ENTERIC FEVER IN HAZAREEBAGH. The station of on
Hazareobagh is acquiring an unenviable notoriety frequent outbreaks of enteric fever which
account of the
occur
the
among
British
troops
Situated
cantoned there.
Nagpore plateau, at an elevation of 2,014 feet above sea level, with an average temperature of 7-1?, ranging between 61? in December and January and 8G? in June, a rainfall of 52 inches and a mean humidity of 42, it might, a priori, be expected to furnish conditions under which the European would maintain a higher standard of health than perhaps in any other locality on the plains of Hindoostan. Nor is general and statistical evidence of its salubrity wanting. It possesses the reputation of a bracing and healthy climate; on
the
uplands
of the Chota
it is resorted to as
a
sanitarium ; civil officials consider them-
being appointed to serve in it; and the sickness and mortality of the Europeans, imprisoned in established there, have ilie penitentiary which has been selves fortunate in
for years been almost nominal. community furnished Dr. Mouat
Indeed the health with
one
of this
of the
strongest support his
illustrations with
which he lately endeavored to argument that the risks which surround European life in India do not very
materially
exceed those which affect
longevity in clearly apparent in recent
Yet the fact has become
Europe.
years that the British regiments domiciled in Ilazarecbagh are So much has this painful fact reverse of healthy.
the very
impressed the authorities that we believe the propriety of abandoning the place as a military station is at present under serious consideration. Now the questions which naturally arise in connection with this matter are ;?(1) to what disease or diseases is this unhealthiness due? (2) under what circumstances is it developed ? and (3) is it remediable otherwise than by adopting the extreme measure of abondoning a station which might be rendered healthy ? Looking to tho past history of this station i4 the sickness and mortality of tho British troops occupying contrast
favorably with the averages clearly from tho following
of the Presidency.
This
showing the ratio of per 1,000 of strength of the admissions, daily sick and deaths troops the European the of Army of the Bengal Presidency, and living in Hazareebagli during the ten years, 18G0-G9. appears
Admission
Presidency. 1751 9
bath.
IIazaree-
bagb. 15357
Daily
sick bath.
Presidency 67 1
table
Hazaroe-
bagh. 70 3
Death batb-
Presidency. 29-08
Hazaree-
bagb.
19-16 it
remarkable when ^ that on three occasions during this perio ag unhealthy regiments were sent for change to Hazaree t because of the reputed salubrity of the station. Nor docs v a general sickness and mortality of the station exhibit The result thus shown is all tho
more
is borne in mind
of unfavorable contrast to other stations when the results are ava three years succeeding this statistics period, whose able, are taken into account.
^
ENTERIC EEVER IN IIAZAREEBAGrH.
September 1, 1874.]
"
6. Admission
Daily
sick batb.
batb.
Yeabs. Presi-
Hazaree-
Presi-
dency.
bagh.
dency.
Hazaree-
bagh.
Death-bate.
bagh.
17319
877-1
G3-8
32-1
2190
19-00
1449 6
1384-4
57-9
60-9
17*53
10 91
1872
1514 5
1118 3
CO-8
45 5
27'45
6 83
when
judged by
These sentences
ree-
dency.
1871
even
Consequently an outbreak of enteric fever implies poidrinking water, or other ingeata with decomposing
of air,
excrement." Haza-
Presi-
1870
While, therefore, Hazareebagh,
soning
the sta-
represent the views
point of unhealthiness and mortality, still it has become painfully evident that, owing to occasional outbreaks of enteric fever, more sickness and death take place than might be expected. In 1871 we published a very valuable paper, contributed by Drs. Hannah and O'Farrell, detailing on outbreak of this disease in the 63rd Regiment. This paper conBengal
stations in
tained details of seventeen evidence adduced left
cases
doubt
and five deaths.
