At page 281 of relapsing or famine fever Dr. Lyons again using my name, says :?" Dr. Crawford's account of the general population of Raj poo tana does not support W. J. Moore's statement, that there was no relapsing fever in that province during the famine. The 2nd Bengal Cavalry at Deolee in Rajpootana suffered from an epidemic in 1869, which is thus described by Dr. Crawford. The intermittent fever was of a severe type and unusually obstinate, with a greater tendency to become remittent, and to congestions of the lungs, liver, and spleen, than in former years. It was also in several cases complicated with scorbutic and dysenteric symptoms, convalescence was very protracted, in many eases, and weakly men were constantly re-admitted, after any slight exertion off duty.' Of the surrounding population Dr. Crawford wrote, intermittent fever was rather common in August. It increased in prevalence until the month of October, when more than two-thirds of the population of the district were said to be prostrated by fever, and as far as I can learn, this disease caused more deaths in the villages throughout the district, than the previous epidemic of cholera had done. In November, the disease had abated considerably in prevalence, notwithstanding the famine existing at the time, and the great number of starving wretches who crowded into the station. I observed them gathering '
REMARKS ON DR. LYONS' "TREATISE ON RELAPSING OR FAMINE FEVER."
By W. J. Moohe, L.R.C.P., Surgeon Major, liajpootana Political Agency, and SuperintendentGeneral of Dispensaries and Vaccination, liajpootana. (Continued from
page
204.)
Again, Captain Muir, the Political Agent of the Haraotee, (Kotah, Boondee, Jallawar), thus wrote :?"In June and July (1869) distress was very severe, and deaths from positive starvation lamentably numerous. Miserable skeletons found their way into the station (Deolee) in the last stage of emaciation and weakness, and with that terribly drawn expression of face which the famine rendered so familiar. Too often they only crawled in to die." And again?" In the begining of October, prices for the. first time showed symptoms of retrograding, and as the produce of the harvest became available to fall, the plentiful rains gave promise of a good spring crop, there was ample occupation for all classes of tho community, and prospects were everystates
where brightening, when tho country was called upon to undergo its last aud, perhaps, its severest trial. Low intermittent fever, and in places scurvy, prostrated the people, who, weakened by long courso of bad or insufficient food, sank and died.
mortality during October, November, December, owing to great; upwards of half the deaths, which occurred throughout the year, being ascribed to it. In marching through what were large populous villages, two or three wan figures were alone to be seen, while in many parts of Kotah, the jowar was standing far into the cold weather, there being
The this
epidemic, was very
no one
to cut it."
perhaps, therefore, be granted that the amount of distress prevailing in 1869, even if not in 1868, was quite sufficient to produce true relapsing fever?which, however, we have seen by concurrent testimony was not so produced. The mortality of dispensary patients was, as noted in my report, much greater thau usual during 1869. But as remarked The number treated in the dispenof cholera so of fever. It will
"
saries does not, however, unfortunately convey even an approximate idea of the number suffering and dying in Rajlast year. Neither have I any means of ob-
pootana during
taining correct information on this head. But in Marwar, for instance, it is stated one person died in every 15 of the population, making the total number 75,000." As already noted, Colonel Brooke estimated the loss from fever at 20 per cent, of tho entire population. Captain Muir ascribes half the death-rate to the same cause. A mortality far above the 10 per cent, quoted by Br. Lyons as the average deatli ratio to total population from true relapsing fever; forming an argument at least as forciblo as some used by Dr. Lyons why the epidemic in Rajpootana could not have been his favourite disease. The history of tho famine in Rajpootana presents facts quite as terrible as those mentioned in my article on Sanitary Progress in the Calcutta Revietv, to which Dr. Lyons has thought proper to apply the term astounding.'' "
'
various weeds and roots, the seeds of grasses, berries of the small briar bush, &c. The low castes immediately cut up, and devoured all the cows and bullocks, &c., that happened to die in their
neighbourhood, and I heard ordinarily given to
tion of the oil-cake
food,
that many mixed a porcattle with their other
Dr. Crawford also states that he observed
famino fever.
plain that was prevalent,
But it is
intermittent fever that fever."
