TEMPERATURE CHART OF A CASE OF ENTERIC FEVER, CHARACTERISED BY TWO RELAPSES, THE PATIENT WAS A YOUNG MAN OF 19 YEARS. 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 wwwwwww their course, a fall occurs about the eighth day,* while in primary typhoid the temperature retains till the twelfth day nearly, though not quite, the maximum attained in from the fourth to the sixth days. † This fall about the eighth or ninth day, in the absence of hæmorrhage and other accidents, he looks upon as a most valuable and favourable prognostic indication, he thinks that the eighth and ninth days' temperatures in typhoid relapses have a critical significance.§ The specially interesting feature in this case is the unusual duration of the interval between the first and second attacks. Murchison gives statistics of relapses with eighteen and nineteen days' intermissions, and one of twenty-five days. In Pearson Irvine's cases three had intervals of ten days. Dr. Allan, of the City of Glasgow Fever Hospital, records a case | which had two relapses, with sixteen days between the attacks. His case was a very interesting one, and had quinine administered freely, without any clear evidence of benefit from its use. Pearson Irvine seems to doubt that relapses of typhoid may set in so long after primary typhoid, as happened in this case. He says: "I am convinced that in many cases of deferred relapse a careful daily observation of the temperature would have shown that the patients were victims of repeated relapses, possibly exceedingly mild, but still determinable by the thermometer." It is difficult to believe that a recurrence of a typhoid attack, weeks or even months after a patient's convalescence, is due to the primary cause of the disease." ** This interesting question remains: Whether was the first relapse due to the primary contagion-as is most probably the case when relapse sets in shortly after the termination of the previous attack, and possibly having something to do with the constipation or with the ulceration, of which the bleedings recorded in the chart are the signs-or whether was it due to a new infection? The probable cause of the outbreak was investigated by Dr. Duncan, who ascertained that the majority, if not the whole of the patients, had been using milk from one source, the sanitary arrangements of which were deplorably defective. The dairy which supplied milk to this household was supposed to sell no milk *Loc. cit., p. 119. Loc. cit., pp. 119, 132. || Glasgow Med. Journal, May 1881, p. 363. Loc. cit., p. 112. + Loc. cit., p. 132. § Loc. cit., p. 120. ** Loc. cit., p. 136. other than that furnished by its own cows; but it was subsequently ascertained on inquiry that, when their own supply threatened to run short, the dealers obtained the extra milk they required from this same source. When this was discovered, the doubtful milk was discontinued, but whether sufficiently early to make any difference to the patient I cannot ascertain. The house drains were found in a tolerably good state, but were carefully overhauled and ventilated long before the termination of the primary attack. ON BI-CHROMATE OF POTASH POISONING. BY EDWARD ORR MACNIVEN, M.B. & C.M.EDIN., House Physician in the Glasgow Royal Infirmary, B. D., æt. 22 years, workman in Mr. Carlyle's chrome works, Garngad Hill, was admitted into Dr. Maclaren's Wards in the Royal Infirmary, on the 10th December 1882, suffering from the effects of swallowing a quantity of bi-chromate of potash. History. The patient, a fairly muscular man, who had fallen in love with a young woman who did not return his affections, in a freak of jealousy went to the chrome works about five o'clock on Sunday evening and swallowed a lump of chrome (the purified salt) in the solid form. He then returned to his lodging, which is about fifteen minutes' walk from the works. As soon as he reached his room he experienced the following symptoms : The first thing he noticed was a lightness in the head; then he experienced a sensation of great heat in the stomach, with a glow of heat all over the body; this was followed by a cold sweat. Next he became nauseated and vomited freely. He then suffered from agonising pain in the epigastric region, along with giddiness, specks before the eyes, and loss of power of the legs. (He had complete power of his arms.) His thirst was intense; as he aptly expressed himself, "he felt as if he could drink the sea dry." Lastly, he complained of severe rigors, with coldness of the whole body-more especially of the extremities. The patient was carried into the hospital at ten minutes to seven o'clock, nearly two hours after swallowing the poison; on examination I found the pupils slightly dilated, the face pale and extremely cold, the pulse feeble and fluttering. There was no vomiting then; but he complained of intense pain over the region of the stomach, and a feeling of great depression. No cramps or diarrhoea were present. There was a degree of stupor, but he answered questions fairly well. Sensibility to touch and pain was well marked. Treatment. This consisted in giving a full dose of sulphate of zinc; washing out the stomach with tepid water by means of the stomach pump till the fluid was colourless. As the pulse threatened to fail, I injected subcutaneously 20 mins. of sulphuric ether, which was followed by a marked improvement. The patient was covered with plenty of warm blankets, and hot bottles were applied to the feet and sides. A mustard poultice was applied over the stomach, which gave great relief to the patient. I next tried the administration of some tepid coffee, well diluted with milk, and plenty of brown sugar in it; this was rejected at once. Next I tried some milk well mixed with a good quantity of lime water, and 10 grains of subnitrate of bismuth, and this was retained. Barley water was given as a drink, and the patient was ordered a milk diet with lime water. The patient slept fairly well that night, and in the morning every symptom had disappeared, except a slight soreness of the mouth. Diet was strictly attended to as usual. The patient made a perfect recovery without a single bad symptom. Remarks.-1. The first symptom-viz., "the lightness in the head" (apparently a tendency to syncope), took place fifteen minutes after he had swallowed the poison. 2. Had it not been (a) That vomiting occurred in his lodgings (which happened about twenty minutes after he had taken the poison), and (b) That the patient had taken food about an hour and a half before he entered the works, the effects might have been much more disastrous. 3. Although a good quantity of the poison was found in his stomach, yet the rapid evacuation of its contents, together with the application of tepid water, along with milk, lime water, and bismuth, tended to soothe the mucous membrane, and diminish the chance of inflammatory action. The application of the mustard externally had also a beneficial effect in the same direction. 4. Over zii, according to the * patient's account, must have been swallowed, and by a rough analysis of the stomach's contents, I estimated that it contained nearly zi of the bichromate. No trace of the poison was found in the urine with *I made the patient select a piece of the bi-chromate which he thought was exactly the same size as that which he swallowed, and then I weighed it and found it over 3ii. |