The effect of well water in producing typhoid fever cannot he satisfactorily proved, but the original suspicion of its beinc th?J source of the disease has been greatly strengthened by the report; of the medical officer of Privy Council on several late outbreaks of typhoid fever in England, and noticed in the Times of 27th August last, which bears on the present epidemic, so as hardly to leave a doubt that the same cause has been at work here, viz., excremental contamination of water. That the disease owed its origin to some local cause is further borne out by these facts. The first suspicious case occurred fully 3 weeks after arrival at the station; no instance of a similar form of disease had been, observed in the other corps, Native or European, nor among the civil population, nor was there much similarity between it and the fever that raged in the Lahore jail several years ago, and last summer again am >ng the Abyssinian muleteers. Rose-coloured spots on the skin and gurgling in the ileum wore not unfrequent, and the characteristic lesion of the bowels and mesentery was in every fatal case invariable. Many cases were returned as remittent fevers, and not a few as cephalica, and one case of pneumonia and two of bronchitis were most severe attacks. ***### The greatest defect in the hygiene of the station during the year has been the well water. Its influence on the health o? the Regiment has been marked, and will yet affect it. The general health, oven when no immediate effect was observed by it, became below par. Many men who suffered from diarrhcea in April had relapses of that or some allied complaint, or became cachectic, and seemed, to use the words of the report already referred li to drag through a protracted convalescence to an imperfect to, so
dSwMjHiniUttrt, TYPHOID FEVER, Itf MEEAN MEER.
recovery." TO TIIE EDITOR OP THE INDIAN MEDICAL GAZETTE.
Dear Sir,?Dr. Bryden in liis " Vital Statistics" makes reference to my opinion that the well water at Meean Meer was the cause of typhoid fever in the 85th regiment there from 1868 to 1870. The enclosed extracts from the annual medical reports of the
regiment are herewith forwarded, in the hope that their bearing Dr. Bryden's "generalisations," and the importance of the subject nt the present time, may at this distant date justify on
their publication. These generalisations
are?
?That typhoid is the disease of young in the hot weather of the first
principally India.
soldiers, occurring year's residence in
2nd.?That it is of spontaneous origin, and due to the inof heat and change of climate, and not attributable to a local cause. The first year's experience (1868) bears out the first of the generalisations. Among 460 men under 25 years of age, 7 of the 11 fatal cases occurred, and all died between May and September with one exception. The cessation of the disease throughout 1869, the second year residence, and its reappearance in the cold weather of 1870 the corninencimvnt of the third year's residence, among old soldiers, are opposed to this view, while the coincidence of the epidemics with the use of the notoriously impure well water gave good grounds for considering that to be the local cause
fluence
the outbreaks. Another fact, difficult to reconcile with the "influence of
neat"
theory, took place at Meean Meer during the camp held in February 1870. At the same time typhoid fever was present in the 85th foot; the 5th Lancers on the march to Sealkot'e "^ore suffering from it, while the other regiments including t''e 39th foot, only 4 months from Ireland, and the 92nd Highlanders, 3 years in India, were free from it. The reason for reonly to fatal cases in these reports was the disinclination ?f many at that time to believe that the fever was really typhoid unless diagnosis was confirmed by post-mortem examinatbere
aring
tion.
I am, &o., Wm. Sicef.x,
Surgeon-Major, Extract Of those diseases
85th
from Report for
Light Infantry. 1808.
typhoid fever was the most fatal. From this alone rnu" occurred, including the fatal case of abscess, -tt, hom?st probable causo of this outbreak was supposed to bo ,''?o wpU -which an epidemic of diarrhoea was also caused Wftt,ert after the arrival of the regiment. reference to tho Sanitary Commissioner's Tleport, it appeared V**t the well water was unfit for use, owing to the prevalence of matter introduced from tho neighbouring now disused cessP?o!s. On tho substitution'of canal water, diarrhoea immediately Several instances again and again occurred, and wore almost Variably traced to the use of well water.
lttitno(liately t,()i ^rffanic
|?asc(l.
Detract from Annual Report for 1869. Enteric fever, which had been the Cause of 11 deaths in 1833, nlmost disappeared during the last year. One case terminated fat,illy and perhaps sis others occurred. Its prevalence in 1868 lias influenced the doath-rate of the present year materially. The postmortem appearances in the ileum in the three fatal cases of phthisis, acute miliary tuberculosis and hypertrophy of heart with pulmonary extravasation showed that they had suffered from enteric fever in 1868, as was suspected. The effect of hill residence on those who had suffered from this disease in 1868, has resulted apparently in complete recovery. The outbreak was supposed to have been caused by well water in the infantry lines. During the present year these wells have not been used for drinking or cooking purposes, excepting for three days in August, when the canal supply failed. The fatal case occurred subsequent to this.