The clinical
to the nature of the
which have in
Europe
grown out of a very large accumulation of evidence regarding the circumstances of origin and propagation of this disease. In this
gated.
views of a very different kind have been promulIt has been observed that the disease affects mainly
country
the young and newly-arrived soldier, and it has been laid down " climate" with dogmatic confidence that the disease is due to
unacclimatized youths. tistics of British troops, is rather below than above the average acting upon of
24-5
That the disease is one of
adolescents is a well-established fact both in and out of
India,
Dr. Murchison has shown that about three-fourths of the fatal in the London Fever
Hospital are under 25 years of age. quite so high in the army of India, because children and young boys are excluded; but it must also be remembered that the proportion of adolescents must be higher in any army than in a mixed population. Again it is quite true that not only do young soldiers die in proportionally large numbers but they also die in large numbers in the early years This is quite intelligible on the supposiof their service. tion they are then subjected to the cause of the disease, whatever that may be, aDd that in every subsequent year their liability to take the disease lessens from advancing If enteric fever age and perhaps habituation to the cause. cases
The
proportion
is not
disease, and excessive, still any sickness and mortality, which are capable of prevention, afford material for very anxious thought, more especially if the disease caused is capable of propagation. We understand that the 2nd Battalion of the 22nd Regiment is now passing through an outbreak of larger dimensions than that which affected the were simply a matter of acclimatization it is marvellous what C3rd. This regiment arrived in India last cold weather and small proportion of young soldiers die of it?only some a in Hazareebagh in December 1873. The first case of typhoid 5 per 1,000 of strength?and that we seldom or never hear of fever was observed on the 10th of February 1874, and it proved other young Europeans coming to India?young civil and fatal on the 19th of the same month. Up to the 1st of August military officers, for instance?getting typhoid fever. Surely if 25 cases and 12 deaths had taken place. In other respects the climate" acting on peculiarly predisposed subjects, were the regiment has by no means been unhealthy. The disease has cause of the disease we should hear of cases among them. been entirely confined to the regiment. The prisoners in the The fact is that the climate" hypothesis was constructed on European penitentiary and the jail, the civil residents and an arithmetical basis, and is not entitled until supported by military officers, the inhabitants of the bazaar, the Madras detailed evidence founded on particular instances to any weight. sepoys and the police are quite free from the disease, which is, in On the other hand what we may call the dirt hypothesis has fact, confined to the regiment, and, with two exceptions, to the been constructed on the basis of etiological inquiry extending soldiers. There can be no doubt whatever regarding the Is over a very large field and a great number of instances. diagnosis of the disease. It has been proved to be enteric there then any evidence that the Hazareebagh enteric is due to fever by minute clinical and post-mortem investigation. We dirt, or the possibility of obtaining any ? The simple fact that hope to furnish our readers with details on this point ere long, one among a number of communities suffers of itself points only but meantime the fact is above cavil that the disease which But beyond this there are to some localized cause. strongly is causing the sickness and mortality, which are occurring in the that the barracks and the soil on which for believing grounds 2-22nd Regiment, is true typhoid fever. According to the most are not above suspicion. built are Experience has in India they advanced doctrines of the present day this fever is caused by that the old sites of cities, proof ample camps, and crowded given excremental poisoning or decomposition of animal organic cantonments are peculiarly unhealthy. The ground on which Dr. Murchison's conclusions matter of some sort in some way. the present barracks are built has, we believe, been occupied by regarding the etiology of enteric fever, in the last edition of his since the beginning of the troops century?by the Ramgurh standard Treatise on continued fevers," are as follows :? up to 1833, by European troops from 1840 to 1845, Contingent 1. Enteric fever is either an endemic disease or its epideand again by European troops for the last 18 or 20 years. mics are circumscribed. It is said to have been an old village site before then. The hot after and in autumn 2. "It is most prevalent weather. present barracks were built exactly on the site of the old 3. It is independent of overcrowding, and attacks the rich barracks. They are now old and in bad repair, and the danger and poor indiscriminately. of old buildings is added to the danger of old sites. But in " a of 4. It may be generated independently previous case by addition to this there is, we understand, a positive nuisance fermentation of ftecal and perhaps other forms of organic within the cantonment boundary. matter. no
though the incidence of
as
the outbreak was not
"
"
"
"
"
?5.
