THE INDIAN MEDICAL GAZETTE.
3^2
CORRESPONDENCE, NOTES,
&c.
" Communications respecting editorial matters should be addressed TO THE EDITOR," thoso concerning business matters of the Gazette, &*c., should be addressed to the Publishers, Messrs. NEWMAN Dalhousic Square, Calcutta. & Co., All original articles and reports should be written ON ONE SIDE omy the paper. of Communications which reached us too late for insertion in this :Y umber or those kept over for want of space, will appear, if possible, in our next issue.
ENTERIC FEVER I\T INDIA. To the
Editor,
"Indian Medical Gazette."
" on Enteric fever in Calcutta." published in the September number of the /. M. G. you state that : " The remarkable infrequency of enteric fever in India, notwithstanding the widely prevalent conditions for pythogenic disease, is illustrated by the fact that only one solitary case of that disease appears in the returns of the Presidency Hospitals for the year 1883, and the patient was not a native,"?and you discredit its appearance in previous returns by asserting that it is '' now well ascertained that the earlier records included under that designation many cases of disease which were only the It would more severe and continued forms of malarial fevers." be interesting to know on what grounds the diagnosis of previous years has been upset. The returns on which these remarks are founded refer only to the hospitals in Calcutta, yet you " the remarkable infrequency of enteric assume that they prove fever in India." The contrary could be proved from other returns, but as the same objection may be made to them as to the earlier Calcutta ones, the question resolves itself into one of
Sir,? In jour remarks
diagnosis.
What is the fever which is diagnosed as remittent ? Is it a malarial fever characterized by distinct remissions, passinggradually into perfect intermissions, and accompanied by enlargement of the spleen and liver and generally with jaundice ; or "is it a disease of a remittent type, which for want of a diagnosis is called remittent fever, but which, when a post-mortem examination is possible, is found to have been either sunstroke, hepatitis, kidney disease, enteric fever or the sequelfe of chronic starvation ? The one form of fever is cured by quinine, it has the other, [n my own practice and 110 appreciable effect on in that of others I have seen not a few cases of the latter type, but from an experience in many parts of the Bengal Presidency I am convinced that true idiopathic remittent fever is a rare disease in towns, stations and cantonments. Remittent fever is a severe form of intermittent. It means the presence of the malarial poison in an intense and concentrated form, and would necessarily be accompanied, in the locality in which it occurs, by numerous cases of intermittents. The other class occurs in a sporadic manner in people seldom or True remittents when appropriately never exposed to malaria. treated with quinine assume after a few days purely intermittent type, and do not continue for weeks uninfluenced by large and frequent doses of quinine. It would indeed be strange, with the existing sanitary condition of Indian towns, if cases of enteric fever were not prevalent ; and to me it seems equally strange that cases of idiopathic remittent fever should be so frequent, as they are reported, in densely crowded native cities, in palatial barracks, and in station,
bungalows. A long and carefully reported
series of all
cases
of remittent
fever is much wanted.
September 35th, 18S4.
I have, &c., JAMES (."LEGHORN,
Civil
Surgeon,
Allahabad.
referred to was, as it purported to be, an abstract of the matter contained in the Surgeon-General's Report The beto the prevalence of enteric fever in Calcutta. relating lief " that the earlier records included under that designation many cases of disease which were only the more continued forms of malarial fever"' appeared from the context to have been arrived at by a more careful study of their clinical characters and the systematic recourse to post-mortem examination in the fatal cases. It was also pointed out that the experience of hospitals by affording greater facilities for obtaining these two elements of increased accuracy in the diagnosis of enteric fever, must give more reliable evidence concerning the actual occurrence of enteric fever than the experience And the hospital experience of Calcutta of private practice. is unfavorable to the belief that enteric fever is of frequent
[The
paragraph
occurrence.
To take
[November, 1884. the
experience
of
one
hospital?the
Medical College Hospital which receives without restriction patients of all classes, sufferi ng from all kinds of ailments and
having a daily average of in door patients of about 300. During the past two years in not more than 3 or 4 cases was there even the slight suspicion of t he fever being of the enteric type.
And out of over 30 post-mortem examinations in cases of ' remittent' fever in only two was enteric ulceration present. That the young Europe; in Soldier now suffers in India from enteric fever in nearly equal ratio to his brothers at home appears to have been proved beyoi id dispute.' And young Europeans in Civil life are also attacked occasionally. But that the Natives of India " rot withstandingr the widely prevalent conditions for pythogenic disease" su fl'er much from enteric fever is a proposition which is yet wa inting in proof. The subject is one of exceeding interest, and should commend itself to the attention of every one interest! ed in the etiology of enteric fever. We will he glad to receive for publication any evidence derived from well authenticated i-cases regarding the occurrence of enteric fever amongst na.tives. \Ye quite agree with Dr. Cleghorn that much more care should be taken than usually is, in the endeavour to differentiate out true malarial remittent fever from fevers of a :remittent or quasi remittent type. Ed. I. M. G.]