no
cases
of
he did not as a
recognize the variety of relapsing
Now, first, let it be asked, if the characteristics of the disease
occurring at Deolee among the men of the 2nd Bengal Cavalry, as described by Or. Crawford and quoted by Dr. Lyons, and the description by the latter author of relapsing fever, have sufficient in common to justify Dr. Lyons in the conclusion of identity. And, for the sake of comparison, the two descriptions are placed in apposition. Dr. Lyons
(Page 1). contagious fever, generated by starvation, chiefly met with A
among the poorer classes, and
occurring
as an
epidemic during
of scarcity and famine. It may be intermittent, remittent, or continued. Its average duration varies from five to but is sometimes seven days, shorter, and occasionally longer. Its symptoms are an abrupt invasion ; but occasionally some seasons
premonitory symptoms (such as languor,loss of appetite,diarrhoea,
restlessness, or muscular pains in the loins or limbs,) precede the attack for a few days,?quick, full, and often bounding pulse ; white, moist tongue, becoming dry brownish ortheoven black; epigastrum, tenderness at and vomiting; often nausea,
jaundice, enlarged and painful liver, and spleen; constipation,
but occasionally diarrhoea; skin hot and dry?generally no eruption, but in one variety a scarlet eruption disappearing on pressure; urine high coloured, or tinged yellow, in the jaundiced cases : severe headache and pains in ttoe back and limbs; great debility and restlessness, and occasionally delirium and coma; generally an abrupt cessation or marked mitigation of these
Dr. Crawford. The intermittent fever was of a severe type, and unusually obstinate, with greater tendency to become remittent, and to congestion of lungs, liver, and spleen, than in former years. It was also, in several cases, complicated, with scorbutic and dysenterie symptoms: convalescence was very protracted in many cases, and weakly men were constantly re-admitted after any slight exertion of dutv.
THE INDIAN MEDICAL GAZETTE.
232
It. will be noticed that Dr. of
relapsing fever,
ments
Lyons,
in the above very clear chiefly met with
states that it is
to know, were sufficiently well fed, admirable arrangebeen made by granting furloughs, and timely pro-
having
vision of food for the crisis.
Dr. Crawford
particularly mentions the intermittent type of the fever; and although Dr. Lyons tells us relapsing fever may be intermittent, it is scarcely possible that a medical officer of experience would have mistaken the sufficiently characteristic symptoms of relapsing fever, as detailed by Dr. Lyons, had such been present; especially when, as I can state from my own personal knowledge, that the attention of Dr. Crawford had been drawn to the probability o? relapsing fever occurrina during the famine. But Dr. Crawford gives us no history of an abruptly commencing fever, or of a fever lasting from five to seven days, or of jaundice, or of the characteristic relapse, although indeed mentioning re-admissions. He merely states that the malady was unusually obstinate, with a greater tendency to run into the remitting form, and to congestions of internal organs. He describes, in fact, the ordinary autumnal fevers of the country?maladies which have been frequently similarly described as occurring during seasons when neither famine nor scarcity were prevalent. let it be asked if Dr. the
plain
Lyons
statement of
Dr.
is
justified Crawford,
in comthat he
fever," by asserting that Dr. Crawford did not recognize the malady, and that therefore such malady and this, in the face of Dr. was a variety of relapsing fever; observed
no
famine
Crawford's statement, that. " in November the disease had considerably in prevalence, notwithstanding the famine
abated
existing at the time." The verdict, I think, must, be that Dr. Lyons, although permitted to hold and to express his opinions, was not. justified in the authoritative manner in which he asserts
Dr. Crawford mistaken.