Detract from Annual Report of 1870. Enteric fever, which had almost ceased during 1869, reappeared in the early part of 1870. A patient, admitted on 1st January for ague, began to show sus~ picious symptoms about the 12th, and died after a prolonged iiluessThe post-mortem appearances were well marked, and admitted of no doubt as to the real nature of the disease. Before the end of January there were several patients suffering' similarly and before the end of May, 8 cases had been entered, of which 7 proved fatal. Subsequent to this, with the exception of the fatal case of diarrhoea in September, no instance occurred throughout the remaining portion of the year. The intimate connection of this outbreak and of those of 1865 and 1869 with the water supply of the infantry line3 has been so extraordinary as scarcely to leave a doubt that the well water hist been the source of the disease as originally suspected on its first of the Regiment. ; appearance immediately after the arrival The wells according to 11 r. Strachey's Report (Cholera Commiswhiclr old from feet distant than 180 more not are cesspools sioner) full ot were 60 feet deep, nnd some of which had been at one time excrement to within a few feet of the surface. and fresh healthy. The Regiment left Ireland on the 30th January scarlatina among the Excepting two deaths f *om measles and from for long before children, no death or serious sickness had occurred Un embarkation or during the voyage or progress up-country. for several used was water arrival at Meean Meer on 5th April, well , days for every purpose. and from 5th July It was also used from 23th June to 1st July, when the canal tailed, and it was also detected in the to the ?
18th,
barrack filters frequently during tins period deaths had occurred at Meean Before the end of September 10 Meer and Fort Lahore. userl tor two days in August when In 13J9 well water was only 29th October the only fatal case of the canal was dry. On the the present year the canal was dry from typhoid fever died. In l'st January to 5th February, and during that time water from a well that h id been previously filled from the canal was used for drinking and cooking. On the 1st January there was not a suspicious ca'se of fever in hospital. On the 11th a case of ague was observed to show symptoms of, and eventually died of enteric fever. Before the end of Marck four deaths had taken place, two more occurred in April and one i" .
52
THE INDIAN MEDICAL GAZETTE.
from the same cause, and probably also tlio fatal case of remitfever and diarrhoea in September. During these three years the Koyal Artillery at the station havo not suffered from the disease, and up to the end of March of this year had only lost one man (from local disease), while in 1869, when the canal did not fail and was the source of the water supply generally, the artillery death-rate was considerably higher than that of the 85th. The only condition not common to both is the absence of these " cloacro" in the artillery lines. These facts a more delicate test than is known to nppenr to be chemistry of the excremental contamination of these wells, and strongly support the analyses latterly made. There are several points in the last outbreaks at considerable variance with the opinion expressed in the latest reports of the variQus sanitary commissioners, vis., that first year's soldiers and particularly young men are most liable to attack, and that it is a disease of the hot weather. Of the severe fatal cases returned, five wero over two years in the country and over 25 years of age; two had been three months in the country, one of whom was over 23 years of age; all of them died before the middle of May, viz., three in February, 1 in March, 2 in April, and 1 in May. This experience has been confirmed in two fatal cases of the same disease transferred to the Hospital 8^th Regiment by tho 5th Lancers in February. The total admissions from enteric fever were 8; this by no means indicates, its extent. Many of the long continued illnesses were doubtless caused by it and the cachectic state of health of tho Regiment generally in the early part of the year, and even now, is in a great measure attributed to the poisonous influence of the ?well water.
May tent
[Febiutaey 1,
1875.
dSwMjHiniUttrt, TYPHOID FEVER, Itf MEEAN MEER.
recovery." TO TIIE EDITOR OP THE INDIAN MEDICAL GAZETTE.
Dear Sir,?Dr. Bryden in liis " Vital Statistics" makes reference to my opinion that the well water at Meean Meer was the cause of typhoid fever in the 85th regiment there from 1868 to 1870. The enclosed extracts from the annual medical reports of the
regiment are herewith forwarded, in the hope that their bearing Dr. Bryden's "generalisations," and the importance of the subject nt the present time, may at this distant date justify on
their publication. These generalisations
are?
?That typhoid is the disease of young in the hot weather of the first
principally India.
soldiers, occurring year's residence in
2nd.?That it is of spontaneous origin, and due to the inof heat and change of climate, and not attributable to a local cause. The first year's experience (1868) bears out the first of the generalisations. Among 460 men under 25 years of age, 7 of the 11 fatal cases occurred, and all died between May and September with one exception. The cessation of the disease throughout 1869, the second year residence, and its reappearance in the cold weather of 1870 the corninencimvnt of the third year's residence, among old soldiers, are opposed to this view, while the coincidence of the epidemics with the use of the notoriously impure well water gave good grounds for considering that to be the local cause
fluence
the outbreaks. Another fact, difficult to reconcile with the "influence of
neat"
theory, took place at Meean Meer during the camp held in February 1870. At the same time typhoid fever was present in the 85th foot; the 5th Lancers on the march to Sealkot'e "^ore suffering from it, while the other regiments including t''e 39th foot, only 4 months from Ireland, and the 92nd Highlanders, 3 years in India, were free from it. The reason for reonly to fatal cases in these reports was the disinclination ?f many at that time to believe that the fever was really typhoid unless diagnosis was confirmed by post-mortem examinatbere
aring
tion.
