TYPHOID FEVER. The
Array
of enteric fever in the European occupies a dozen pages of the twenty-
subject
sixth annual report of the Sanitary Commissioner with the Government of India, and it is
agreeable to note therein that the useless and pernicious statistical method of diagnosis as adopted by the special commission to enquire into the alleged increase of enteric fever has, As and let us hope finally, been abandoned. our consideration of was out time at the pointed of that report, the application of the statistical building a theory thereon was radically wrong, misleading, and not adapted to the scientific advances of the day, and it was not by such means that the question as to the prevalence of enteric fever in Lucknow, Meerut, method and the
and elsewhere could be settled, nor could the of such suspected prevalence be thus
causes
ascertained. be decided of
the
most
The issue,
by malady
recent
a
study
Ave
observed,
only
aided
by the adoption of bacteriological, microscopical
chemical tests, whilst prevalence could be
a
clue to the
onl}'
prevalence
causes
obtained
ployment of those well-known quiry pursued in England and time of the
could
of the clinical features
by
the and
of its
the
methods of
emen-
elsewhere at the
of the disease and
011
the spot. A beginning has been made in this direction. The bacillus typhosus has been found, not by an Indian Medical Officer, but by Professor Bernhard Fischer of Kiel, in Germany, in specimens of spleen and mesenteric glands forwarded to that distinguished bacteriologist from two cases of enteric fever. rial
to
tion
was
The transmission of the matefor the purpose of identifica-
Germany probably prompted by
a
desire to have
it examined
familiar with the
necessary and reactions
with the appearby the typhoid
by an observer manipulations and
presented micro-orgauism and the identification
ance
may be
Joly
TYPHOID FEVEE.
1891.]
accepted
as
more
authoritative than if
been announced
Indian
cannot
that it
by an help remarking
India should have
to resort
work of this kind.
it had
observer, still we pity that to Germany for
seems a
We would here repeat what frequently urged in this journal, that the arrangements for the scientific study of disease in India are not such as we should wish
have
we
or as
the circumstances of the
211
that suspicious wells should be shut up, and that all wSlls should be regularly cleansed. It is worthy of note that Fort William, which
analysed;
has
an
fever
an
excellent
water-supply,
admission
rate per
had of enteric
1,000 of the strength
only "9 and no deaths, against Bareilly and Mhow, with admission rates of 77'9 and 75-4 a mortality of 23-77 per 1,000 of strength, and The bazaars and 17*89 1,000 respectively. per country render for their of
of Calcutta are not conspicuous sanitary practicable. bazaars in from differ If condition. Upper they The discovery however of the bacillus tya in it is possessing purer water-supply, and phosus by Professor Fischer in these two India, it is in this respect also that we think Fort specimens, and later on by Surgeon-Major Rankof the military caning in the urine of a third case, leads, as the Sani- William differs from many
desirable and
Commissioner
tary
to the
remarks,
conclusion
that at least some of the fatal fevers of India with intestinal lesions are identical with the enteric fever of
Europe.
climate
considered
And that hence the source of real enteric fever in India must be looked for in the contamination of ingesta, and ence.
must be
This is
doubtless will be followed
There
are
a
by practical
some
of India.
parts
interesting
statements in the
The
Sanitary Commissioner's report.
following
table shows the young soldier under 24 to be five times more liable to enteric fever than the soldier above 30:?
influ-
secondary important conclusion,
a most
tonments in other
Mortality
from Enteric Fever and ratio op .LIABILITY TO IT AT DIFFERENT AGES.
and
results.
24 and under.
only necessarv to read the extracts furnished in the report of the sanitary condition of
25 to 29.
It is
3
a Ia military stations to be satisfied that a ? P4 all is not above suspicion. 9-81 G4-50 3-25 21-37 1-83 12-03 Impure or suspicious water-supply, sub-soil 1889 close contaminated proxipollution, milk-supply, mity of trenching grounds to barracks, and This, however, only bears out the experience defective drainage seem to have played a leading gained of this disease in other countries, and part in the local incidence of the disease. These though a statistical fact of importance only
some
o
of the
?
?
.3 O
conditions which typhoid fever in
commonly associated Europe and are within the practical range of speedy removal. The most important point accordingly is to remove are
with
are
these local conditions which are so detrimental This may to the health of the young soldier. not be an easy matter as regards that part of it
which relates
adjacent no
difficulty,
once
or
from bazars but there should be
private supplies
to
to cantonments;
if there is
taken to have it
steps should be removed, in providing
at
iu
shows how necessary it is under the present army system obtaining in India, that every possible
protect the youug soldier
prisoners in jails enjoy in comparison with European troops. This is summed up in the following tabular statement:? native
the
military station a water-supply above suspicion, a pure milk-supply, and proper sanitary arrangements for the disposal of sulliage
special attention should be paid to the condition of the wells in military cantonments, that they should be properly covered and not open as at present; that their
waters
should be
periodically
on
The most curious, and so far inexplicable, fact noted in the report is the great immunity from enteric fever which the native troops and the
every
and the treatment of refuse and sewage. It is not asking anything extraordinary that
should be taken to his arrival in India.
sanitary precaution
1877
to
Admissions.