let. it be asked, why Dr. Lyons makes, to say the " an observation as that Dr. Crawford's account of the general population of Rajpoot ana does not support W. J. Moore's statement that there was no relapsing fever in
Thirdly,
least,
of
in connection with the local poor relief, and with local famine works, rendered in a true Christian charitable spirit were as untiring as unobstrusive and valuable. But Dr. Crawford could
never
have been
so
unfortunate
province during the 'faminethe fact being that Dr. supports my statement in every particular. My report of the greater prevalence of fever at Deolee, than at other places,in 1868, has been already mentioned; and my report of the extraordinary prevalence of fever throughout Rajpootana in 1869, when the Deolee dispensary showed one of the highest ratios, has been quoted. In this, therefore, Dr. Crawford and In November, myself are in accord. Dr. Crawford says: notwithstanding the prevalence of famine, the disease had that
Crawford
"
and so do I. Dr. Crawford states that he observed no of famine fever ; and neither did I, although not far from Deolee during the season 1869, and through Deolee, with Dr. abated
cases
Crawford at his hospital, and inspecting the Deolee dispensary, during the season 1868. It is therefore clearly apparent that Dr. Lyons is entirely wrong when he writes, Dr. Crawford's account of the general population of Rajpootana does not support W- J- Moore's statement." Dr. Lyons, by a pecu"
liar mental process, first assumes Dr. Crawford to be wrong, and then from this coign of vantage asserts that Dr. Crawford, thus assumed to bo in error, does not agree with me. But even permitting, for the sake of argument, that Dr. Crawford had not been iu such remarkable concord with myaeif,
more
than
a
few miles from Deolee?
accompanied him on tlie Tonk road, then in progress as a famine work, for a morning ride. And thorefore mentioning Dr. Crawford's report as on the general population of Kajpootana, is simply absurd. In the first season of the famine, I marched through various parts of Rnjpootana, about 1,500 miles. In the second season of the famine about the same distance. My duties were, inspecting dispensaries, and inspecting vaccination. My opportunities, therefore, of becoming acquainted with the condition of the country, were infinitely greater than those afforded to Dr. Crawford. And even were it correct, as Dr. Lyons would have us believe, that relapsing fever occurred at Deolee, I should still consider my opportunities the better for forming an opinion on tlio condition of the general population?opportunities which, considering the immense extent of roadless country to be traversed, entailing five or six months under canvass each year, wore confessedly few enough, but still far superior to those of the gentleman whom, nolens volens, the author of relapsing or famine fever" would set up as his authority on the condition of the general population of the such
distances,
for
"
Secondly, menting on "
accepted as applicable to the general Eajpootana. Dr. Lyons' acquaintance with this part, of the country is probably nil, and ho may be surprised to learn that the province comprises an area of about 123,000 square miles. Dr. Crawford was a friend of mine, and I now lament his death. He was the medical officer of the 2nd .Bengal Cavalry, and his exertions during the memorable period of the famine,
population
among the poorer classes. Dr. Crawford's epidemic occurred among the men of the native cavalry at Deolee, who, I have reason
1873.
his accounts could not be
symptoms on the termination of the fever, with or without free perspiration or diarrhoea. After a complete apyretic interval, varying from 2 to 14 days, but rarely longer, an abrupt relapse. account
[September 1,
province.
\
;
instance,
as
I once
REMARKS ON DR. LYONS' "TREATISE ON RELAPSING OR FAMINE FEVER."
By W. J. Moohe, L.R.C.P., Surgeon Major, liajpootana Political Agency, and SuperintendentGeneral of Dispensaries and Vaccination, liajpootana. (Continued from
page
204.)
Again, Captain Muir, the Political Agent of the Haraotee, (Kotah, Boondee, Jallawar), thus wrote :?"In June and July (1869) distress was very severe, and deaths from positive starvation lamentably numerous. Miserable skeletons found their way into the station (Deolee) in the last stage of emaciation and weakness, and with that terribly drawn expression of face which the famine rendered so familiar. Too often they only crawled in to die." And again?" In the begining of October, prices for the. first time showed symptoms of retrograding, and as the produce of the harvest became available to fall, the plentiful rains gave promise of a good spring crop, there was ample occupation for all classes of tho community, and prospects were everystates
where brightening, when tho country was called upon to undergo its last aud, perhaps, its severest trial. Low intermittent fever, and in places scurvy, prostrated the people, who, weakened by long courso of bad or insufficient food, sank and died.
mortality during October, November, December, owing to great; upwards of half the deaths, which occurred throughout the year, being ascribed to it. In marching through what were large populous villages, two or three wan figures were alone to be seen, while in many parts of Kotah, the jowar was standing far into the cold weather, there being
The this
epidemic, was very
no one
to cut it."