I am, &o., Wm. Sicef.x,
Surgeon-Major, Extract Of those diseases
85th
from Report for
Light Infantry. 1808.
typhoid fever was the most fatal. From this alone rnu" occurred, including the fatal case of abscess, -tt, hom?st probable causo of this outbreak was supposed to bo ,''?o wpU -which an epidemic of diarrhoea was also caused Wftt,ert after the arrival of the regiment. reference to tho Sanitary Commissioner's Tleport, it appeared V**t the well water was unfit for use, owing to the prevalence of matter introduced from tho neighbouring now disused cessP?o!s. On tho substitution'of canal water, diarrhoea immediately Several instances again and again occurred, and wore almost Variably traced to the use of well water.
lttitno(liately t,()i ^rffanic
|?asc(l.
Detract from Annual Report for 1869. Enteric fever, which had been the Cause of 11 deaths in 1833, nlmost disappeared during the last year. One case terminated fat,illy and perhaps sis others occurred. Its prevalence in 1868 lias influenced the doath-rate of the present year materially. The postmortem appearances in the ileum in the three fatal cases of phthisis, acute miliary tuberculosis and hypertrophy of heart with pulmonary extravasation showed that they had suffered from enteric fever in 1868, as was suspected. The effect of hill residence on those who had suffered from this disease in 1868, has resulted apparently in complete recovery. The outbreak was supposed to have been caused by well water in the infantry lines. During the present year these wells have not been used for drinking or cooking purposes, excepting for three days in August, when the canal supply failed. The fatal case occurred subsequent to this.
Detract from Annual Report of 1870. Enteric fever, which had almost ceased during 1869, reappeared in the early part of 1870. A patient, admitted on 1st January for ague, began to show sus~ picious symptoms about the 12th, and died after a prolonged iiluessThe post-mortem appearances were well marked, and admitted of no doubt as to the real nature of the disease. Before the end of January there were several patients suffering' similarly and before the end of May, 8 cases had been entered, of which 7 proved fatal. Subsequent to this, with the exception of the fatal case of diarrhoea in September, no instance occurred throughout the remaining portion of the year. The intimate connection of this outbreak and of those of 1865 and 1869 with the water supply of the infantry line3 has been so extraordinary as scarcely to leave a doubt that the well water hist been the source of the disease as originally suspected on its first of the Regiment. ; appearance immediately after the arrival The wells according to 11 r. Strachey's Report (Cholera Commiswhiclr old from feet distant than 180 more not are cesspools sioner) full ot were 60 feet deep, nnd some of which had been at one time excrement to within a few feet of the surface. and fresh healthy. The Regiment left Ireland on the 30th January scarlatina among the Excepting two deaths f *om measles and from for long before children, no death or serious sickness had occurred Un embarkation or during the voyage or progress up-country. for several used was water arrival at Meean Meer on 5th April, well , days for every purpose. and from 5th July It was also used from 23th June to 1st July, when the canal tailed, and it was also detected in the to the ?
18th,
barrack filters frequently during tins period deaths had occurred at Meean Before the end of September 10 Meer and Fort Lahore. userl tor two days in August when In 13J9 well water was only 29th October the only fatal case of the canal was dry. On the the present year the canal was dry from typhoid fever died. In l'st January to 5th February, and during that time water from a well that h id been previously filled from the canal was used for drinking and cooking. On the 1st January there was not a suspicious ca'se of fever in hospital. On the 11th a case of ague was observed to show symptoms of, and eventually died of enteric fever. Before the end of Marck four deaths had taken place, two more occurred in April and one i" .
52
THE INDIAN MEDICAL GAZETTE.
from the same cause, and probably also tlio fatal case of remitfever and diarrhoea in September. During these three years the Koyal Artillery at the station havo not suffered from the disease, and up to the end of March of this year had only lost one man (from local disease), while in 1869, when the canal did not fail and was the source of the water supply generally, the artillery death-rate was considerably higher than that of the 85th. The only condition not common to both is the absence of these " cloacro" in the artillery lines. These facts a more delicate test than is known to nppenr to be chemistry of the excremental contamination of these wells, and strongly support the analyses latterly made. There are several points in the last outbreaks at considerable variance with the opinion expressed in the latest reports of the variQus sanitary commissioners, vis., that first year's soldiers and particularly young men are most liable to attack, and that it is a disease of the hot weather. Of the severe fatal cases returned, five wero over two years in the country and over 25 years of age; two had been three months in the country, one of whom was over 23 years of age; all of them died before the middle of May, viz., three in February, 1 in March, 2 in April, and 1 in May. This experience has been confirmed in two fatal cases of the same disease transferred to the Hospital 8^th Regiment by tho 5th Lancers in February. The total admissions from enteric fever were 8; this by no means indicates, its extent. Many of the long continued illnesses were doubtless caused by it and the cachectic state of health of tho Regiment generally in the early part of the year, and even now, is in a great measure attributed to the poisonous influence of the ?well water.
May tent
[Febiutaey 1,
1875.
