ated on
slight rise of ground on the left bank of the BrahmnThe river is its northern boundary. On the south it is
a
putra.
surrounded
by a crescent of swamps, the horns of ?which abut upon the river. Thus, roughly speaking, the station may be likened to an island. The population numbers over 10,000 souls, and,
when
we
consider that
so
large
a
limited area, and that there are no kind for the disposal of sewage matter, on
a
diseases, the
such as cholerai and
locality.
typhoid,
are
population means
we
likely
of
is
an
packed
efficient
may grant that to find a home in
Tank water is largely used for drinking purposes, especially by the sepoys, whose lines are distant from the river. The
By
Joseph
The
supply of water in the tanks is fed by drainage from the surrounding soil; but the drainage from soil, upon which a closely packed population has dwelt for ages, must necessarily be loaded with organic impurities. The origin of the disease in the first two cases was distinctly
NOTES ON ENTERIC FEVER. O'Brien, MA., M.D., Surgeon, 43rd Assam Light
Infantry. following
eases may be of use in the attention of medical officers serving in this province to the local existence of enteric fever. There is, I think, but little room for doubt that the disease exists more commonly amongst natives than is generally supposed. The cases that I now publish would probably have been recorded as remittent
publication
of the
directing
fever if
had chance to occur under the care of a outpost or detachment station. through the Sanitary Reports of the Native
they
Assistant at
Looking Bengal for
Hospital
an
Army
of
the past four years, I was surprised to see how few cases of enteric fever have been recorded, while the number of cases of simple continued and remittent fever is consi-
derable. The
accompanying table shows the number during the four years:?
of admissions for
each disease
Simple Continued Fever,
Tear.
Remittent Fever.
Enteric
Fever.
traced to the use of the water of a tank in the middle of the sepoys' lines. The water of this tank was so bad (I believe it has since been closed up) that a sentry had to be placed on its
banks
to
564 677 641
1873
785
0 1 13 19
Total.,
517
2,667
33
1871 1872
Most of the
cases of fever have, apparently, been enand there is no question that the great majority of the severer fevers were examples of this disease. Since the cases now published came under my observation in 1873 and 1874, I have been on the look out for others; but though I have seen several fatal cases of fever and made postmortem examinations of almost all of them, I have not met with
tered
as
severe
remittent,
another example of the specific enteric lesion.
Still, while admitting that remittent is the most commonly observed, and the chief cause of mortality, amongst Indian fevers, I am of opinion that typhoid prevails more extensively than is generally supposed. It is only of late days that attention has been directed to the subject, and we find accordingly in the returns of the Native Army that, while no cases were recorded in 1870, there was 1 in 1871, 13 in 1872, 19 in 1873, and we shall probably find, when the annual report is published, that there were still more in 1874. And there is no reason why this should not be so. Enteric fever occurs in Europe in connection with the evils of defective sanitation, such as bad drainage and sewerage arrangements,
impure drinking water, etc.?evils that may every town and village in this country.
be said to exist in
The first three cases that I now record occurred in Gowhatty, unhealthy town in Lower Assam. The climate is humid and the natural drainage of the surface bad, and the
an
relaxing,
conservancy arrangements most insufficient.
The town is situ-
use.
Notwithstanding
the
prohibition
it was
men, Jerwah Recruits, had been in the using the water. The Jerwahs are a semi-savage people, not very cleanly in their habits, and in no way particular about what water they drink, so these two men probably thought the prohibition absurd and and had no hesitation in two
vexatious,
breaking through
it.
In case No. 3 the man had been in hospital since 23rd October and did not show the first symptoms of typhoid until 14th November. As the hospital and its precincts were kept scrupulously clean, and as this man had no contact with the other two cases, I was forced to conclude that the water he used for the drinking or cooking was instrumental in originating the
disease. The
thy
cases occurred in Shillong, which is a healThe recruit mentioned in case No. 4, however, arrived from Gowhatty and probably brought
remaining two
hill station.
had but 231 60 112 114
1870
forbid its these
found that habit of
recently
the seed3 of the disease with him.