but
"
by the sick to persons in health, is not like that of small-pox given
We have been informed that to the southward of the
It may be communicated
even
then the
off from the
body
decomposition
poison
in
a
virulent form, but is
of the excreta after their
developed by
discharge.
the
distance of from
quarter to half a mile,
barracks,
somewhat lower level, the ground has been used as a latrine ground from the time the station was first occupied. This ground is not so used, now at
a
a
on
a
THE INDIAN MEDICAL GAZETTE.
246
but to the present moment it is so offensive as to prevent the residents from driving in that direction of an evening. The only two cases of typhoid which have occurred outside the
regiment have appeared,
we
understand,
in houses
adjoining
It is also stated that the disease first appeared in the barrack, near the south end of cantonment, and that when this was evacuated no more cases occurred in that company. this spot.
These circumstances may
or
may uot have
hny bearing
on
the
present outbreak, but it is evident, from what we have heard from several reliable quarters, that the impossibility of pythogenesis in
Hazareebagh
is not absolute.
outbreak will be made the
subject
We trust that the present
of a
searching investigation.
The nose and eye are not sufficient to discover the typhoid poison. Its existence must, with our present means of investi-
gation, depend rather on constructive than positive evidence; why has not the very simple and crucial test of moving the troops to a presumably healthier site, even in tents, been tried ? The climate hypothesis of typhoid causation is a very convenient formula and saves no end of trouble, but we most thoroughly distrust it. Before abandoning a station like Hazareebagh, offering to Europeans so good a prospect of healthy existence, every possible means of discovering local insanitary conditions and remedying them should, we think, bo adopted. At any rate it would appear to be wise to pause before spending a large sum of money on patching up the old barracks, as it is, we understand, intended; they would certainly appear not to be like Caesar's wife above suspicion. but
[September 1, 1874,
Hazareobagh is acquiring an unenviable notoriety frequent outbreaks of enteric fever which
account of the
occur
the
among
British
troops
Situated
cantoned there.
Nagpore plateau, at an elevation of 2,014 feet above sea level, with an average temperature of 7-1?, ranging between 61? in December and January and 8G? in June, a rainfall of 52 inches and a mean humidity of 42, it might, a priori, be expected to furnish conditions under which the European would maintain a higher standard of health than perhaps in any other locality on the plains of Hindoostan. Nor is general and statistical evidence of its salubrity wanting. It possesses the reputation of a bracing and healthy climate; on
the
uplands
of the Chota
it is resorted to as
a
sanitarium ; civil officials consider them-
being appointed to serve in it; and the sickness and mortality of the Europeans, imprisoned in established there, have ilie penitentiary which has been selves fortunate in
for years been almost nominal. community furnished Dr. Mouat
Indeed the health with
one
of this
of the
strongest support his
illustrations with
which he lately endeavored to argument that the risks which surround European life in India do not very
materially
exceed those which affect
longevity in clearly apparent in recent
Yet the fact has become
Europe.
years that the British regiments domiciled in Ilazarecbagh are So much has this painful fact reverse of healthy.
the very
impressed the authorities that we believe the propriety of abandoning the place as a military station is at present under serious consideration. Now the questions which naturally arise in connection with this matter are ;?(1) to what disease or diseases is this unhealthiness due? (2) under what circumstances is it developed ? and (3) is it remediable otherwise than by adopting the extreme measure of abondoning a station which might be rendered healthy ? Looking to tho past history of this station i4 the sickness and mortality of tho British troops occupying contrast
favorably with the averages clearly from tho following
of the Presidency.
This
showing the ratio of per 1,000 of strength of the admissions, daily sick and deaths troops the European the of Army of the Bengal Presidency, and living in Hazareebagli during the ten years, 18G0-G9. appears
Admission
Presidency. 1751 9
bath.
