472 Notes on Famine Diseases.

ART. X V I I . - - N o t e s on Famine Diseases. By ALEXANDER PORTER, M.D., F.R.C.S., M.R.I .A. ; Brigade Surgeon, I.M.S ; Fellow of the Madras University; and Professor of Medical Jurisprudence, Madras Medical College.

( Co~tlnued .from ~ag~ 375.)

IV. CHOLERA.

CHOLERA is probably not, strictly speaking, a bowel complaint pure and simple, but for many reasons it is convenient to consider here the few cases that came under dissection at this period. These amount to 13 in all, consisting of 7 men, 4 women, and 2 children ; but although few in number they illustrate some of the most common phases of the disease--patients brought to hospital dead or dying, stricken down from perfect health in a few hours ; others attacked while suffering from an ordinary bowel complaint. Those who consider the disease an aggravated bowel complaint will find among these cases examples of diphtheritic effusion and other appearances of the severest type of alvlne flux; while the advocate of the disease being a sort of sunstroke is not without a case in point in one of the children.

As to causation, those who advocate lumbrici in the intestine as a cause can find lots of evidence of their theory among these cases; while the advocate of the air or water theory would have had as little difficulty in obtaining at the Fafnine Relief Camp evidence supporting his own particular view. One thing seems certain--viz., that the first case in au outbreak of cholera is always a person who has come from a place where the disease prevails, and somehow from him it spreads; another point observable is that a resident is less liable to be attacked than a stranger who is perhaps only passing through the station or village where the disease is prevalent.

As to the duration of the attack in the present ~urat~on of cases, one man was brought in dead after an illness, attack, it was said, of eleven hours; two died in nineteen,

.having been ill about four, hours ; and one lived seven- teen days, having been ill some hours on admission with very marked symptoms of cholera; three men were attacked after an average of nine days in hospital with diarrhoea or dysentery, and died in an average of fifteen hours; one woman was brought in dead, having been ill nearly a whole day, it was said ; and one was brought in all but dead, without a history ; one died in forty-eight,

By DR. ALEXANDER PORTER. 473

having been ill on admission about four, hours; and one was attacked after having been four days in hospital with chronic dysentery, and died in thirty-slx hours; both children died in thirty-six, having been ill on admission about four, hours.

The small intestine was found empty in one woman Contents o f Small Intestine. and one child; contained " r ice-water" fluid in four

men and two women; blood-tinged semi-pultaceous fluid in two men and one woman; yellow fluid in one man; and a

little green pult in one child. Lumbrici to the number Lumbrlsi. of 95, including those that had reached the mouth or

large gut, were found in five men, three women, and one child. In the child three were in the mouth and three in the small gut. The average for the men was nearly eight, and for the women nearly seventeen each; as many as forty were found in one woman, while twelve was the largest number found in one man.

The large intestine was found empty in both children, Contents n]" Large Iutestine. and in one man and one woman. In the man it was

distended with gas, and in the woman it had some red mucus adherent to the mucous coat.

In four men and three women it contained " r ice-water" stools, and in two men it contained secondary cholera stools, blood-tinged semi-pultaceous fluid. Lumbrici had reached this part of the gut in three cases, and they were found in the mouth in two cases.

The walls of the small intestine were thin in both Walls of Small children and in two men ; in one this was most marked Intestine

in the lower end of the ileum; and they were anmmic in both children and in two adults. In one child the gut was tinged livid en masse, and in the other an odd venous radicle showed through, and the mucous membrane near the valve was white, rugose, and somewhat thick. In a man who had been ill some time with dysentery, the mucous coat was thin and pale, with a

livid tinge in the ileum, especially towards the valve, ~n~ia . from venous radicles showing through ; and in a woman

who also had been ill some time with dysentery it was anmmic and pigmented, pale slate-coloured. In the remaining six men and three women there was congestion of the whole mucous coat, and sometimes of the sub-peritoneal tissues also.

The character of the injection was deep rose in a lIgpercemla, man, reddish pink in a man and a woman, bright red

in a man and a woman, red with lengths deeper red to

474 Notes on Famine Diseases.

livid in two men, deep red paling towards valve in a man, and livid deeper in parts in a woman.

In three men and three women the peritoneal surface was red to deep livid from injection of the sub-peritoneal vessels. In one of these--a man- - the mucous coat was only deep rose-coloured, and in another- -a woman-- i t was anaemic and slate-coloured.

t)eyer's patches were remarkably prominent in one Peger'slaatches. of the children, and in a man they looked depressed

from the prominence of the surrounding membrane, and they were a much paler red than it.

The solitary glands were pale and prominent and Xolitary glands, about the size of No. 9 shot in six men, three women,

and in both children. Besides in the children, there was no injection of the mucous coat in the case of one man and one woman. The distribution of the enlarged glands was all through the gut in the children and in some adults, but they were always most conspicuous in the ileum.

