Remittent Fever and the remainder under Common Continued Fever, Typhus, Typhoid and Ephemeral. The From the same number under each is not specified. Report statistics are cited for the 10 years 1847-56. The strength of the troops aggregated 245,111 and the deaths from all causes were 10,442?42*6 per 1000 of strength. The fever deaths amounted to 1,586, 6*47 per 1000 of strength and 15-1 per cent of the whole: 400 were registered under Remittent Fever, 1,151 under Common Continued Fever, 28 under Ague, 7 under
and
Typhus
under
none
Typhoid.
The next series of figures quoted is from the of the Army Medical Department for the 11 years 1860-70 : strength 659,621, total deaths 16,778?25*4 per 1000 of strength : fever deaths
Reports
per 1000 of
2,135?3*23
and 12*7 per cent
strength
of the whole. The majority of fever deaths (795): are registered under Remittent, 672 are attributed to Continued
Fever,
382 to
Typhus. unde'* the head of Typhoid Fever from
Clje Jfrtbtmx SUftxcgl Svelte. AUGUST
con-
Surgeon-General
At the
typhoid fever
time
report by Surgeon-General prevalence and causation of among European troops in the Bengal 1876 was submitted for review, and the same
J. Kerr-Innes
on
a
the
Command in Commission deliberated
on
both documents simulSecretary of State for
and submitted to the
taneously,
India a memorandum containing the result of their deliberations. The memorandum does not advance any fact or view of much novelty, but it discusses the
question in a sensible, practical manner, and it may be of service to summarise and comment on the conclusions arrived at. of
existing
fever
was
statistics
unknown
British
troops
Report
of the
state of the
The Commission find
on
scrutiny
that, until the year 1861, typhoid as
a
in India.
of
mortality among Figures are quoted from the cause
Royal Commission on the sanitary Army in India in proof of this. During
the 16 years 1838-45 the strength of the European Army in India aggregated 213,192, and the deaths from all causes amounted to 14,271 or 66*9 per 1000 ; among these 2,827 were due to fever, 13'26 per 1000 of strength and 19*8 per cent of the whole. The
majority
of the deaths
(1,599)
were
was
This statement
attention to
public
the
prevalence
Dr. of
Enteric Fever in the European Army in 1870, the officers of the Department had recognised its existence, and the absence of the disease from Dr. Bryden's; tables
Commission have had under
C. A. Gordon's Report on Enteric Fever in the Madras Presidency, on .which we penned some observations in our issue for October last.
1861 onwards
12, 11, 15, 15, 16, 15, 19,47, 44, an important one, because it shows that, before
TYPHOID FEVER IN INDIA.
sideration
Typhoid,
is
1, 1879.
THE ARMY SANITARY COMMISSION ON
Sanitary
259 to
65.
Bryden drew
The Army
Intermittent,
The number of deaths registered
and 29 to
registered
under
prior
to 1871 is
simply due to their imperfect conThis circumstance very strongly indicates
struction.
propriety of so framing statistical tables that they display all particulars of disease-prevalence and
the
may
whether
death-causes, be of interest or
may not appear to the prepossession
they may or importance under
of the hour. The last series of
light
by
or
the Commission
figures adduced Dr. Bryden's summaries for These give an aggregate strength
are
the years 1871-75. of 292,162, a total of
5,149 deaths?17'6 per 1000 ; a total of fever deaths of 823?2-81 per 1000 of strength and 15"9 per cent of the whole. The deaths entered under Enteric Fever amount to 466, more thanahalf of all
fever
deaths ; the
under the heads These
the
remaining 357 being registered Remittent, Continued and Intermittent.
figures place
question
the statistics of diseases,
the matter in very clear
Comes to
owing
Surgeon-General being
is the remarkable
to
(1)
1861 of
light, and change in
altered nomenclature
an
(2) greater precision
the appearance since
are
be,
a
of
diagnosis,
new
or
(3)
fever in India ?