IIazaree-
bagb. 15357
Daily
sick bath.
Presidency 67 1
table
Hazaroe-
bagh. 70 3
Death batb-
Presidency. 29-08
Hazaree-
bagb.
19-16 it
remarkable when ^ that on three occasions during this perio ag unhealthy regiments were sent for change to Hazaree t because of the reputed salubrity of the station. Nor docs v a general sickness and mortality of the station exhibit The result thus shown is all tho
more
is borne in mind
of unfavorable contrast to other stations when the results are ava three years succeeding this statistics period, whose able, are taken into account.
^
ENTERIC EEVER IN IIAZAREEBAGrH.
September 1, 1874.]
"
6. Admission
Daily
sick batb.
batb.
Yeabs. Presi-
Hazaree-
Presi-
dency.
bagh.
dency.
Hazaree-
bagh.
Death-bate.
bagh.
17319
877-1
G3-8
32-1
2190
19-00
1449 6
1384-4
57-9
60-9
17*53
10 91
1872
1514 5
1118 3
CO-8
45 5
27'45
6 83
when
judged by
These sentences
ree-
dency.
1871
even
Consequently an outbreak of enteric fever implies poidrinking water, or other ingeata with decomposing
of air,
excrement." Haza-
Presi-
1870
While, therefore, Hazareebagh,
soning
the sta-
represent the views
point of unhealthiness and mortality, still it has become painfully evident that, owing to occasional outbreaks of enteric fever, more sickness and death take place than might be expected. In 1871 we published a very valuable paper, contributed by Drs. Hannah and O'Farrell, detailing on outbreak of this disease in the 63rd Regiment. This paper conBengal
stations in
tained details of seventeen evidence adduced left
cases
doubt
and five deaths.
The clinical
to the nature of the
which have in
Europe
grown out of a very large accumulation of evidence regarding the circumstances of origin and propagation of this disease. In this
gated.
views of a very different kind have been promulIt has been observed that the disease affects mainly
country
the young and newly-arrived soldier, and it has been laid down " climate" with dogmatic confidence that the disease is due to
unacclimatized youths. tistics of British troops, is rather below than above the average acting upon of
24-5
That the disease is one of
adolescents is a well-established fact both in and out of
India,
Dr. Murchison has shown that about three-fourths of the fatal in the London Fever
Hospital are under 25 years of age. quite so high in the army of India, because children and young boys are excluded; but it must also be remembered that the proportion of adolescents must be higher in any army than in a mixed population. Again it is quite true that not only do young soldiers die in proportionally large numbers but they also die in large numbers in the early years This is quite intelligible on the supposiof their service. tion they are then subjected to the cause of the disease, whatever that may be, aDd that in every subsequent year their liability to take the disease lessens from advancing If enteric fever age and perhaps habituation to the cause. cases
The
proportion
is not
disease, and excessive, still any sickness and mortality, which are capable of prevention, afford material for very anxious thought, more especially if the disease caused is capable of propagation. We understand that the 2nd Battalion of the 22nd Regiment is now passing through an outbreak of larger dimensions than that which affected the were simply a matter of acclimatization it is marvellous what C3rd. This regiment arrived in India last cold weather and small proportion of young soldiers die of it?only some a in Hazareebagh in December 1873. The first case of typhoid 5 per 1,000 of strength?and that we seldom or never hear of fever was observed on the 10th of February 1874, and it proved other young Europeans coming to India?young civil and fatal on the 19th of the same month. Up to the 1st of August military officers, for instance?getting typhoid fever. Surely if 25 cases and 12 deaths had taken place. In other respects the climate" acting on peculiarly predisposed subjects, were the regiment has by no means been unhealthy. The disease has cause of the disease we should hear of cases among them. been entirely confined to the regiment. The prisoners in the The fact is that the climate" hypothesis was constructed on European penitentiary and the jail, the civil residents and an arithmetical basis, and is not entitled until supported by military officers, the inhabitants of the bazaar, the Madras detailed evidence founded on particular instances to any weight. sepoys and the police are quite free from the disease, which is, in On the other hand what we may call the dirt hypothesis has