper, see page 221.]

YOL. CXIV.~I~O. 370, THIRD SERIES. Q

242 Case of Co~tinued Fever resembling Enteric.

ment of the Meath Hospital, where he was seen by me. He looked dull, apathetic, and was obviously very ill. His temperature was 103"4 ~ pulse 100, respirations 24. I concluded that he was suffering from enteric fever, and had him put to bed at once. On proceeding to further examine him it was seen that the facial muscles, particularly about the lips, were tremulous, that his face was flushed, his tongue coated, but with red, clean edges and tip, and ataxie on being extended. The area of splenic dulness was increased ; the abdomen was flat, and a very profuse eruption of large rose spots showed on the front and back of the trunk, and a few on the extremities. These disappeared on pressure. Patches of taches bleut~tres were visible on the abdomen. His cerebration was slow, and his memory defective, so that I did not worry him with persistent questioning as to his illness, but this much he was sure of that he had been feeling unwell for about 12 days. i had no doubt in my mind that I had to deal with a case of enteric fever and treated him accordingly. During the next 24 hours he had three liquid, yellow-coloured motions, the rash became darker in colour, and the facies more typhus like. His temperature was 104"2 ~ F. on Tuesday morning, and as he had not slept he was ordered trional. On Wednesday he had developed a small crop of herpes on the right side of his mouth, his temperature was 104"6 ~ F., he was lying very low in bed in the dorsal position, his rash was abundant and quite dusky, in fact it looked extremely like that of typhus fever. On that day (Wednesday) a little blood was sent to Professor A. H. White, who tried the Widal reaction on the following day and found clumping with no higher dilution than I in 25. During these days liquid motions were passed, the patient became very weak and restless, picking at the bedclothes and disinclined to take nourishment. Black coffee and hypodermics of strychnin were given, but no alcohol. On Saturday, the sixth day after admission, he became very cross, tried to get out of bed, refused his nourishment, and was delirious at night. The next day (Sunday) he was wildly delirious, had to be kept in bed by means of a sheet fastened over him, and absolutely refused nourishment. I t will be seen from the chart that his temperature from Saturday morning until the following Wednesday was marked by a lower range than before. He passed urine and fmces incontinently and his delirium continued. On Wednesday at 6 30 p.m. his temperature marked 105"4 ~ F., and he died at 1 45 on Thursday morning--the eleventh day after admission and the seventeenth from the date

By DR. J_~.~IES CRAIG. 243

of the rigors. There was no vomiting during the time he was in hospital, nor did he complain of pain or acute tenderness over the abdomen, nor of exceptional thirst. His brother had had no illness.

Sept. Oct., 1901.

a F r o m r i g o r s .

Owing to a resolution passed by an enlightened Managing Com- mittee only a partial post-mortem examination was made. The rash had disappeared. On opening the abdomen I found the spleen moderately enlarged, the small intestines were full of yellowish eoloured, liquid freees; the mucous membrane in the entire length was injected a bright red eolour, no ulceration was present, and there was an absence of any particular involvement of the Peyer's patches--in fact there was acute inflammation.

I sent the intestines and spleen to Professor White, who reported that the typhoid bacillus was not present, but that instead he had cultivated the Bacillus enteritidis from the organs.