THE INDIAN MEDICAL GAZETTE.
80
1886.
pure almost
enteric fever
if
information
our
ENTERIC FEVER IN THE EUROPEAN ARMY OF INDIA IN 1884. The section of the report of the Sanitary Coramissiouer with the Government of India enteric fever is full of interest.
to
relating
is still shrouded in
The
and
subject uncertainty doubt?uncertainty as regard diagnosis, pathology, and astiology, and this report is all the more
valuable in that it is
tism and
"
statistical data.
regarded has steadily
from
The number of fever
cases
enteric," the report states,
now
as
"
risen
a
years"?
recent
during
admission-rate of 2*8 per 1,000, death-rate of 1*44 in 1875 to 11*7 and
risen from and
in
dogma-
its inferences
cautious
so
devoid of
so
an
the
2*74 in 1884, 1875-84
6*7
being
appear that
more
rates
for the decade
and 2*61.
It would thus
mean
sickness and
markable facts
are
deduced from
figures?namely (1)
that
are
due
but two
re-
mortality
to this cause than in former years; a
of the
study
while the sickness
mortality attributable to enteric fever have increased, the admission and death-rates of all fevers (including enteric) have rather decreased than increased; and (2) that while the number of deaths caused by enteric fever has increasand
ed in relation to
creased
as
strength,
compared
with
it has
notably
de-
that
the
admissions,
is,
fatality of the disease has fallen from 50-60 per cent of cases to 23*45. This would argue that (1) the type milder, or (2) that either
keener.
lias become the Madras to
question
of the the
disease has become
faculty
whether in many not
diagnosing
it
The latter is the view of
Surgeon-General.
fashion have
of
But it is open
cases
authority
influenced medical
or
officers
pronounce the severer cases of continued and remittent fever to be true enteric when
to
"enteric" they present "typhoid" symptoms complications. The Bombay Surgeon-General or
considers that
"
there is a form of fever called enteric fever, which is not that disease proper, but which is due to malaria, and presents great difficulties in diagnosis from true enteric
were
Certain it is that stations
officers present, and anomalies.
he
which,
have
believes, might
pre-existing complete."
cases
made
from
the
and
returns
medical
different
by
comparison, great In one province
on
cent of those attacked
1886.
we
be traced to
invariably
different
"
states that
fever;" and he further
SUtq Jiulian dUftydhiat MARCH,
[March,
in
died,
variations
66'67 per another 17*99.
one year in the same province 100 per cent One of admissions died, in another 31*25.
In
medical
other,
officer, taking
promptly
of enteric fever
to
that of
of enteric
"
an-
from the head
simple
fever, and another man finds that six cases
from
charge
over
removes 11 cases
continued of
out
seven
fever under treatment
were
revisions of
diagnosis," having been presumaoriginally treated as either remittent or
bly
malarial continued fever.
These facts
empha-
tically attest the great doubts and difficulties which exist as regards the diagnosis of the Other facts cast doubts
disease.
on
the
quesThe greater liability of arrived soldiers is consistent
tion of its
pathology.
young and newly with what is known in other countries regarding o the natural history of enteric fever, but its o
seasonal
prevalence
associates it
with climatic fevers in reasonable hesitation
general
as
regarding
its
*->
so
markedly
to
suggest oo
specific
a
char-
may be held that conditions favourable to the generation and prevalence of it
Still
acter.
kind of fever may be so for another, or that the two kinds of fever are caused by varieties of And this speculation is one poison or noxa.
one
quite
consistent with what
we
know,
or
rather
know, regarding the causation of typhoid The present report agrees with its India.
do not in
predecessors in asserting can
be found
to
that "no clue whatever
the causation of the disease in
In one any local insanitary conditions." instance the use of unglazed earthenware in the latrines
was
blamed, but the evidence
in favour of this view is or
by
no
means
advanced
complete
convincing. It is curious to contrast the
prevalence
of
enteric fever in the European army with its incidence among Native troops and prisoners. The
cases
among these amounted
only
to '2 per
March, 1886.] 1000, and
OFFICIAL SCIENCE.
,
the deaths to *09, the ratios being It is worthy of note also
the same in both cases.
that the death-rate from enteric officers men.
(l-06)
was
fever among less than half that of the
And that the
mortality
from the
same
among women (l-48) was also much smaller. There is still much to be learned regard-
cause
ing enteric fever in India, and we commend the subject to the earnest and sustained attention of medical officers.
