72 the INDIAN MEDICAL GAZETTE. [March 2, 1874.

REPORT ON THE RECENT EPIDEMIC OF FEVER IN THE RAWULPINDEE JAIL.

By Surgeon-Major JOHN INCE, m.d., Civil Surgeon, Jtawiilpindee.

(Concluded from page 50.)

3ed Series.

Twelve Reports of Tost-Mortem Examinations of Fever Cases lohich occurred during the Epidemic of 1873 at the Rawul- pindee Jail, by Db. Ince, Civil Surgeon.

Case I?Prisoner Gunputr, aged 25, height 5 ffc. 4 in., taken ill 20th February, died about 2 p.m. 28th February, ill about eight days. Prominent symptoms: frontal headache, furious delirium, succeeded by coma, lasting until death. Post-mortem exami- nation 19 hours after death.

Body.?Fairly nourished ; doubtful petechial spots on front of chest and arms ; considerable "marbling" on dependent parts; rigor mortis slight, and in lower limbs only.

jBrain.?Vessels of dura mater gorged with dark fluid blood ; arachnoid opaque ; serum increased ; pia mater congested ; consistence of brain firm; red points large and numerous.

Ltings.?Right lung bound down by old adhesions to costal pleura ; left free ; no effusion into pleuritic cavity ; hypostatic congestion of both lungs posteriorly, chiefly in lower lobes ; both crepitant throughout; weight, right 19 ozs., left 16 ozs. Heart.?A small decolorised clot in right ventricle ; right

auricle empty ; a small dark and semi-fluid clot in left ventricle ; left auricle empty; muscular texture rather pale; valves

healthy ; weight 7? OZ3. Liver.?Capsule opaque and firmly adherent to diaphragm;

color and section healthy ; weight 41 ozs. Spleen.?Capsule slate color; section dark purple; weight

16 ozs.

Kidneys.?Pale, otherwise apparently healthy ; weight, right 5 ozs., left 6 ozs.

Intestines contained some dark and solid foeeal matter; mesenteric glands rather large; a few scattered patches of

congestion in jejunum and ileum, some of them amounting almost to slight ecchymoses; solitary glands very prominent in lower portion of ileum ; Peyer's patches well marked but not diseased ; color healthy. Blood.?Dark and very fluid.

Case II.?Prisoner Mahiboolla, aged 35, height 5ft. 6 in., taken ill 19th February, died about 2 a. m. Lst March, ill about

10 days. Prominent symptoms : frontal headache, furious deli- rium, succeeded by coma, nearly until death. Post-mortem examination seven hours after death.

Body.?Rather emaciated ; much mottling of dependent portions of skin; rigor mortis marked; no spots or macula;.

Brain.?Pacchionian glands much enlarged ; vessels of dura mater distended; arachnoid opaque; serum milky and more abundant than usual; much hypersemia of pia mater; consis-

tence of brain firm ; red points dark and numerous. Lungs.?Both adherent posteriorly by old and partial ad-

hesions ; considerable hypostatic congestion in both lower

lobes ; both crepitant throughout; weight, right 23 ozs., left

17 ozs. . , .

'

.

jjeart.?A large decolorised clot in left ventricle, extending into aorta ; other cavities empty ; structures apparently healthy ; weight 9 ozs. .

Liver. Lar^e, of usual color, section rather coarse ; weight 61 ozs. ;' gall bladder nearly full of dark bile.

Spleevi.??Capsule slate color; section deep chocolate, coarse ; weight 31 ozs.

Kidneys.?Supra-renal capsules normal; both organs con-

gested ; several cjsts in cortical portion of right, one of them larger than a pea ; weight, right 6j ozs., left 7| ozs.

Intestines.?Slight congestion in several parts of jejunum and ileum; Peyer's patches very distinct, but not diseased; color healthy. Blood.?Dark and fluid.

Case III.?Prisoner Dhoollah,aged 38, height 5 ft. 10 inchgs, taken ill 18th February, died about 9 p. in. 1st March, ill about 11 days. Prominent symptoms : headache, delirium, and stupor. Post-mortem examination 12 hours after death.

Body.?Fairly nourished, no spots; rigor morti3 slightly marked ?

