TYPHOID OR ENTERIC FEVER AMONG SOLDIERS IN INDIA.* By Deputy Surgeon-General
Joseph Ewart,
M.D., F.C.U., F.R.C.P., LOND. Late
Professor of Medicine in the Medical College, and College Hospital, Calcutta,
First Physician to the
That this disease has
long found a congenial home gathered from the classical works of and Clark, Annesley, Twining. Professor Maclean, the
in India may be * DO
Read before the
International Medical Congress,
August'
?
INDIAN MEDICAL.GAZET'IE;
[January, 1885.
"
m
teache.
distinguished saw
and treated
cast
ine at
:t' mil
Netley,
typhus, typhoid, often
of coii.inued fever at Madras
h
in
our
Indian
by Gerhard,
But .he honour of firs
Empire,
or.
identifying
experience upon it
so
far
as
prevailing view that it did not exist in tropics, by observing and recording a
of the
not
India and the case at Meerut in November, 1851. At the post-mortem examination, the characteristic ulceration of Peyer's
subsequently saw, Hospital, one
whilst
Calcutta General
or
which recovered, and three others, of which there
diagnosis autopsies. European
was
never was
any
corroborated
Scriven's soldiers
cases
occurred in
as
in such
the North-Western
at the
Ajmere, Rajputana,
to discover
and of the
necroptic
increasing prevalence, it,
stituted,
was
showing troops serving
and the
aug-
as
pointed
out
by Bryden,
the most mortal
form of fever in the European army of that country. Its very general recognition is, doubtless, attributable better
diagnosis,
and verification
young
by carefully
conducted
That it had
always existed,
widely
importation,
Provinces,
the existence of
place
have been notable facts. It
to
as was
fest from the
Indian authorities
en-
out in my
pointed been :
grouped
chiefly
first
cases
at
teric fever among the natives of India. Three wellmarked cases, with an epitome of the symptoms during
life,
of the British
at the
British Burmah, and Lower Bengal. In 1855, it fell to my lot whilst stationed
a
remained unrecognised in the returns of the Sanitary Commissioner with the Government of India until i8/r, from which year, down to 1881, it has con-
and in these the
sailors, residing
or
scattered localities
all
mortality
mented death-rate from
regarding the nature
the revelations
rather no un-
it in the army medical returns,
present time, its
two doubtful cases
doubt,
by
serving
was
with
in India until 1861, or about ten years after Scriven's first case was noticed. But, from that year to the
of Medical Science, No. VII., p. 512, 1857). In 1854 he published some notes of three cases met with in Burmah (Medical Times and Gazette, p. 70, Jan. 28th, He
assigned
to
the sickness and
patches at the lower end of the ileum was found fully confirming the provisional diagnosis (Indian Annals
1854).
the declaration founded and around Calcutta and
poison. Although the answer to these inquiries tardily delivered, it was at length given, certain sound, in the affirmative. Thus,
I
to
error
and
made, both in
in many parts of India, that, in a number of remittents and continued fevers, very large the chief and fatal factor is the typhoid fever
exclusively Surgeon-Major Scriven, aware, Medical the Service. He exposed Bengal formerly of the
modified and
elsewhere
it
'.he ; crixted lines laid down
Stewart, and j enner, belongs,
am
gained,
was
was
relapsing fevers,
aggr avated by the presence of malaria I have repeatedly observed since this
in the system.
Secunderab? d, ;u the T.'h c mi, nd in China as far north as Nankin, extending ove; twenty days in duration, with bowel oompli. ntion, wi ich he had no hesitation in stating ?: 33o) n.iu.i: li n e been cases o^
(1838),
enteric fever.
materially
or
post-mortem
in fatal cases examinations.
and that it
supposed by
was no new
some, is mani-
recorded in the works of the
previously
referred to, and that,
monograph of 1856, it
had
as
always
among remittent and continued fevers?
the former?has
now
been
amply proved.
mortality from it, prevalence of, marked by a corresponding diminution in.