3^2
CORRESPONDENCE, NOTES,
&c.
" Communications respecting editorial matters should be addressed TO THE EDITOR," thoso concerning business matters of the Gazette, &*c., should be addressed to the Publishers, Messrs. NEWMAN Dalhousic Square, Calcutta. & Co., All original articles and reports should be written ON ONE SIDE omy the paper. of Communications which reached us too late for insertion in this :Y umber or those kept over for want of space, will appear, if possible, in our next issue.
ENTERIC FEVER I\T INDIA. To the
Editor,
"Indian Medical Gazette."
" on Enteric fever in Calcutta." published in the September number of the /. M. G. you state that : " The remarkable infrequency of enteric fever in India, notwithstanding the widely prevalent conditions for pythogenic disease, is illustrated by the fact that only one solitary case of that disease appears in the returns of the Presidency Hospitals for the year 1883, and the patient was not a native,"?and you discredit its appearance in previous returns by asserting that it is '' now well ascertained that the earlier records included under that designation many cases of disease which were only the It would more severe and continued forms of malarial fevers." be interesting to know on what grounds the diagnosis of previous years has been upset. The returns on which these remarks are founded refer only to the hospitals in Calcutta, yet you " the remarkable infrequency of enteric assume that they prove fever in India." The contrary could be proved from other returns, but as the same objection may be made to them as to the earlier Calcutta ones, the question resolves itself into one of
Sir,? In jour remarks
diagnosis.
What is the fever which is diagnosed as remittent ? Is it a malarial fever characterized by distinct remissions, passinggradually into perfect intermissions, and accompanied by enlargement of the spleen and liver and generally with jaundice ; or "is it a disease of a remittent type, which for want of a diagnosis is called remittent fever, but which, when a post-mortem examination is possible, is found to have been either sunstroke, hepatitis, kidney disease, enteric fever or the sequelfe of chronic starvation ? The one form of fever is cured by quinine, it has the other, [n my own practice and 110 appreciable effect on in that of others I have seen not a few cases of the latter type, but from an experience in many parts of the Bengal Presidency I am convinced that true idiopathic remittent fever is a rare disease in towns, stations and cantonments. Remittent fever is a severe form of intermittent. It means the presence of the malarial poison in an intense and concentrated form, and would necessarily be accompanied, in the locality in which it occurs, by numerous cases of intermittents. The other class occurs in a sporadic manner in people seldom or True remittents when appropriately never exposed to malaria. treated with quinine assume after a few days purely intermittent type, and do not continue for weeks uninfluenced by large and frequent doses of quinine. It would indeed be strange, with the existing sanitary condition of Indian towns, if cases of enteric fever were not prevalent ; and to me it seems equally strange that cases of idiopathic remittent fever should be so frequent, as they are reported, in densely crowded native cities, in palatial barracks, and in station,
bungalows. A long and carefully reported
series of all
cases
of remittent
fever is much wanted.
September 35th, 18S4.
I have, &c., JAMES (."LEGHORN,
Civil
Surgeon,
Allahabad.
referred to was, as it purported to be, an abstract of the matter contained in the Surgeon-General's Report The beto the prevalence of enteric fever in Calcutta. relating lief " that the earlier records included under that designation many cases of disease which were only the more continued forms of malarial fever"' appeared from the context to have been arrived at by a more careful study of their clinical characters and the systematic recourse to post-mortem examination in the fatal cases. It was also pointed out that the experience of hospitals by affording greater facilities for obtaining these two elements of increased accuracy in the diagnosis of enteric fever, must give more reliable evidence concerning the actual occurrence of enteric fever than the experience And the hospital experience of Calcutta of private practice. is unfavorable to the belief that enteric fever is of frequent
[The
paragraph
occurrence.
To take
[November, 1884. the
experience
of
one
hospital?the
Medical College Hospital which receives without restriction patients of all classes, sufferi ng from all kinds of ailments and
having a daily average of in door patients of about 300. During the past two years in not more than 3 or 4 cases was there even the slight suspicion of t he fever being of the enteric type.
And out of over 30 post-mortem examinations in cases of ' remittent' fever in only two was enteric ulceration present. That the young Europe; in Soldier now suffers in India from enteric fever in nearly equal ratio to his brothers at home appears to have been proved beyoi id dispute.' And young Europeans in Civil life are also attacked occasionally. But that the Natives of India " rot withstandingr the widely prevalent conditions for pythogenic disease" su fl'er much from enteric fever is a proposition which is yet wa inting in proof. The subject is one of exceeding interest, and should commend itself to the attention of every one interest! ed in the etiology of enteric fever. We will he glad to receive for publication any evidence derived from well authenticated i-cases regarding the occurrence of enteric fever amongst na.tives. \Ye quite agree with Dr. Cleghorn that much more care should be taken than usually is, in the endeavour to differentiate out true malarial remittent fever from fevers of a :remittent or quasi remittent type. Ed. I. M. G.]