Brain.?Pacchionian glands prominent; vessels of dura mater gorged with rather dark and fluid blood ; arachnoid rather opaque; about one oz. clear serum collected from cavities of the brain; pia mater and choroid plexus much congested ; consistence of brain firm ?, red points dark and numerous; weight 52 ozs. Lungs.?Left adherent throughout by old and firm adhe-

sions ; right also slightly adherent posteriorly; hypostatic congestion of both, especially in lower lobes ; both crepitant throughout; viscid mucus exudes from cut surfaces of both on pressure ; weight, right 33 ozs., left 23 ozs. Heart.?A small partially decolorised clot in right ventricle ;

left ventricle contained small quantity of dark fluid blood ; other cavities empty ; structures generally appear healthy ; weight

ozs.

Liver.?Large and congested ; weight 63 ozs.; gall bladder nearly filled with dark bile. Spleen.?Somewhat enlarged. Kidneys.?Both congested ; weight, right 6 ozs., left 7i ozs. Intestines.?Duodenum much congested, valvulas couniventes

also somewhat hyperamic in parts, as well as portions of the

ileum, otherwise normal throughout.

Case IV.?Prisoner Nawab, aged 35, height 5 ft. 4 in., taken ill 19th February, died about 2 p.m. 2nd March, ill 11 days. Prominent symotoms : frontal headache, low delirium passing into deep stupor. Post-mortem, examination 19 hours after death.

Body.?Fairly nourished ; rigor mortis slight. Brain.?Vessels of dura mater gorged with blood; pacchio-

nian bodies enlarged; the whole surface of arachnoid opaque ; sub-arachnoidal fluid increased in quantity; red points large and numerous ; consistence of brain firm ; weight 48 ozs. Lungs.?Both fairly distended and slightly overlapping heart;

slight hypostatic congestion of both lower lobes posteriorly; both crepitant throughout; weight, right V7\ ozs., left 15 ozs'. Heart.?Pericardial serum somewhat increased; small quan-

tity of dark fluid blood in left ventricle ; other cavities empty ; structures healthy ; weight 9J ozs.

Liver.?Enlarged, weight 55 ozs.; gall bladder nearly full of dark green viscid bile.

Spleen.?Apparently healthy ; weight 16 J- ozs. Kidneys.?Cortical structure of left course; right apparently

healthy ; weight, right 4? ozs., left 5^ ozs. Stomach.?Empty, except some thick and copious mucus;

coats healthy. Intestines.?Brunner's glands prominent, much congestion

of lower part of ileum, and region of ileo-coecal valve, otherwise healthy throughout, and contained considerable quantity of solid foeces.

Blood.?Dark and fluid.

Case V.?Prisoner Meeran, aged 48, height 5ft. 7in., taken ill 22nd February, died about 8 p.m. 4th March, ill about 10 days.- Prominent symptoms : frontal headache, typhomania, passing into deep stupor. Post-mortem examination 13 hours after death.

Body.?Fairly nourished; no eruption ; rigor mortis marked. Brain.?Vessels of dura mater gorged with blood, arachnoid

milky, about 2ozs. clear serum collected from arachnoid and

ventricles; pia mater much congested ; red points rather dark and numerous ; consistence firm; weight 43 ozs. Lungs.?Well distended and overlapping heart ; both free

from adhesions; hypostatic congestion of both posteriorly; both crepitant throughout; considerable frothy mucus exudes from both on pressure of sections; weight, right 22 ozs., left 20J ozs.

Heart.?Right auricle contained dark clot; right ventricle a decolorised clot ; left auricle small decolorised clot ; left ven-

tricle empty; structure generally healthy; weight 8 ozs. Liver.?Color dark brown, section coarse, weight oG ozs. ;

gall bladder nearly full of dark olive and "gritty" bile.

Spleen.?Capsule of slate dolor and shrivelled; section

of chocolate color and coarse; weight G^ ozs.

March 2, 1874.] OFFICIAL PAPE11S.

Kidneys.?Both pale, otherwise healthy ; weight of each 4 oza.; supra-renal capsules healthy. Stomach?Empty, except small quantity of thick opaque

and pale mucus. Intestines.?Thick yellow mucus in jejunum; diminish-

ing in color towards colon, where yellowness re-appeared with solid fceces ; after washing, a few patches of hypersemia Tisible in parts of jejunum and ileum, otherwise healthy throughout; Peyer s patches well marked, but not diseased.

Blood.?llather dark and fluid.

Case VI.?-Kynd Golam, aged 40, height 5ft. 5in., taken ill 27th February, died about 8 p.m. 7th March, ill about eight days. Prominent symptoms : frontal headache, typhomania, rapidly passing into coma. Post-mortem examination 12 hours after death.