The increased
appearances at the inferior
and
end of the ileum, were recorded and published in the have been seventh number of the Itidian Annals. At the con- the frequency of, and the death-rate from, remittent cluding part of that paper, it was remarked that "with- and continued fevers. These facts have been estab-
post-mortem examinations be- lished by the statistics of the late Surgeon-Major since his untimely death, have been ing hiade in all those fatal cases which are denominat- ; Bryden, and, ed remittent fever, the conclusions drawn must be at- annually confirmed by his successors in office.
out the most
scrutinizing
degree of uncertainty. Are not many of these examples of typhoid and typhus fever?'' Ijn 1857-59, several well-marked cases of typhoid fever were noted whilst I was in charge of the Meywar Bheel.Corps, among the Bheels of the regiment and the aborigines of the district. This experience, coupled with that previously obtained at Ajmere, induced me again to enquire on this occasion, through the columns df thi' Indian Lancet, whether many of the remittents
tended
with
some
,
met with in hot countries
were
not
in
reality
Ever since Scriven directed attention to this
subject,
enteric fever has been recognised as a constant factor in the sickness and mortality at the Calcutta European General
Hospital, to
which he
was
attached for several,
years. Its endemic occurrence, in all parts of India, has been acknowledged by Edward Goodeve, Chevers^,
Fayrer, Mo'rehead, Francis, Cornish, Furnell, Lyons,.. Moffat, Massy, O'Brien, Cleghorn, Green, Hanbury,. Hunter, and a host of others belonging to the British
either and Indian medical services.
ENTERIC FEVER AMONG SOLDIERS
January, 1885.] The as
result is that enteric fever
general
now
figures
pyrexial disease met among the younger soldiers serving in India. by year we have been hearing more of its far the most fatal form of
by
with Year
Decen
vember,
during solutely and
I\TDI
the
iL
and
;
1,323 and almost ab.
"
non-malarious
June;
February;
ami
January
warm
.5r.tr.-
iv?
larch, April, May ?nc?ist, rainy, warm, nonths of July, August,
the
1,2-8 during
So that there were, in the course of eleven years ending 1881, no fewer than 1,453* deaths among the European troops, 115 among the women,
hot, and extreme 11 iari September and Ou
Joseph Ewart,
M.D., F.C.U., F.R.C.P., LOND. Late
Professor of Medicine in the Medical College, and College Hospital, Calcutta,
First Physician to the
That this disease has
long found a congenial home gathered from the classical works of and Clark, Annesley, Twining. Professor Maclean, the
in India may be * DO
Read before the
International Medical Congress,
August'
?
INDIAN MEDICAL.GAZET'IE;
[January, 1885.
"
m
teache.
distinguished saw
and treated
cast
ine at
:t' mil
Netley,
typhus, typhoid, often
of coii.inued fever at Madras
h
in
our
Indian
by Gerhard,
But .he honour of firs
Empire,
or.
identifying
experience upon it
so
far
as
prevailing view that it did not exist in tropics, by observing and recording a
of the
not
India and the case at Meerut in November, 1851. At the post-mortem examination, the characteristic ulceration of Peyer's
subsequently saw, Hospital, one
whilst
Calcutta General
or
which recovered, and three others, of which there
diagnosis autopsies. European
was
never was
any
corroborated
Scriven's soldiers
cases
occurred in
as
in such
the North-Western
at the
Ajmere, Rajputana,
to discover
and of the
necroptic
increasing prevalence, it,
stituted,
was
showing troops serving
and the
aug-
as
pointed
out
by Bryden,
the most mortal
form of fever in the European army of that country. Its very general recognition is, doubtless, attributable better
diagnosis,
and verification
young
by carefully
conducted
That it had
always existed,
widely
importation,
Provinces,
the existence of
place
have been notable facts. It
to
as was
fest from the
Indian authorities
en-
out in my
pointed been :
grouped
chiefly
first
cases
at
teric fever among the natives of India. Three wellmarked cases, with an epitome of the symptoms during
life,
of the British
at the
British Burmah, and Lower Bengal. In 1855, it fell to my lot whilst stationed
a
remained unrecognised in the returns of the Sanitary Commissioner with the Government of India until i8/r, from which year, down to 1881, it has con-
and in these the
sailors, residing
or
scattered localities
all
mortality
mented death-rate from
regarding the nature
the revelations
rather no un-
it in the army medical returns,
present time, its
two doubtful cases
doubt,
by
serving
was
with
in India until 1861, or about ten years after Scriven's first case was noticed. But, from that year to the
of Medical Science, No. VII., p. 512, 1857). In 1854 he published some notes of three cases met with in Burmah (Medical Times and Gazette, p. 70, Jan. 28th, He
assigned
to
the sickness and
patches at the lower end of the ileum was found fully confirming the provisional diagnosis (Indian Annals
1854).