There was a spot or two of submucous ecchymosis ~ubmucous Ecch~os/s. in the jejunum in two men, and about a hundred spots

(some an inch in diameter and a few prominent) in the jejunum in the woman in whom there was no injection of the mucous coat. And in one of the children the whole mucous tract was studded with punctated ecchymoses each a line or so in diameter.

A pseudo-membrane was present in this part of the Pseudo-membrane. gut in three cases. I t was of some thickness, rough,

and confined to the lowest two feet of the ileum in the man who died from secondary cholera; it formed a gray film in the ileum, and was removable in places in a woman who died from cholera in for ty-eight hours, and it lined the ileum and was unac- companied by congestion of the mucous coat in another woman,

who had been ill a fortnight with dysentery and thir ty- Pig,nentat~on. six hours with cholera. Pigmentation of the mucous

coat was present in the last case and in the case of tile man who died from secondary cholera.

The walls of the large intestine were thin and pale Large in both children; in one the mucous coat was dingy, Intestine.

with livid mottles from injection of venous radicles, and was stained green. In a man the mucous coat

Pale. aos~. was pale, and in another it was rosy, with the solitary glands prominent and white; in a woman it was dull

By DR. ALEXANDER PORTER. 475

pink, with pseudo-membrane adherent in the ascending colon, and patches of brown effusion into the coat in the trans-

Putt red. verse and descending colon. In a man it was dull red with prominence of solitary glands in the ascending and transverse colon, paler in the descending colon,

Deep red. but deep livid lower down. It,was deep red in three men and two women ; in one of the former the injec-

tion was deepest in the cmcum, and the mouths of the follicles were seen as minute white circles all through, but most markedly in the transverse colon; in one the coat looked as if washed in blood, and in the third there was a pseudo-membrane lining it all through, the injection being absent from the descending colon.

In a man the injection of the mucous coat was dark D~r~ llvla, livid at the end of the gut, paler in the middle, and

with filmy patches of pseudo-membrane in the cmcum ; and in a woman it was dark livid, deeper in parts, but less so in the sigmoid flexure, and it was lined all through to the descending colon with a pseudo-membrane, which was thick at its termination and seemed recently shed from the lower end of the gut.

A pseudo-membrane is thus seen to have been pre- Pseudo- sent in four cases--two men and two women-- three of membrane.

them the same cases as we have seen this lesion to have been found in the small gut, and the fourth a man who had been a week or so ill with dysentery and died from cholera in eighteen hours. This is the case above mentioned in which there were filmy patches on the cmcum.

And the solitary glands were prominent in the cases ~qolltary 9lands. of two men and one woman given in detail above.

There was some swelling, accompanied by deep con- ~qwelling. gestion of the mucous coat, in one of the men who had

been under t reatment for dysentery, and in the man Thic~eni,,U. who was brought in dead. And there was thickening

of the tissues at the lower end of the gut in two of the dysentery cases--one a man and one a woman.

Ulcers were found in three men, one woman, and ~cers. one child. The latter was brought in with his mother,

No. 356, without a history, and died in a few hours. The ulcers were few, small, and circular, about three lines in diameter, appearing to originate in spots of ecchymosis or in the follicular glands, which were patulous. All the other cases were under t reatment for bowel complaint when attacked.

476 _Notes on Famine Diseases.

The ulcers were small and circular, confined to the lower end of the gut in one man, and to both ends in one woman. In one man there were three ulcers in the caput coli, livid based, transverse, three inches long by three lines broad, with slightly thickened edges, and a gray slough adherent to one; and in another there were in the cmcum and ascending colon several gray-based, thick- edged, tubercular-like ulcers, some circular, some oval transversely, and in the transverse colon were girdle ulcers encircling three- quarters of the gut. Lower down the ulcers were circular, small, a line in diameter, and healing. No infarcted glands were found, and there was no injection or thickening of the coats generally.

Submucous ecchymoses were found in both children. ~ubmucou$ Ecch, ymosis. In one they consisted of about a hundred spots, each

a line or so in diameter, and scattered over the lower part of the gut, from the transverse colon downwards, and in the other they were seen as small black dots about a quarter of a line in diameter, and all through the gut at about one hundred to the square inch.

[A series of cases illustrating this paper will be found at page 505, under heading of " Clinical and Pathological Records."]

THE TREATMENT OF SYPHILITIC CONDYLOMATAo

DR. A. G. PARSONS, of Durham, N. C., writes that he has tried the following ointment in many cases of syphilitic growths on the scrotum, and around the anus, and has never met with a failure:--1% Morph. sulph., gr. 2; pulv. camphor, gr. 20. Bismuthi subnitrat.--Hydrarg. chlor, mitis, ~ 3 jss. ; r ~ j. Signa.--Wash with soap and water, and then rub the ointment in thoroughly twice a day. In a few days, Dr. Parsons says, the warts will be found to have entirely disappeared.-- The N. Y. Med. Record, N6v. 13, 1886.