perhaps, therefore, be granted that the amount of distress prevailing in 1869, even if not in 1868, was quite sufficient to produce true relapsing fever?which, however, we have seen by concurrent testimony was not so produced. The mortality of dispensary patients was, as noted in my report, much greater thau usual during 1869. But as remarked The number treated in the dispenof cholera so of fever. It will
"
saries does not, however, unfortunately convey even an approximate idea of the number suffering and dying in Rajlast year. Neither have I any means of ob-
pootana during
taining correct information on this head. But in Marwar, for instance, it is stated one person died in every 15 of the population, making the total number 75,000." As already noted, Colonel Brooke estimated the loss from fever at 20 per cent, of tho entire population. Captain Muir ascribes half the death-rate to the same cause. A mortality far above the 10 per cent, quoted by Br. Lyons as the average deatli ratio to total population from true relapsing fever; forming an argument at least as forciblo as some used by Dr. Lyons why the epidemic in Rajpootana could not have been his favourite disease. The history of tho famine in Rajpootana presents facts quite as terrible as those mentioned in my article on Sanitary Progress in the Calcutta Revietv, to which Dr. Lyons has thought proper to apply the term astounding.'' "
'
various weeds and roots, the seeds of grasses, berries of the small briar bush, &c. The low castes immediately cut up, and devoured all the cows and bullocks, &c., that happened to die in their
neighbourhood, and I heard ordinarily given to
tion of the oil-cake
food,
that many mixed a porcattle with their other
Dr. Crawford also states that he observed
famino fever.
plain that was prevalent,
But it is
intermittent fever that fever."
no
cases
of
he did not as a
recognize the variety of relapsing
Now, first, let it be asked, if the characteristics of the disease
occurring at Deolee among the men of the 2nd Bengal Cavalry, as described by Or. Crawford and quoted by Dr. Lyons, and the description by the latter author of relapsing fever, have sufficient in common to justify Dr. Lyons in the conclusion of identity. And, for the sake of comparison, the two descriptions are placed in apposition. Dr. Lyons
(Page 1). contagious fever, generated by starvation, chiefly met with A
among the poorer classes, and
occurring
as an
epidemic during
of scarcity and famine. It may be intermittent, remittent, or continued. Its average duration varies from five to but is sometimes seven days, shorter, and occasionally longer. Its symptoms are an abrupt invasion ; but occasionally some seasons
premonitory symptoms (such as languor,loss of appetite,diarrhoea,
restlessness, or muscular pains in the loins or limbs,) precede the attack for a few days,?quick, full, and often bounding pulse ; white, moist tongue, becoming dry brownish ortheoven black; epigastrum, tenderness at and vomiting; often nausea,
jaundice, enlarged and painful liver, and spleen; constipation,
but occasionally diarrhoea; skin hot and dry?generally no eruption, but in one variety a scarlet eruption disappearing on pressure; urine high coloured, or tinged yellow, in the jaundiced cases : severe headache and pains in ttoe back and limbs; great debility and restlessness, and occasionally delirium and coma; generally an abrupt cessation or marked mitigation of these
Dr. Crawford. The intermittent fever was of a severe type, and unusually obstinate, with greater tendency to become remittent, and to congestion of lungs, liver, and spleen, than in former years. It was also, in several cases, complicated, with scorbutic and dysenterie symptoms: convalescence was very protracted in many cases, and weakly men were constantly re-admitted after any slight exertion of dutv.
THE INDIAN MEDICAL GAZETTE.
232
It. will be noticed that Dr. of
relapsing fever,
ments
Lyons,
in the above very clear chiefly met with
states that it is
to know, were sufficiently well fed, admirable arrangebeen made by granting furloughs, and timely pro-
having
vision of food for the crisis.