Gordon insists that the old fevers a new name. He goes further
recorded under
the accuracy of the diagnosis, contending " are not those of pythogenic typhoid fever" at all, but various forms of climatic fever. The Commission question the grounds on which Surgeon-
and
impugns
that the
cases
General Gordon's conclusions
were
arrived at.
They
1, 1879.] THE ARMY SANITARY COMMISSION ON TYPHOID FEYER IN INDIA. 235
August
consider that the
India is very
and
follows.
diagnosis of the medical officer treating registering ought to be taken into prominent account, even though the record in the case book" may be imperfect, and they think that this diagnosis should not be rejected because the recorded incidents
clearly brought
out and
stated
as
"
of the
and
case
reported circumstances
the
do not square
surroundings
of the
"
in
even
cases
England will
be found to fail to
furnish them, and if we assume that this fever is always connected with such a cause as sewers we must grant that,
as
there
be
can
there no
Indian stations,
sewers at
are no
Fever.
Cases.
Deaths
116 53
48 17
112
37 28
with theoretical
exactly standards or hypothetical etiological requirements. If precise or typical standard symptoms are arrogated, many
Typhoid
Numbers.
typhoid fever
After all the
there."
Under 24 years, Above 24 years, Two years and under Above two years, These
figures
Brvden's
8,708
27,94-2 8,857 27,793
..
are
conclusion
57
I
very striking, and confirm Dr. that " among young soldiers
many
24 years, of age and under landed in India, I in about 185 of them must die of enteric fever in
European soldiers in India, more, especially young soldiers, and these in the early years of their service,
the first two years of service." Another remarkable fact brought out by Surgeon-General Innes is, that
question is,
what is this fever which is
and what its
mere
posological dispute
public service
the
lead to
to be dealt with.
is of far less
than the
importance
thing itself,
the real
overlooking
There is a very to be accounted
complications
for and its removeable causes
so
"
causes ?
or
cause
fatal fever with enteric
killing
A to
unless it may
of the mischief,
reasons
because these may not be included in the definition." The Commission broadly conclude that Surgeon-General
Gordon has not by any means demonstrated that enteric fever" has not existed and does not exist among British troops in Madras, and in this we agree with them. The evidence recorded in public 11
returns and
reports,
and
repeatedly
in the
pages
doubt on our mind that journal, " true enteric fever," realizing the most reliable and authoritative definitions and descriptions of the type, of this
leaves
does exist to
a
largo
no
extent in the
European Army
of
India. The Commission are, however, quite justified in demanding, under the circumstances, that medical
officers should justify their diagnosis by of symptoms and signs and endeavour
precisely
and
satisfactorily
the
local
a
full detail to fix
and
more
personal
under which cases occur. So that, if the etiology of the disease differs in India in any respect from its etiology in Europe, such differences may be defined and the causation demonstrated for purposes of causes
prevention. They suggest for example that cases which presented at first the symptoms o>f malarial fever and subsequently assumed an enteric type, should be
compared
with
cases
as
presenting
beginning to end for purposes regards both type and causation.
from
The second
with
part
malarial features of differentiation
of the memorandum is concerned
Surgeon-General Innes's special inquiry regarding the circumstances and causes of the cases of typhoid fever which occurred in the Bengal Command in 1876. The influence of age and length of residence in
the
proportion of deaths
in
the
Cavalry
from enteric fever is
higher Artillery than in the Infantry, being 2-34 and 1*56 respectively.
and
the ratios per 1000 Foul stables and stable duties of this difference.
An
assigned
are
attempt
is
made
as
causes
to detail
sanitary defects associated with the cases which occurred at different stations in the Bengal Command in 1876. The result is not satisfactory, and does not establish any specific relation between
the local
particular sanitary defect and this fever. SurgeonGeneral Innes concludes that the enteric fever of India presents the same phenomena during life and
any
same post-mortem appearances as in colder climates. He surmises that the disease is an allied variety of its European congener, and urges that it is vain to look for an identical etiology. The Commission concur in this conclusion, and point to temperature and malaria as probably exercising a modifying causative influence. It may be useful to quote at length the general conclusions formulated by the Commission. They are these.
the
"enteric" fever in India is soldiers during the earlier and the surest way to arrest the of service, periods mortality, were it practicable, would be to land soldiers in India after the 24th year of their age.
and
Typhus
under
none
Typhoid.
