IN INDIAN GAOLS. 931 



prove that the case was anything but what it was supposed to be- 

 namely, enteric fever. A second of the five died with general 

 peritonitis, consequent upon perforation of the intestine of one of 

 ' three small corroding ulcers in ileum, one on ileo-colic valve, one 

 a few inches further back, and a third about a foot from ileo-colic 

 valve.' The mesenteric glands are stated to have shown no signs 

 of disease ; but the man had been ill six weeks ; and this fact, 

 which explains the former one so far as it needs explaining, is at 

 the same time incompatible with the hypothesis of typhus, and ex- 

 plicable upon that of typhoid. Of the third of the five cases 

 (Case 7) it is recorded that he was admitted into the hospital on 

 April 7th ' with continued fever, and all that can be recollected 

 concerning him is that he was much troubled with cough and with 

 pain in the right side.' The man died on June 5th, and the 

 autopsy revealed tubercles crowding the left lung, vomicae in the 

 right, and ulcers with elevated hardened edges in the ileum. This 

 appears to have been a case of tuberculosis. Two of the five fatal 

 cases (Cases 3 and 4) remain to be dealt with. In neither of them 

 was there any intestinal or mesenteric mischief; and neither of 

 them, therefore, could have been ' enteric ' fever. The persistence 

 of typhus spots is about the only post-mortem appearance patho- 

 gnomonic of typhus ; and this is said to have been absent in one of 

 the two cases (Case 3), whilst of the other case (Case 4) we are 

 told it began as 'intermittent fever.' With regard to the three 

 remaining cases of the eight in which there was a favourable ter- 

 mination, it is more difficult to speak positively either way as to 

 typhus or typhoid. But with reference to the value of the rash as 

 a diagnostic mark, in two of these three cases, I must say, con- 

 sidering what we know of the protean variations which typhoid 

 fever may, even in our chilly climate, put on as to the character of 

 the cutaneous eruption accompanying it ^—variations consisting in 

 the development of a ' scarlet rash,' of ' petechiae,' of ' vibices,' of 

 ' sudamina,' in addition to the typical lenticularly raised rose-spots— 

 that it is open to me or to any one else to demur to any one of 

 these cases being positively set down as certainly not enteric. 

 With reference, lastly, to the third of the three cases which sur- 

 vived (Case 8), it is well to mark that the case lasted more than an 



1 See Murchison, 'Treatise on Continued Fevers,' pp. 474, S^PJ »»*! '^^ "^^ 



Lancet,' Dec. 10, 1870. 



30a 



