experience declares that he is unable to form a definite or judgment regarding the nature of the fever which has been devastating the districts of Burdwan and Hooghly, two conclusions become very evident,?first, that we should suspend our belief in the existence of typhoid or typhus fever until more satisfactory and convincing evidence is forthcoming ; and, secondly, as Dr. Chevers very pointedly indicates, that there is an urgent need for such a careful and elaborate investigation and
final
'
of those Indian fevers which manifest
type,
and
are
or
appear to be
a
remittent or continued
contagious,
that all doubts
to their nature and causation shall be set at rest.
position, as regards the Hooghly fevers, is this.
as
present
nature and type of the Burdwan and A host of medical witnesses have
paludal, and have testified that the essentially and prominently a periodic fever, manifesting all phases of periodicity, from mild intermittents to the most malignant remittents, with head symptoms, bilious vomiting jaundice, and diarrhoea. They have also described the sequela) of cases which do not prove fatal, as those which we Tcnow to occur in marsh fevers and in none others. There, therefore, can be no manner of doubt that, whatever else there may be, we have to do mainly with a marsh fever. Dr. Boy's paper, which we print on another page, gives strong confirmation of this view. Dr. Yerchere, on the strength of what wo must pronounce a most insufficient induction, has arrived described it
as
malarial
Our
or
fever is
at the conclusion that the fundamental type of the disease prevailing in Burdwan and Hooghly is typhus, and ho looks upon the ague, or malarious element, as phenomenon; and, in the correspondence under
secondary review, we find Dr. Greene, on evidence which a distinguished pathologist pronounces to be defective and inconclusive, insisting that the fever he has had to deal with is typhoid. Under these circumstances, the wise
course
a
appears to be to hold to the
origin of this malady until we possess more paludal convincing testimony than has hitherto been forthcoming, in support of its being a true instance either of the specific typhus nature and
THE INVESTIGATION OF INDIAN FEVERS. We
publish elsewhere a most interesting and important correspondence regarding the nature of the fever which has during recent years been prevailing in the district of Hooghly, and which appeared in force in and around the town of Seranipore during the cold season of 1872-73. Dr. Greene, the Civil Surgeon Serampore, has arrived at the conclusion that this fever is typhoid in type. In the reports which we reprint he shows that he studied the phenomena of the prevailing malady very carefully, and in a very large number of instances, and gives in detail the grounds on which he has arrived at and holds the opinion that the disease is nothing else than typhoid These reports were submitted by the medical or enteric fever. of
true
department to Dr. Norman Chevers, than whom there is no Dr. more competent judge in India on such a subject. a careful study of the papers, declares that he after Chevers, is quite unable to decide whether the fever in question was true enteric fever or a paludal {ever Mhich had, through intensity of the poison and malignancy of the symptoms, run into the
typhoid
or
typhus-like
state which
we
lately
described
His judgment rather inclines to the latter in these pages. ?view, on the ground that the sequelae described by Dr. Greene, as
occurring
in cases which did not prove
fatal,
are
specially
characteristic of paludal fever and not at all characteristic of ?nteric fever. When a physician of Dr. Chevers' acquirements
or
enteric fever. "We do not overlook the circumstance that the
spread of this disease indicates to some extent a contagious quality ; but an endemic disease very frequently, unless investigation is very discriminating and minute, wears an appearance of contagiousness, and we do not attach much value to the apparent relation of the so-called epidemic to lines of road. The seizure of several members of the same family successively gives, also, as Dr. Roy remarks, a fallacious indication of contagiousness. It is quite apparent, however, that a special investigation of Indian fevers, by competent agents, and with the aid of all the appliances of modern research, is loudly demanded. The demand arises simultaneously from many quarters, and cannot long be resisted. Dr. Ewart, in his reports of the Calcutta General Hospital, has strongly insisted on the urgent necessity of a special investigation of Indian fevers. Dr. Fairweather, in his Sanitary Beport of the Punjab for 1872, which we review elsewhere, gives strong reasons for a similar recommendation, and is supported by the local Government. The medical department earnestly urged a special inquiry regarding the nature and causation of the Burdwan fever, and we observe from the last administration report of the Bengal Government that the matter has been warmly pressed on the Government of India. Dr. Chevers, in the correspondence now under notice, mode of
Mabch 2,
THE G?A1NTT MEDICAL COLLEGE, BOMBAY.