The next series of figures quoted is from the of the Army Medical Department for the 11 years 1860-70 : strength 659,621, total deaths 16,778?25*4 per 1000 of strength : fever deaths
Reports
per 1000 of
2,135?3*23
and 12*7 per cent
strength
of the whole. The majority of fever deaths (795): are registered under Remittent, 672 are attributed to Continued
Fever,
382 to
Typhus. unde'* the head of Typhoid Fever from
Clje Jfrtbtmx SUftxcgl Svelte. AUGUST
con-
Surgeon-General
At the
typhoid fever
time
report by Surgeon-General prevalence and causation of among European troops in the Bengal 1876 was submitted for review, and the same
J. Kerr-Innes
on
a
the
Command in Commission deliberated
on
both documents simulSecretary of State for
and submitted to the
taneously,
India a memorandum containing the result of their deliberations. The memorandum does not advance any fact or view of much novelty, but it discusses the
question in a sensible, practical manner, and it may be of service to summarise and comment on the conclusions arrived at. of
existing
fever
was
statistics
unknown
British
troops
Report
of the
state of the
The Commission find
on
scrutiny
that, until the year 1861, typhoid as
a
in India.
of
mortality among Figures are quoted from the cause
Royal Commission on the sanitary Army in India in proof of this. During
the 16 years 1838-45 the strength of the European Army in India aggregated 213,192, and the deaths from all causes amounted to 14,271 or 66*9 per 1000 ; among these 2,827 were due to fever, 13'26 per 1000 of strength and 19*8 per cent of the whole. The
majority
of the deaths
(1,599)
were
was
This statement
attention to
public
the
prevalence
Dr. of
Enteric Fever in the European Army in 1870, the officers of the Department had recognised its existence, and the absence of the disease from Dr. Bryden's; tables
Commission have had under
C. A. Gordon's Report on Enteric Fever in the Madras Presidency, on .which we penned some observations in our issue for October last.
1861 onwards
12, 11, 15, 15, 16, 15, 19,47, 44, an important one, because it shows that, before
TYPHOID FEVER IN INDIA.
sideration
Typhoid,
is
1, 1879.
THE ARMY SANITARY COMMISSION ON
Sanitary
259 to
65.
Bryden drew
The Army
Intermittent,
The number of deaths registered
and 29 to
registered
under
prior
to 1871 is
simply due to their imperfect conThis circumstance very strongly indicates
struction.
propriety of so framing statistical tables that they display all particulars of disease-prevalence and
the
may
whether
death-causes, be of interest or
may not appear to the prepossession
they may or importance under
of the hour. The last series of
light
by
or
the Commission
figures adduced Dr. Bryden's summaries for These give an aggregate strength
are
the years 1871-75. of 292,162, a total of
5,149 deaths?17'6 per 1000 ; a total of fever deaths of 823?2-81 per 1000 of strength and 15"9 per cent of the whole. The deaths entered under Enteric Fever amount to 466, more thanahalf of all
fever
deaths ; the
under the heads These
the
remaining 357 being registered Remittent, Continued and Intermittent.
figures place
question
the statistics of diseases,
the matter in very clear
Comes to
owing
Surgeon-General being
is the remarkable
to
(1)
1861 of
light, and change in
altered nomenclature
an
(2) greater precision
the appearance since
are
be,
a
of
diagnosis,
new
or
(3)
fever in India ?
Gordon insists that the old fevers a new name. He goes further
recorded under
the accuracy of the diagnosis, contending " are not those of pythogenic typhoid fever" at all, but various forms of climatic fever. The Commission question the grounds on which Surgeon-
and
impugns
that the
cases
General Gordon's conclusions
were
arrived at.