Body.?Fairly nourished; much " mottling" of surface, especially back of chest and arms; no maculffi nor petechia;; rigor mortis slight. Brain.?Dura mater closely adherent to the calvarium; its

vessels much congested ; pacchionian bodies enlarged ; arachnoid opaque, about 6 drachms serum ; pia mater very hyperaemic ; choroid plexus slightly so ; consistence firm ; red points dark and numerous ; weight 52f ozs. Lungs : both fairly distended ; old and partial adhesions pos-

teriorly on both, and of right at base to diaphragm ; slight hy- postatic congestion of both posteriorly; both crepitant and buoyant or floating on water throughout; left rather more

congested than right, and frothy mucus exudes on pressing its cut surface ; weight, right 18?ozs., left 18| ozs. Heart.?2 drams clear serous fluid in pericardium ; right

auricle contained dark semi-fluid clot, right ventricle a small decolorised and adherent clot; left cavities ei>pty; muscular texture pale and flabby ; valves healthy ; weight 8jozs. Liver.?Capsule opaque ; peculiar tumor projecting from

upper surface of right lobe which (tumor) weighed 2j ozs., and will be sent for examination to Principal of Calcutta College ; texture of organ soft and granular; color normal; weight 63 ozs.; gall bladder contained small quantity of normal bile.

Spleen.?Capsule corrugated, of light slate color; section

pinkish-brown ; weight 14 ozs. Kidneys.?Apparently healthy, each weighed 5jozs. Stomach contained about 4 ozs. gruel ; coats healthy. Intestines contained some solid yellow fceces; Peyer's

patches well marked in jejunum, less so in ileum ; no ulceration

or other diseased condition of them or any other part of the intestines.

Blood.?Dark and fluid.

Case VII.?Prisoner Gokul, aged 35, height 5ft. 4in., taken ill 4th March, died about 5 p.m. 10th March, ill about six days. Prominent symptoms: frontal headache and stupor followed by coma. Post-mortem examination 15 hours after death.

Body.?Fairly nourished ; no macula;; considerable mottling of dependent portions of skin ; rigor mortis marked.

Brain.?Vessels of dura mater considerably distended ;

arachnoid slightly opaque in upper and posterior portions at base ; sub-arachnoidal fluid about 3 drachms ; each lateral ven- tricle contained about ? drachm clear pale straw-colored serum ; consistence of brain firm ; weight 46? ozs.

Lungs.?Fairly distended, both adherent posteriorly and at bases to diaphragm by old and very tough adhesions ; much hypostatic congestion, but both organs crepitant and buoyant throughout; much frothy mucus exudes from both on pressure of divided surfaces; weight, right 23^ ozs., left 214 ozs.

Heart.?About 2 drachms pericardial fluid ; texture pale and flabby ; cavities empty ; valves healthy ; weight 9J ozs.

Liver.?Healthy in aspect; weight 48 ozs ; gall bladder about half fall of normal bilef

Spleen. Capsule slate color; section purplish; weight 1H ozs. -

Kidneys. Right normal; separate portions of left not so

clearly defined as usual; cortical substance coarse and relatively somewhat increased ; weight, right 5jOzs., left 5i ozs.

Stomach contained about 6 ozs. olive green mucous fluid, a few patches of slight ecchymosis upon an otherwise unusually pale and smooth interior.

Intestines contained solid yellow faeces ; Peyer's patches in- distinct ; considerable arborescence iu lower portion of ileum; otherwise healthy throughout. Blood.?Dark and rather fluid.

Case VIII.?Prisoner Futteh Khan, aged 30, height 5 feet 6 inches, taken ill 1st February, died about 2 a.m. 12th March, ill about 33 days. Prominent symptoms: frontal headache, stupor, cough, and expectoration ; consciousness returned about the 10th day, then complained of burning heat and pain in both feet which became tender, of darker color, and eventually sphacelated; died from debility. Post-mortem examination about 7 hours after death.

Body.?Much emaciated ; skin of both feet black and shrivel- led and partially detached ; about two inches above the malleoli of both legs there was a ring of tolerably healthy granulations, about 2 inches broad, both complete and singularly symmetrical as to size and situation ; all the parts below these rings were dry- ish,forming an eschar; in short, both feet and ankleswere sphace- lated, and gradually undergoing spontaneous amputation ; there

was also a bed sore about three inches in diameter over the

right hip, the trochanter major of which was exposed ; there

were no maculae; rigor mortis well marked. Brain.?Dura mater pale; pacchionian bodies numerous

and prominent; arachnoid slightly opaque throughout; about 4 ozs. of serum collected from cavities of brain ; pia mater pale ; substance of brain firm and pale ; weight 46 ozs.