1874.]'
it is for hygienic and therashows how absolutely necessary as for scientific purposes to determine what well as peutic,
really is. unsatisfactory
the Burdwan fever
We have ourselves
repeatedly our knowledge regardpointed ing remittent and continued fevers in India, and urged special enquiry. It may be argued, indeed, that medical officers of ability and experience are scattered all over India, and possess every opportunity of adding to our knowledge of Indian out the
state of
fevers of every form and in every circumstance. Executive often Tery severe and exacting, is not, however,
work,
consistent with which
alone
the can
systematic solve
the
and
painstaking investigation in question, and very necessary appliances or the
points
few medical officers possess the time to make use of them. We look to medical officers for as
much observation and information
and
we
are
not
disappointed;
circumstances
admit, something more is wanted, sole duty and occupation it as
but
special agency whose prosecute this enquiry. Fever in India is a much more important subject as concerns life and health than cholera, and the one is more worthy of special attention than the other. We would, therefore, most earnestly press on the attention of Government the absolute necessity which exists of increasing our knowledge regarding Indian fevers ; and, with an increase of knowledge, an increase of power of prevention and cure will unfailingly come. No better opportunity can exist than now exists in Burdwan of making a commencement. The fever there is at present in abeyance, but it will inevitably break out again during and after the ensuing rains, and there is abundance of time to commission and equip two or more competent medical officers to conduct an inquiry regarding its nature and causation before then. We observe that the Punjab Government has appointedacommission,consisting of Drs. Dallas, Gray, and Scriven, to make inquiries regarding the fever which prevailed last year in the Kawulpindee jail. We much doubt the utility of oral inquiries conducted after an epidemic has disappeared. What is really wanted is systematic and skilled observation during the progress of an epidemic. namely,
a
shall be to
71
final
'
of those Indian fevers which manifest
type,
and
are
or
appear to be
a
remittent or continued
contagious,
that all doubts
to their nature and causation shall be set at rest.
position, as regards the Hooghly fevers, is this.
as
present
nature and type of the Burdwan and A host of medical witnesses have
paludal, and have testified that the essentially and prominently a periodic fever, manifesting all phases of periodicity, from mild intermittents to the most malignant remittents, with head symptoms, bilious vomiting jaundice, and diarrhoea. They have also described the sequela) of cases which do not prove fatal, as those which we Tcnow to occur in marsh fevers and in none others. There, therefore, can be no manner of doubt that, whatever else there may be, we have to do mainly with a marsh fever. Dr. Boy's paper, which we print on another page, gives strong confirmation of this view. Dr. Yerchere, on the strength of what wo must pronounce a most insufficient induction, has arrived described it
as
malarial
Our
or
fever is
at the conclusion that the fundamental type of the disease prevailing in Burdwan and Hooghly is typhus, and ho looks upon the ague, or malarious element, as phenomenon; and, in the correspondence under
secondary review, we find Dr. Greene, on evidence which a distinguished pathologist pronounces to be defective and inconclusive, insisting that the fever he has had to deal with is typhoid. Under these circumstances, the wise
course
a
appears to be to hold to the
origin of this malady until we possess more paludal convincing testimony than has hitherto been forthcoming, in support of its being a true instance either of the specific typhus nature and
THE INVESTIGATION OF INDIAN FEVERS. We
publish elsewhere a most interesting and important correspondence regarding the nature of the fever which has during recent years been prevailing in the district of Hooghly, and which appeared in force in and around the town of Seranipore during the cold season of 1872-73. Dr. Greene, the Civil Surgeon Serampore, has arrived at the conclusion that this fever is typhoid in type. In the reports which we reprint he shows that he studied the phenomena of the prevailing malady very carefully, and in a very large number of instances, and gives in detail the grounds on which he has arrived at and holds the opinion that the disease is nothing else than typhoid These reports were submitted by the medical or enteric fever. of