They
1, 1879.] THE ARMY SANITARY COMMISSION ON TYPHOID FEYER IN INDIA. 235
August
consider that the
India is very
and
follows.
diagnosis of the medical officer treating registering ought to be taken into prominent account, even though the record in the case book" may be imperfect, and they think that this diagnosis should not be rejected because the recorded incidents
clearly brought
out and
stated
as
"
of the
and
case
reported circumstances
the
do not square
surroundings
of the
"
in
even
cases
England will
be found to fail to
furnish them, and if we assume that this fever is always connected with such a cause as sewers we must grant that,
as
there
be
can
there no
Indian stations,
sewers at
are no
Fever.
Cases.
Deaths
116 53
48 17
112
37 28
with theoretical
exactly standards or hypothetical etiological requirements. If precise or typical standard symptoms are arrogated, many
Typhoid
Numbers.
typhoid fever
After all the
there."
Under 24 years, Above 24 years, Two years and under Above two years, These
figures
Brvden's
8,708
27,94-2 8,857 27,793
..
are
conclusion
57
I
very striking, and confirm Dr. that " among young soldiers
many
24 years, of age and under landed in India, I in about 185 of them must die of enteric fever in
European soldiers in India, more, especially young soldiers, and these in the early years of their service,
the first two years of service." Another remarkable fact brought out by Surgeon-General Innes is, that
question is,
what is this fever which is
and what its
mere
posological dispute
public service
the
lead to
to be dealt with.
is of far less
than the
importance
thing itself,
the real
overlooking
There is a very to be accounted
complications
for and its removeable causes
so
"
causes ?
or
cause
fatal fever with enteric
killing
A to
unless it may
of the mischief,
reasons
because these may not be included in the definition." The Commission broadly conclude that Surgeon-General
Gordon has not by any means demonstrated that enteric fever" has not existed and does not exist among British troops in Madras, and in this we agree with them. The evidence recorded in public 11
returns and
reports,
and
repeatedly
in the
pages
doubt on our mind that journal, " true enteric fever," realizing the most reliable and authoritative definitions and descriptions of the type, of this
leaves
does exist to
a
largo
no
extent in the
European Army
of
India. The Commission are, however, quite justified in demanding, under the circumstances, that medical
officers should justify their diagnosis by of symptoms and signs and endeavour
precisely
and
satisfactorily
the
local
a
full detail to fix
and
more
personal
under which cases occur. So that, if the etiology of the disease differs in India in any respect from its etiology in Europe, such differences may be defined and the causation demonstrated for purposes of causes
prevention. They suggest for example that cases which presented at first the symptoms o>f malarial fever and subsequently assumed an enteric type, should be
compared
with
cases
as
presenting
beginning to end for purposes regards both type and causation.
from
The second
with
part
malarial features of differentiation
of the memorandum is concerned
Surgeon-General Innes's special inquiry regarding the circumstances and causes of the cases of typhoid fever which occurred in the Bengal Command in 1876. The influence of age and length of residence in
the
proportion of deaths
in
the
Cavalry
from enteric fever is
higher Artillery than in the Infantry, being 2-34 and 1*56 respectively.
and
the ratios per 1000 Foul stables and stable duties of this difference.
An
assigned
are
attempt
is
made
as
causes
to detail
sanitary defects associated with the cases which occurred at different stations in the Bengal Command in 1876. The result is not satisfactory, and does not establish any specific relation between
the local
particular sanitary defect and this fever. SurgeonGeneral Innes concludes that the enteric fever of India presents the same phenomena during life and
any
same post-mortem appearances as in colder climates. He surmises that the disease is an allied variety of its European congener, and urges that it is vain to look for an identical etiology. The Commission concur in this conclusion, and point to temperature and malaria as probably exercising a modifying causative influence. It may be useful to quote at length the general conclusions formulated by the Commission. They are these.
the
"enteric" fever in India is soldiers during the earlier and the surest way to arrest the of service, periods mortality, were it practicable, would be to land soldiers in India after the 24th year of their age.