fact, confined to the regiment, and, with two exceptions, to the been constructed on the basis of etiological inquiry extending soldiers. There can be no doubt whatever regarding the Is over a very large field and a great number of instances. diagnosis of the disease. It has been proved to be enteric there then any evidence that the Hazareebagh enteric is due to fever by minute clinical and post-mortem investigation. We dirt, or the possibility of obtaining any ? The simple fact that hope to furnish our readers with details on this point ere long, one among a number of communities suffers of itself points only but meantime the fact is above cavil that the disease which But beyond this there are to some localized cause. strongly is causing the sickness and mortality, which are occurring in the that the barracks and the soil on which for believing grounds 2-22nd Regiment, is true typhoid fever. According to the most are not above suspicion. built are Experience has in India they advanced doctrines of the present day this fever is caused by that the old sites of cities, proof ample camps, and crowded given excremental poisoning or decomposition of animal organic cantonments are peculiarly unhealthy. The ground on which Dr. Murchison's conclusions matter of some sort in some way. the present barracks are built has, we believe, been occupied by regarding the etiology of enteric fever, in the last edition of his since the beginning of the troops century?by the Ramgurh standard Treatise on continued fevers," are as follows :? up to 1833, by European troops from 1840 to 1845, Contingent 1. Enteric fever is either an endemic disease or its epideand again by European troops for the last 18 or 20 years. mics are circumscribed. It is said to have been an old village site before then. The hot after and in autumn 2. "It is most prevalent weather. present barracks were built exactly on the site of the old 3. It is independent of overcrowding, and attacks the rich barracks. They are now old and in bad repair, and the danger and poor indiscriminately. of old buildings is added to the danger of old sites. But in " a of 4. It may be generated independently previous case by addition to this there is, we understand, a positive nuisance fermentation of ftecal and perhaps other forms of organic within the cantonment boundary. matter. no
though the incidence of
as
the outbreak was not
"
"
"
"
"
?5.
but
"
by the sick to persons in health, is not like that of small-pox given
We have been informed that to the southward of the
It may be communicated
even
then the
off from the
body
decomposition
poison
in
a
virulent form, but is
of the excreta after their
developed by
discharge.
the
distance of from
quarter to half a mile,
barracks,
somewhat lower level, the ground has been used as a latrine ground from the time the station was first occupied. This ground is not so used, now at
a
a
on
a
THE INDIAN MEDICAL GAZETTE.
246
but to the present moment it is so offensive as to prevent the residents from driving in that direction of an evening. The only two cases of typhoid which have occurred outside the
regiment have appeared,
we
understand,
in houses
adjoining
It is also stated that the disease first appeared in the barrack, near the south end of cantonment, and that when this was evacuated no more cases occurred in that company. this spot.
These circumstances may
or
may uot have
hny bearing
on
the
present outbreak, but it is evident, from what we have heard from several reliable quarters, that the impossibility of pythogenesis in
Hazareebagh
is not absolute.
outbreak will be made the
subject
We trust that the present
of a
searching investigation.
The nose and eye are not sufficient to discover the typhoid poison. Its existence must, with our present means of investi-
gation, depend rather on constructive than positive evidence; why has not the very simple and crucial test of moving the troops to a presumably healthier site, even in tents, been tried ? The climate hypothesis of typhoid causation is a very convenient formula and saves no end of trouble, but we most thoroughly distrust it. Before abandoning a station like Hazareebagh, offering to Europeans so good a prospect of healthy existence, every possible means of discovering local insanitary conditions and remedying them should, we think, bo adopted. At any rate it would appear to be wise to pause before spending a large sum of money on patching up the old barracks, as it is, we understand, intended; they would certainly appear not to be like Caesar's wife above suspicion. but
[September 1, 1874,