the declaration founded and around Calcutta and
poison. Although the answer to these inquiries tardily delivered, it was at length given, certain sound, in the affirmative. Thus,
I
to
error
and
made, both in
in many parts of India, that, in a number of remittents and continued fevers, very large the chief and fatal factor is the typhoid fever
exclusively Surgeon-Major Scriven, aware, Medical the Service. He exposed Bengal formerly of the
modified and
elsewhere
it
'.he ; crixted lines laid down
Stewart, and j enner, belongs,
am
gained,
was
was
relapsing fevers,
aggr avated by the presence of malaria I have repeatedly observed since this
in the system.
Secunderab? d, ;u the T.'h c mi, nd in China as far north as Nankin, extending ove; twenty days in duration, with bowel oompli. ntion, wi ich he had no hesitation in stating ?: 33o) n.iu.i: li n e been cases o^
(1838),
enteric fever.
materially
or
post-mortem
in fatal cases examinations.
and that it
supposed by
was no new
some, is mani-
recorded in the works of the
previously
referred to, and that,
monograph of 1856, it
had
as
always
among remittent and continued fevers?
the former?has
now
been
amply proved.
mortality from it, prevalence of, marked by a corresponding diminution in.
The increased
appearances at the inferior
and
end of the ileum, were recorded and published in the have been seventh number of the Itidian Annals. At the con- the frequency of, and the death-rate from, remittent cluding part of that paper, it was remarked that "with- and continued fevers. These facts have been estab-
post-mortem examinations be- lished by the statistics of the late Surgeon-Major since his untimely death, have been ing hiade in all those fatal cases which are denominat- ; Bryden, and, ed remittent fever, the conclusions drawn must be at- annually confirmed by his successors in office.
out the most
scrutinizing
degree of uncertainty. Are not many of these examples of typhoid and typhus fever?'' Ijn 1857-59, several well-marked cases of typhoid fever were noted whilst I was in charge of the Meywar Bheel.Corps, among the Bheels of the regiment and the aborigines of the district. This experience, coupled with that previously obtained at Ajmere, induced me again to enquire on this occasion, through the columns df thi' Indian Lancet, whether many of the remittents
tended
with
some
,
met with in hot countries
were
not
in
reality
Ever since Scriven directed attention to this
subject,
enteric fever has been recognised as a constant factor in the sickness and mortality at the Calcutta European General
Hospital, to
which he
was
attached for several,
years. Its endemic occurrence, in all parts of India, has been acknowledged by Edward Goodeve, Chevers^,
Fayrer, Mo'rehead, Francis, Cornish, Furnell, Lyons,.. Moffat, Massy, O'Brien, Cleghorn, Green, Hanbury,. Hunter, and a host of others belonging to the British
either and Indian medical services.
ENTERIC FEVER AMONG SOLDIERS
January, 1885.] The as
result is that enteric fever
general
now
figures
pyrexial disease met among the younger soldiers serving in India. by year we have been hearing more of its far the most fatal form of
by
with Year
Decen
vember,
during solutely and
I\TDI
the
iL
and
;
1,323 and almost ab.
"
non-malarious
June;
February;
ami
January
warm
.5r.tr.-
iv?
larch, April, May ?nc?ist, rainy, warm, nonths of July, August,
the
1,2-8 during
So that there were, in the course of eleven years ending 1881, no fewer than 1,453* deaths among the European troops, 115 among the women,
hot, and extreme 11 iari September and Ou
