i4o6 THE ENTEROIDEA GROUP OF TROPICAL FEVERS 



C. Parenteric due to germs of genus Enter oides Castellani and 

 Chalmers. Cases of parenteric seem occasionally to be caused under 

 certain circumstances by such germs, which as a rule are not patho- 

 genic faecal bacteria. The following germs have been found capable 

 at times of becoming pathogenic: B. entericus Castellani: B. khartou- 

 mensis Chalmers and MacDonald ; B. par entericus Castellani. 



D. Parenteric due to germs of genus Lankoides Castellani and 

 Chalmers. These seem to be rare, though a few cases have been 

 recorded due to B. ceylonensis A Castellani and B. ceylonensis B 

 Castellani. 



E. Parenteric due to germs of genus Balkanella Castellani and 

 Chalmers and genus Wesenbergus Castellani and Chalmers. These 

 cases appear to be very rare, the germs of this group apparently 

 seldom becoming pathogenic. 



F. Parenteric due to bacteria of genus Escherichia Castellani and 

 Chalmers. Cases of parenteric due to bacteria of this group (so- 

 called coli group) are in our experience very rare. True, germs of 

 this group are comparatively often found in the blood of cases cf 

 fever, and, moreover, are often agglutinated by the blood of the 

 patient, but repeated bacteriological examinations very frequently 

 show that these germs play only the role of secondary or associated 

 infections, and that the cases are often true cases of enteric (typhoid, 

 para A, or para B), the coliform germs having entered the general 

 circulation through the intestinal ulcers. One should also keep in 

 mind the frequent invasion of germs of this group in the pre- agonic 

 period. 



Parenteric due to germs of the tribe Protecs, such as B. cloaccs, B.pyocyaneus, 

 B. pvoteus vulgaris, etc., is rare, these germs generally acting as secondary 

 infective agents. 



Morbid Anatomy. — Very little is known. Intestinal ulcers do 

 not seem to be present. The mesenteric lymph glands may be 

 larger than normal, and the spleen and liver may be enlarged, and 

 the latter organ may show cloudy swelling and fatty degeneration. 

 The heart is flabby, and may be in a condition of fatty degeneration. 



Pathology. — This seems to be somewhat similar to the pathology 

 of enteric. 



Symptomatology. — Parenteric is clinically very similar to enteric, 

 the onset being at times slow, the fever subcontinuous or con- 

 tinuous, ending by lysis. 



At times, however, the onset is sudden, and the fever may have 

 a most irregular course. The duration varies between ten days and 

 several weeks, or occasionally months. The patient in some cases 

 takes the ' typhoid look, ' being apathetic and expressionless ; at other 

 times he does not appear to be very ill. Intestinal symptoms may 

 be present or totally absent, but a certain amount of meteorism is 

 often noticeable. The spleen may be palpable, but this is of much 

 less frequent occurrence than in enteric. Roseola is extremely 

 rare and intestinal haemorrhages practically unknown, the germs of 

 the parenteric group giving rise very seldom to intestinal ulcers. 