Dr. Crawford
particularly mentions the intermittent type of the fever; and although Dr. Lyons tells us relapsing fever may be intermittent, it is scarcely possible that a medical officer of experience would have mistaken the sufficiently characteristic symptoms of relapsing fever, as detailed by Dr. Lyons, had such been present; especially when, as I can state from my own personal knowledge, that the attention of Dr. Crawford had been drawn to the probability o? relapsing fever occurrina during the famine. But Dr. Crawford gives us no history of an abruptly commencing fever, or of a fever lasting from five to seven days, or of jaundice, or of the characteristic relapse, although indeed mentioning re-admissions. He merely states that the malady was unusually obstinate, with a greater tendency to run into the remitting form, and to congestions of internal organs. He describes, in fact, the ordinary autumnal fevers of the country?maladies which have been frequently similarly described as occurring during seasons when neither famine nor scarcity were prevalent. let it be asked if Dr. the
plain
Lyons
statement of
Dr.
is
justified Crawford,
in comthat he
fever," by asserting that Dr. Crawford did not recognize the malady, and that therefore such malady and this, in the face of Dr. was a variety of relapsing fever; observed
no
famine
Crawford's statement, that. " in November the disease had considerably in prevalence, notwithstanding the famine
abated
existing at the time." The verdict, I think, must, be that Dr. Lyons, although permitted to hold and to express his opinions, was not. justified in the authoritative manner in which he asserts
Dr. Crawford mistaken.
let. it be asked, why Dr. Lyons makes, to say the " an observation as that Dr. Crawford's account of the general population of Rajpoot ana does not support W. J. Moore's statement that there was no relapsing fever in
Thirdly,
least,
of
in connection with the local poor relief, and with local famine works, rendered in a true Christian charitable spirit were as untiring as unobstrusive and valuable. But Dr. Crawford could
never
have been
so
unfortunate
province during the 'faminethe fact being that Dr. supports my statement in every particular. My report of the greater prevalence of fever at Deolee, than at other places,in 1868, has been already mentioned; and my report of the extraordinary prevalence of fever throughout Rajpootana in 1869, when the Deolee dispensary showed one of the highest ratios, has been quoted. In this, therefore, Dr. Crawford and In November, myself are in accord. Dr. Crawford says: notwithstanding the prevalence of famine, the disease had that
Crawford
"
and so do I. Dr. Crawford states that he observed no of famine fever ; and neither did I, although not far from Deolee during the season 1869, and through Deolee, with Dr. abated
cases
Crawford at his hospital, and inspecting the Deolee dispensary, during the season 1868. It is therefore clearly apparent that Dr. Lyons is entirely wrong when he writes, Dr. Crawford's account of the general population of Rajpootana does not support W- J- Moore's statement." Dr. Lyons, by a pecu"
liar mental process, first assumes Dr. Crawford to be wrong, and then from this coign of vantage asserts that Dr. Crawford, thus assumed to bo in error, does not agree with me. But even permitting, for the sake of argument, that Dr. Crawford had not been iu such remarkable concord with myaeif,
more
than
a
few miles from Deolee?
accompanied him on tlie Tonk road, then in progress as a famine work, for a morning ride. And thorefore mentioning Dr. Crawford's report as on the general population of Kajpootana, is simply absurd. In the first season of the famine, I marched through various parts of Rnjpootana, about 1,500 miles. In the second season of the famine about the same distance. My duties were, inspecting dispensaries, and inspecting vaccination. My opportunities, therefore, of becoming acquainted with the condition of the country, were infinitely greater than those afforded to Dr. Crawford. And even were it correct, as Dr. Lyons would have us believe, that relapsing fever occurred at Deolee, I should still consider my opportunities the better for forming an opinion on tlio condition of the general population?opportunities which, considering the immense extent of roadless country to be traversed, entailing five or six months under canvass each year, wore confessedly few enough, but still far superior to those of the gentleman whom, nolens volens, the author of relapsing or famine fever" would set up as his authority on the condition of the general population of the such
distances,
for
"
Secondly, menting on "
accepted as applicable to the general Eajpootana. Dr. Lyons' acquaintance with this part, of the country is probably nil, and ho may be surprised to learn that the province comprises an area of about 123,000 square miles. Dr. Crawford was a friend of mine, and I now lament his death. He was the medical officer of the 2nd .Bengal Cavalry, and his exertions during the memorable period of the famine,
population
among the poorer classes. Dr. Crawford's epidemic occurred among the men of the native cavalry at Deolee, who, I have reason
1873.
his accounts could not be
symptoms on the termination of the fever, with or without free perspiration or diarrhoea. After a complete apyretic interval, varying from 2 to 14 days, but rarely longer, an abrupt relapse. account
[September 1,
province.
\
;
instance,
as
I once