Lungs.?Right collapsed and firmly adherent by old bands to parietes; left fairly distended and free ; right, on section, found consolidated and of grey color throughout; apex occu-

pied by about 2 ozs. of thinnish yellow pus ; sank in water ;

weight 43 ozs. ; left was pale, crepitant and buoyant throughout, and frothy mucus exuded from its cut surfaces on pressure ; weight 16j ozs.

Heart.?Right cavities much distended with dark coagulse ; left ones also, but in less degree ; texture pale \ valves healthy ; weight. 9? ozs.

Liver.?Apparently healthy ; weight 52? ozs.; gall bladder nearly full of dark thin bile.

Spleen.?Pale and coarse ; weight 10 ozs. Kidneys.?Pale, but apparently healthy; weight, right 5 ozs.,

left 6J ozs.

Stomach.?Empty ; coats pale, but apparently healthy. Intestines.?Pale and somewhat collapsed ; lower part of

ileum and the colon contained solid yellow foeces; Peyer's patches well marked, not. diseased.

Blood.?Pale and rather thin.

Case IX.?Prisoner Mowzam, aged 28, height 5ft. 5in., taken ill 8th March, died about 8 a.m. 14th March, ill about six days. Prominent symptoms: frontal headache, typhomauia followed

by coma. Post-mortem examination 24 hours after death.

Body.?Well nourished ; no maculae ; much mottling of de-

pendent portions of skin, of chest, back of thighs and arms ;

rigor mortis well marked. Brain.?Vessels of dura mater considerably congested ; arach-

noid slightly opaque, about 1 drachm of sub-arachnoidal fluid ;

pia mater much congested, and each lateral ventricle contained

about 1 drachm of clear pale serum; choroid plexus of pinkish color ; consistence of brain firm ; red points large and numer-

ous ; weight 43 ozs. Lungs.?Fairly distended, slight and recent adhesions of

posterior part of middle lobe of right to parietes of chest, left

quite free ; slight hypostatic congestion of both ; both crepi- tant and buoyant throughout; much frothy mucus exudes

from both on pressure of cut surfaces ; weight, right 21j ozs., left 19| ozs. Heart.?A small decolorised clot in right ventricle ; all other

cavities empty ; muscular tissue and valves healthy in appear- ance ; weight 9| ozs. Liver.?Dark colored, but apparently healthy; weight 55 ozs.;

gall bladder about half full of healthy bile. Spleen.?Large and congested; dark purple on section and

coarse ; weight 28? ozs. Kidneys.?Both congested and hypertrophic ; weight, right 6

ozs.. left 7j ozs. Bladder.?Almost empty. Stomach.?Empty ; mucous membrane congested in patches,

otherwise healthy. Intestines contained small quantity of pale solid focces; consi-

derable arborescence of vessels throughout; Peyer's patches clearly marked, particularly in ileum; no ulceration nor other abnormal condition. Blood.?Dark and fluid.

71, THE INDIAN MEDICAL GAZETTE. [March 2, 1874.

Case X.?Prisoner Hussain, aged 38, height 5ft. 4 in., taken ill 5th March, died about 2 p. m. 15th March, ill about 10 days. Prominent symptoms: frontal headache ; delirium and deep stupor. Post-mortem examination 18 hours after death.

Body.?Fairly nourished; numerous purple spots from size of a three penny piece to a shilling on sides of chest and loins ; no

maculaj; rigor mortis slight. Brain.?Vessels of dura mater much congested ; arachnoid

very milky throughout; quantity of sub-arachnoidal fluid in-

creased ; pia mater very hypersemic ; about 2 drachms of clear

serum in each lateral ventricle ; red points dark and numerous; consistence firm ; weight 49 ozs.

Lungs. Both collapsed and bound laterally and parietallv to parietes of chest by firm but apparently recent bands of

lymph; apex and posterior edges of right lobes, all of which were firmly adherent to each other, exceedingly emphysema- tous ; considerable hypostatic congestion of both organs, espe- cially left; both crepitant and buoyant throughout; mucous membrane of both bronchial tubes highly congested, and con- tained much frothy mucous fluid, which oozed out freely on slightest pressure of section of lungs ; weight, right 40f ozs., left 33 ozs.

Heart.?Right auricle empty ; small decolorised clot in right ventricle ; small dark clot in left auricle ; left ventricle empty ; texture pale ; edges of mitral valve slightly nodulated, others healthy ; weight 8^ ozs. Liver.?Color dark ; consistence natural; weight 53 ozs.;

gall bladder nearly full of dark, thick, and coarse or gritty bile. Spleen.?Surface of pinkish color and corrugated ; section pur-

ple. soft, and coarse ; weight ozs.