true
department to Dr. Norman Chevers, than whom there is no Dr. more competent judge in India on such a subject. a careful study of the papers, declares that he after Chevers, is quite unable to decide whether the fever in question was true enteric fever or a paludal {ever Mhich had, through intensity of the poison and malignancy of the symptoms, run into the
typhoid
or
typhus-like
state which
we
lately
described
His judgment rather inclines to the latter in these pages. ?view, on the ground that the sequelae described by Dr. Greene, as
occurring
in cases which did not prove
fatal,
are
specially
characteristic of paludal fever and not at all characteristic of ?nteric fever. When a physician of Dr. Chevers' acquirements
or
enteric fever. "We do not overlook the circumstance that the
spread of this disease indicates to some extent a contagious quality ; but an endemic disease very frequently, unless investigation is very discriminating and minute, wears an appearance of contagiousness, and we do not attach much value to the apparent relation of the so-called epidemic to lines of road. The seizure of several members of the same family successively gives, also, as Dr. Roy remarks, a fallacious indication of contagiousness. It is quite apparent, however, that a special investigation of Indian fevers, by competent agents, and with the aid of all the appliances of modern research, is loudly demanded. The demand arises simultaneously from many quarters, and cannot long be resisted. Dr. Ewart, in his reports of the Calcutta General Hospital, has strongly insisted on the urgent necessity of a special investigation of Indian fevers. Dr. Fairweather, in his Sanitary Beport of the Punjab for 1872, which we review elsewhere, gives strong reasons for a similar recommendation, and is supported by the local Government. The medical department earnestly urged a special inquiry regarding the nature and causation of the Burdwan fever, and we observe from the last administration report of the Bengal Government that the matter has been warmly pressed on the Government of India. Dr. Chevers, in the correspondence now under notice, mode of
Mabch 2,
THE G?A1NTT MEDICAL COLLEGE, BOMBAY.
1874.]'
it is for hygienic and therashows how absolutely necessary as for scientific purposes to determine what well as peutic,
really is. unsatisfactory
the Burdwan fever
We have ourselves
repeatedly our knowledge regardpointed ing remittent and continued fevers in India, and urged special enquiry. It may be argued, indeed, that medical officers of ability and experience are scattered all over India, and possess every opportunity of adding to our knowledge of Indian out the
state of
fevers of every form and in every circumstance. Executive often Tery severe and exacting, is not, however,
work,
consistent with which
alone
the can
systematic solve
the
and
painstaking investigation in question, and very necessary appliances or the
points
few medical officers possess the time to make use of them. We look to medical officers for as
much observation and information
and
we
are
not
disappointed;
circumstances
admit, something more is wanted, sole duty and occupation it as
but
special agency whose prosecute this enquiry. Fever in India is a much more important subject as concerns life and health than cholera, and the one is more worthy of special attention than the other. We would, therefore, most earnestly press on the attention of Government the absolute necessity which exists of increasing our knowledge regarding Indian fevers ; and, with an increase of knowledge, an increase of power of prevention and cure will unfailingly come. No better opportunity can exist than now exists in Burdwan of making a commencement. The fever there is at present in abeyance, but it will inevitably break out again during and after the ensuing rains, and there is abundance of time to commission and equip two or more competent medical officers to conduct an inquiry regarding its nature and causation before then. We observe that the Punjab Government has appointedacommission,consisting of Drs. Dallas, Gray, and Scriven, to make inquiries regarding the fever which prevailed last year in the Kawulpindee jail. We much doubt the utility of oral inquiries conducted after an epidemic has disappeared. What is really wanted is systematic and skilled observation during the progress of an epidemic. namely,
a
shall be to
71
