1893 BMJ (Clinical Research Edition)  
Medical Officer of the School. ON June 23rd, at 9 A.M., it was reported to me that about 30 of the boys in the school had been vomiting. At 11 A.M., when seen by me, these elildren were in bed. They all complained of frontal headache, vomiting, paini in the epigastrium, and in some cases of diarrhcea. In about 10 cases the temuerature was raised to 1010, and these patients had rather dry brown tongues, and a pulse of from 100 to 120. The remainder of the children had normal temperature, a clean
more » ... tongue, and the pulse was about 80. In 3 cases the vomiting was vely severe, but there was no sign of collapse. About 20 girls were seen at the same time, but the attacks were apparently less severe tlan in the boys. During the day of June 23rd about 30 more children were put to bed, but none of them were severe cases. On June 24th there were about 25 more clhildren attacked. These were, on the whole, the most severe cases, about 10 of them showing signs of collapse. On June 25th 15 more cases, 2 severe, occurred; on June 26th about 8; an-d on June 27th 7 more cases, none severe. Since then there lhave been cases resembling the ordinary summer diarrhcea in children, about 2 or 3 a day. Two children died. E. P., aged 14 years, was seized on June 23rd, and was one of the most severe cases. Wllen seen by me he had been vomiting very freely. Temperature 1010, pulse 110, full; tonigue brown, miioist. He sat up in bed and said he felt better. During the afternoon he was sitting up in bed reading. The vomiting had ceased. In the evening he had some cocoa. When seen at 10 P.M. he had some water and said he felt better. He was found dead at 5.30 A.M., June 24th. I was sent for, and saw him at 6.30 A.M. The body was still quite warm, the limbs flaccid, the features calm, jaws tightly clenched, and some bloody foam coming from the mouth. Post-mortem Examination (fifty-four hours after death).-Blood vessels in brain congested, rather more fluid than normal in ventricles, brain iatter soft. Lungs congested, n10 sign of disease. Heart: ventricles li-riily contracted, empty; valves niormal. Stomach: signs of fairly severe imiflammation over the whole of its surface, no erosion. The same appearances were seen in the intestines as in the stomach extending over a conisiderable portion of the small intestiine. The liver, kidnieys, anid spleen conigested, but healtlhy. H. F., aged 14, was attacked oln June 24th with severe frontal headache, vomiiiting, pulging, and pain in the epigastrium. Temperature normiial. Tonigue dry and brown. Pulse 140, very feeble. She was seein at once by me, and removed to the infirmary. A special nurse was in attendance. In lier case the vomiting was very severe, and the girl collapsed. Small doses of iced water were at oince vomited, and small nutrient enemata with brandy returned. Two lhypodermic injections of miiorphine grI and atr-opim sulph. gr.1T*, stopped the vomniting; brandy, ether, and liquor stiychhnie were injected by lypodermic sylinige, but the girl did not rally, and died June 27th. For the last two days the temperature was subnormal, anid the girl very restless; the pupils were large anid sluggish to light. Post-mortem Examnination (twenty-eight hours after death).-Brain congested, but less marked than in the case of E. P. Lungs normal. Heart healthy, ventricles pale, non-adherent clot in left ventricle. The stomach and intestines presented the same appearances as in the above case. Liver and kidneys normal. Spleen rather enlarged. About 140 children in all complained of being ill, and were put to bed, but at least 40 showed no signs of sickness or any illlness whatever. About 80 children were sick two or three timnes, and then said they were quite well again. In 20 there were signs of serious mischief; the vomiting and purging were excessive, and there were signs of collapse. The treatment adopted was rest, water, and milk and water until the sickness abated, and the action of the bowels either increased or quieted as seemed necessary. In a few of the cases small doses of hydrocyanic acid, sodium bicarbonate, and aromatic spirits of ammonia seemed to do good. Brandy by the mouth and rectum was given were necessary. The whole of the children except the two mentioned are well, and have returned to their ordinary duties and diet. In all the cases the vomiting was green bilious. No blood in alny vomit or stools. The diet for the school was: Oni Wedclesday.-Breakfast and tea-Bread and butter or dripping, and miiilk and water anid cocoa made with milk. Dinner-Salt meat (cold), bread, and water. Tlhursday.-Breakfast anid tea as oni Wedlnesday for whole school. Dinner foi boys and girls (over 7 years)-Soup made of stock from the Salt boiled beef of the previous day and bones from the officers' dinners of previous da ,flour, onions, water. Infants' dinner, bread pudding.
doi:10.1136/bmj.2.1697.87-a fatcat:w7rorfbmhjdtzmy6hcrrwe5k5e