In the 5th case I was un-
able to discover any likely cause of the malady. Case No. 1.?16th October 1873, Gowhatty.?On
visiting the regimental hospital this morning, after an absence of some week3 on leave, I was struc k by the appearance of one of the patients, a Jerwah Recruit, aged 22, who was lying in a stupid apathetic state, with flushed hectic face and bright glistening eye, but having withal a peculiarly languid look. On inquiring into his history I learnt that he had been unwell in the lines for a day or two prior to his admission. On 4th October when admitted he was found to be suffering from high fever accompanied by diarrhoea and pain in the bowels. The fever progressed without intermission for three days ; but in the afternoon of the 4th day (8th October) there was said to be a fall of temperature. This was accompanied by a discharge of dark-coloured blood (about 4 ozs.) from the bowels. For three days dark blood in small quantity continued to be discharged with the stools, and during this time the heat of the body remained moderate. On October
13th, the eleventh day of the disease, symptoms pneumonia supervened, viz., pain in left side, cough and hurried respiration. "When I examined the man, 16th October, his condition was of
as
follows:
?
Crepitation audible over lower lobes of both lungs and in upper lobe of left lung ; marked dulness towards bases of both lungs ; harassing cough; profuse purulent expectoration. Abdomen full, soft, doughy; pain felt on pressure near navel ; gurgling distinctly audible on pressure in right iliac fossa. Tongue moist, covered with a white pasty coat, red at edges; lips dry and glazed; sordes upon teetk. Pulse full, rapid (120), jerky.
Maech 1, Skin
NOTES ON ENTERIC FEVER.?BY J. O'BRIEN.
1876.]
dry, rough
and hot
(about 103?).
Urine and stools passed involuntarily. The patient was lying in a semi-conscious state ; answered questions when spoken to ; but with hesitation and difficulty. I examined the trunk for
typhoid spots, but could not find any. 17th.?Three involuntary stools since yesterday; matter passed of a muddy color and homogeneous consistence, like well-mixed paint; putrid smell; no mucus or red blood. The dark drab color of the stools appears to be due to admixture of blood high up in the intestine. I had no thermometer at this time, so I was unable to note the temperature; but pyrexia was considerable. Other symptoms as on 16th. 18
slight rise of ground on the left bank of the BrahmnThe river is its northern boundary. On the south it is
a
putra.
surrounded
by a crescent of swamps, the horns of ?which abut upon the river. Thus, roughly speaking, the station may be likened to an island. The population numbers over 10,000 souls, and,
when
we
consider that
so
large
a
limited area, and that there are no kind for the disposal of sewage matter, on
a
diseases, the
such as cholerai and
locality.
typhoid,
are
population means
we
likely
of
is
an
packed
efficient
may grant that to find a home in
Tank water is largely used for drinking purposes, especially by the sepoys, whose lines are distant from the river. The
By
Joseph
The
supply of water in the tanks is fed by drainage from the surrounding soil; but the drainage from soil, upon which a closely packed population has dwelt for ages, must necessarily be loaded with organic impurities. The origin of the disease in the first two cases was distinctly
NOTES ON ENTERIC FEVER. O'Brien, MA., M.D., Surgeon, 43rd Assam Light
Infantry. following
eases may be of use in the attention of medical officers serving in this province to the local existence of enteric fever. There is, I think, but little room for doubt that the disease exists more commonly amongst natives than is generally supposed. The cases that I now publish would probably have been recorded as remittent
publication
of the
directing
fever if
had chance to occur under the care of a outpost or detachment station. through the Sanitary Reports of the Native
they
Assistant at
Looking Bengal for
Hospital
an
Army
of
the past four years, I was surprised to see how few cases of enteric fever have been recorded, while the number of cases of simple continued and remittent fever is consi-
derable. The
accompanying table shows the number during the four years:?
of admissions for
each disease
Simple Continued Fever,
Tear.
Remittent Fever.
Enteric
Fever.
traced to the use of the water of a tank in the middle of the sepoys' lines. The water of this tank was so bad (I believe it has since been closed up) that a sentry had to be placed on its
banks
to
564 677 641
1873
785
0 1 13 19
Total.,
517
2,667
33
1871 1872
Most of the
cases of fever have, apparently, been enand there is no question that the great majority of the severer fevers were examples of this disease. Since the cases now published came under my observation in 1873 and 1874, I have been on the look out for others; but though I have seen several fatal cases of fever and made postmortem examinations of almost all of them, I have not met with
tered
as
severe
remittent,
another example of the specific enteric lesion.