Kidneys.?Healthy ; weight, right 5 ozs.. left. 5? ozs. Stomach.?Empty; scattered small spots of hyperaemia on

inner surface. Intestines distended, a large quantity of dark colored, solid,

fcecal matter, chiefly in colon; duodenum stained with yellow mucus; Peyer's patches well marked, but not diseased ; much arborescence in scattered spots throughout the intestines, which were otherwise healthy. Blood.?Dark and fluid.

Case XI.?Prisoner Golam Soobani, aged 35, height 5ft. 5in., taken ill 11th February, died about 3 p.m. 18th March, ill about 34 days. Prominent symptoms : frontal headache, delirium and stupor up to 9th day, then fever gradually subsided; had diarrhoea from 8th to 13th Mnrch ; weakness and emaciation continued to increase until two days before death, when deep jaundice set in with some fever. Post-mortem examination 18 hours after death. Body.?Greatly emaciated; skin and conjunctiva) deeply

tinged yellow ; no maculae ; numerous purple spots on sides and back of chest from size of 6 pence to ? a crown; bed sore over

right hip about 3 inches in diameter ; rigor mortis very slight. Brain.?Dura mater of deep yellow color ; arachnoid slightly

opaque at base of cerebrum; about Joz. of sub-arachnoidal fluid ; pacchionian bodies large and numerous ; about 1 drachm clear straw-colored serum in each lateral ventricle; consistence of brain firm ; weight 45 ozs. Lungs.?Fairly distended; color normal, slight, partial, and

recent adhesions of left to parietes ; right free ; some hypostatic congestion, particularly of left; both crepitant and buoyant throughout; free exudation of sanious mucous fluid on pressure of sections, especially of left; weight, right 28? ozs., left

21? ozs.

Heart.?Right auricle filled with dark clot; right ventricle empty ; also left cavities ; valves and other textures apparently healthy ; weight 6f ozs. Liver.?Dark livid color externally, deep olive green on section;

weight 46 ozs. ; gall bladder nearly empty; the small quantity it contained being thin and of the usual color.

Spleen.?Capsule somewhat opaque, in patches ; section of bluish brown color ; weight 16 ozs Kidneys?Large; section coarse; weight, right 5f ozs., left ozs. i

Bladder.?Nearly empty. Stomach contained about 6 ozs. greenish yellow mucous

fluid; coats healthy. Intestines contained small quantity of pale yellow and solid

foeces ; Peyer's patches indistinct; rectum much congested; otherwise healthy throughout.

Blood.?Fluid.

Case XII.?Prisoner Shairzaman, aged 45, height 5ft. 4in., taken ill 12th March, died about 7 a.m. 20th March; ill about ?ight days- Prominent symptoms : frontal headache and stupor;

cough and slight expectoration; no diarrhoea. Post-mortem examination about 24 hours after death. Body.?Fairly nourished ; appears older than 45 ; consider-

able mottling, but no maculae ; rigor mortis marked in lower limbs.

Brain.?Vessels of dura mater much congested ; pacchionian bodies large and numerous ; arachnoid slightly opaque ; serum

increased ; pia mater hyperaemic ; red points rather more distinct than usual ; consistence of brain firm ; about 1 drachm serum in each lateral ventricle ; weight 44 ozs.

Lungs.?Fairly distended; color normal; right bound to

parietes by old and rather extensive adhesions, left free ; much

hypostatic congestion, of right especially, the state of the apex of which resembled that of red hepatization and sank in water ; the other portions of right and whole of left crepitant and buoyant; slight exudation of sanious mucus on pressure of sections of

both, particularly the right ; weight, right 37? ozs., left 22f ozs.

Heart.?Small and flabby ; small quantity of dark semi-fluid blood in right ventricle ; a very small decolorised clot in left ventricle ; other cavities empty ; muscular texture and valves apparently healthy ; weight 7? ozs.

Liver.?Pale and flabby ; section coarse and brownish; weight 47? ozs. ; gall bladder contained about 1 drachm ouly of bile, which was thin and of light color.

Spleen.?Capsule of pinkish hue ; section coarse and of dull livid color; weight 22? ozs.

Kidneys.?Pule, but apparently healthy ; weight, right 5|ozs., left 5? ozs.

Bladder.?Nearly empty. Stomach contained about I oz. thick brownish yellow mucous

fluid ; coats appeared healthy. Intestines collapsed and void of foeces; Peyer's patches atro-

phied ; otherwise healthy throughout. Blood.?Rather dark and fluid.