81
80
1886.
pure almost
enteric fever
if
information
our
ENTERIC FEVER IN THE EUROPEAN ARMY OF INDIA IN 1884. The section of the report of the Sanitary Coramissiouer with the Government of India enteric fever is full of interest.
to
relating
is still shrouded in
The
and
subject uncertainty doubt?uncertainty as regard diagnosis, pathology, and astiology, and this report is all the more
valuable in that it is
tism and
"
statistical data.
regarded has steadily
from
The number of fever
cases
enteric," the report states,
now
as
"
risen
a
years"?
recent
during
admission-rate of 2*8 per 1,000, death-rate of 1*44 in 1875 to 11*7 and
risen from and
in
dogma-
its inferences
cautious
so
devoid of
so
an
the
2*74 in 1884, 1875-84
6*7
being
appear that
more
rates
for the decade
and 2*61.
It would thus
mean
sickness and
markable facts
are
deduced from
figures?namely (1)
that
are
due
but two
re-
mortality
to this cause than in former years; a
of the
study
while the sickness
mortality attributable to enteric fever have increased, the admission and death-rates of all fevers (including enteric) have rather decreased than increased; and (2) that while the number of deaths caused by enteric fever has increasand
ed in relation to
creased
as
strength,
compared
with
it has
notably
de-
that
the
admissions,
is,
fatality of the disease has fallen from 50-60 per cent of cases to 23*45. This would argue that (1) the type milder, or (2) that either
keener.
lias become the Madras to
question
of the the
disease has become
faculty
whether in many not
diagnosing
it
The latter is the view of
Surgeon-General.
fashion have
of
But it is open
cases
authority
influenced medical
or
officers
pronounce the severer cases of continued and remittent fever to be true enteric when
to
"enteric" they present "typhoid" symptoms complications. The Bombay Surgeon-General or
considers that
"
there is a form of fever called enteric fever, which is not that disease proper, but which is due to malaria, and presents great difficulties in diagnosis from true enteric
were
Certain it is that stations
officers present, and anomalies.
he
which,
have
believes, might
pre-existing complete."
cases
made
from
the
and
returns
medical
different
by
comparison, great In one province
on
cent of those attacked
1886.
we
be traced to
invariably
different
"
states that
fever;" and he further
SUtq Jiulian dUftydhiat MARCH,
[March,
in
died,
variations
66'67 per another 17*99.
one year in the same province 100 per cent One of admissions died, in another 31*25.
In
medical
other,
officer, taking
promptly
of enteric fever
to
that of
of enteric
"
an-
from the head
simple
fever, and another man finds that six cases
from
charge
over
removes 11 cases
continued of
out
seven
fever under treatment
were
revisions of
diagnosis," having been presumaoriginally treated as either remittent or
bly
malarial continued fever.
These facts
empha-
tically attest the great doubts and difficulties which exist as regards the diagnosis of the Other facts cast doubts
disease.
on
the
quesThe greater liability of arrived soldiers is consistent
tion of its
pathology.
young and newly with what is known in other countries regarding o the natural history of enteric fever, but its o
seasonal
prevalence
associates it
with climatic fevers in reasonable hesitation
general
as
regarding
its
*->
so
markedly
to
suggest oo
specific
a
char-
may be held that conditions favourable to the generation and prevalence of it
Still
acter.
kind of fever may be so for another, or that the two kinds of fever are caused by varieties of And this speculation is one poison or noxa.
one
quite
consistent with what
we
know,
or
rather
know, regarding the causation of typhoid The present report agrees with its India.
do not in
predecessors in asserting can
be found
to
that "no clue whatever
the causation of the disease in
In one any local insanitary conditions." instance the use of unglazed earthenware in the latrines
was
blamed, but the evidence
in favour of this view is or
by
no
means
advanced
complete
convincing. It is curious to contrast the
prevalence
of
enteric fever in the European army with its incidence among Native troops and prisoners. The
cases
among these amounted
only
to '2 per
March, 1886.] 1000, and
OFFICIAL SCIENCE.
,
the deaths to *09, the ratios being It is worthy of note also
the same in both cases.
that the death-rate from enteric officers men.
(l-06)
was
fever among less than half that of the
And that the
mortality
from the
same
among women (l-48) was also much smaller. There is still much to be learned regard-
cause
ing enteric fever in India, and we commend the subject to the earnest and sustained attention of medical officers.
81