Still, while admitting that remittent is the most commonly observed, and the chief cause of mortality, amongst Indian fevers, I am of opinion that typhoid prevails more extensively than is generally supposed. It is only of late days that attention has been directed to the subject, and we find accordingly in the returns of the Native Army that, while no cases were recorded in 1870, there was 1 in 1871, 13 in 1872, 19 in 1873, and we shall probably find, when the annual report is published, that there were still more in 1874. And there is no reason why this should not be so. Enteric fever occurs in Europe in connection with the evils of defective sanitation, such as bad drainage and sewerage arrangements,
impure drinking water, etc.?evils that may every town and village in this country.
be said to exist in
The first three cases that I now record occurred in Gowhatty, unhealthy town in Lower Assam. The climate is humid and the natural drainage of the surface bad, and the
an
relaxing,
conservancy arrangements most insufficient.
The town is situ-
use.
Notwithstanding
the
prohibition
it was
men, Jerwah Recruits, had been in the using the water. The Jerwahs are a semi-savage people, not very cleanly in their habits, and in no way particular about what water they drink, so these two men probably thought the prohibition absurd and and had no hesitation in two
vexatious,
breaking through
it.
In case No. 3 the man had been in hospital since 23rd October and did not show the first symptoms of typhoid until 14th November. As the hospital and its precincts were kept scrupulously clean, and as this man had no contact with the other two cases, I was forced to conclude that the water he used for the drinking or cooking was instrumental in originating the
disease. The
thy
cases occurred in Shillong, which is a healThe recruit mentioned in case No. 4, however, arrived from Gowhatty and probably brought
remaining two
hill station.
had but 231 60 112 114
1870
forbid its these
found that habit of
recently
the seed3 of the disease with him.
In the 5th case I was un-
able to discover any likely cause of the malady. Case No. 1.?16th October 1873, Gowhatty.?On
visiting the regimental hospital this morning, after an absence of some week3 on leave, I was struc k by the appearance of one of the patients, a Jerwah Recruit, aged 22, who was lying in a stupid apathetic state, with flushed hectic face and bright glistening eye, but having withal a peculiarly languid look. On inquiring into his history I learnt that he had been unwell in the lines for a day or two prior to his admission. On 4th October when admitted he was found to be suffering from high fever accompanied by diarrhoea and pain in the bowels. The fever progressed without intermission for three days ; but in the afternoon of the 4th day (8th October) there was said to be a fall of temperature. This was accompanied by a discharge of dark-coloured blood (about 4 ozs.) from the bowels. For three days dark blood in small quantity continued to be discharged with the stools, and during this time the heat of the body remained moderate. On October
13th, the eleventh day of the disease, symptoms pneumonia supervened, viz., pain in left side, cough and hurried respiration. "When I examined the man, 16th October, his condition was of
as
follows:
?
Crepitation audible over lower lobes of both lungs and in upper lobe of left lung ; marked dulness towards bases of both lungs ; harassing cough; profuse purulent expectoration. Abdomen full, soft, doughy; pain felt on pressure near navel ; gurgling distinctly audible on pressure in right iliac fossa. Tongue moist, covered with a white pasty coat, red at edges; lips dry and glazed; sordes upon teetk. Pulse full, rapid (120), jerky.
Maech 1, Skin
NOTES ON ENTERIC FEVER.?BY J. O'BRIEN.
1876.]
dry, rough
and hot
(about 103?).
Urine and stools passed involuntarily. The patient was lying in a semi-conscious state ; answered questions when spoken to ; but with hesitation and difficulty. I examined the trunk for
typhoid spots, but could not find any. 17th.?Three involuntary stools since yesterday; matter passed of a muddy color and homogeneous consistence, like well-mixed paint; putrid smell; no mucus or red blood. The dark drab color of the stools appears to be due to admixture of blood high up in the intestine. I had no thermometer at this time, so I was unable to note the temperature; but pyrexia was considerable. Other symptoms as on 16th. 18