European troops
Native troops Jail population
188G.
Deaths,
Admissions.
Deaths,
3-15 ?10
22*9 ?2
?10
?4
6-11 ?07 ?16
.
The comments made
1889.
on
the Sanitary Commissioner
this are
peculiar fact by that it may be
212
INDIAN MEDICAL GAZETTE.
due to
ff
1st, racial peculiarity ; 2nd, tolerance acquired lapse of time, generation after generation living saturated in filth ; 3rd, comparative in
immunity
of native adults
as
a
result of pre-
valence of the disease among native children. This last explanation is put forward by BrigadeSurgeons Hamilton and Clegltorn and Surgeon-
Major Holmes, of Lucknow, as probable from facts in their experience. But the point cannot be settled till
more
is
accurately
known
regard-
ing the infantile diseases of natives." There is much to be said on the side of When
immunity can be inoculative processes, it opens up a wide field for speculation on immunity acquired by everything included under acquired gradually
the
tolerance. obtained
general
by
term of acclimatization.
[July
1891.
Array
of enteric fever in the European occupies a dozen pages of the twenty-
subject
sixth annual report of the Sanitary Commissioner with the Government of India, and it is
agreeable to note therein that the useless and pernicious statistical method of diagnosis as adopted by the special commission to enquire into the alleged increase of enteric fever has, As and let us hope finally, been abandoned. our consideration of was out time at the pointed of that report, the application of the statistical building a theory thereon was radically wrong, misleading, and not adapted to the scientific advances of the day, and it was not by such means that the question as to the prevalence of enteric fever in Lucknow, Meerut, method and the
and elsewhere could be settled, nor could the of such suspected prevalence be thus
causes
ascertained. be decided of
the
most
The issue,
by malady
recent
a
study
Ave
observed,
only
aided
by the adoption of bacteriological, microscopical
chemical tests, whilst prevalence could be
a
clue to the
onl}'
prevalence
causes
obtained
ployment of those well-known quiry pursued in England and time of the
could
of the clinical features
by
the and
of its
the
methods of
emen-
elsewhere at the
of the disease and
011
the spot. A beginning has been made in this direction. The bacillus typhosus has been found, not by an Indian Medical Officer, but by Professor Bernhard Fischer of Kiel, in Germany, in specimens of spleen and mesenteric glands forwarded to that distinguished bacteriologist from two cases of enteric fever. rial
to
tion
was
The transmission of the matefor the purpose of identifica-
Germany probably prompted by
a
desire to have
it examined
familiar with the
necessary and reactions
with the appearby the typhoid
by an observer manipulations and
presented micro-orgauism and the identification
ance
may be
Joly
TYPHOID FEVEE.
1891.]
accepted
as
more
authoritative than if
been announced
Indian
cannot
that it
by an help remarking
India should have
to resort
work of this kind.
it had
observer, still we pity that to Germany for
seems a
We would here repeat what frequently urged in this journal, that the arrangements for the scientific study of disease in India are not such as we should wish
have
we
or as
the circumstances of the
211
that suspicious wells should be shut up, and that all wSlls should be regularly cleansed. It is worthy of note that Fort William, which
analysed;
has
an
fever
an
excellent
water-supply,
admission
rate per
had of enteric
1,000 of the strength
only "9 and no deaths, against Bareilly and Mhow, with admission rates of 77'9 and 75-4 a mortality of 23-77 per 1,000 of strength, and The bazaars and 17*89 1,000 respectively. per country render for their of
of Calcutta are not conspicuous sanitary practicable. bazaars in from differ If condition. Upper they The discovery however of the bacillus tya in it is possessing purer water-supply, and phosus by Professor Fischer in these two India, it is in this respect also that we think Fort specimens, and later on by Surgeon-Major Rankof the military caning in the urine of a third case, leads, as the Sani- William differs from many
desirable and
Commissioner
tary
to the
remarks,
conclusion
that at least some of the fatal fevers of India with intestinal lesions are identical with the enteric fever of
Europe.
climate
considered
And that hence the source of real enteric fever in India must be looked for in the contamination of ingesta, and ence.
must be
This is
doubtless will be followed
There
are
a
by practical
some
of India.
parts
interesting
statements in the
The
Sanitary Commissioner's report.
following
table shows the young soldier under 24 to be five times more liable to enteric fever than the soldier above 30:?
influ-
secondary important conclusion,
a most
tonments in other
Mortality
from Enteric Fever and ratio op .LIABILITY TO IT AT DIFFERENT AGES.
and
results.
24 and under.
only necessarv to read the extracts furnished in the report of the sanitary condition of
25 to 29.
It is
3
a Ia military stations to be satisfied that a ? P4 all is not above suspicion. 9-81 G4-50 3-25 21-37 1-83 12-03 Impure or suspicious water-supply, sub-soil 1889 close contaminated proxipollution, milk-supply, mity of trenching grounds to barracks, and This, however, only bears out the experience defective drainage seem to have played a leading gained of this disease in other countries, and part in the local incidence of the disease. These though a statistical fact of importance only
some
o
of the
?
?
.3 O
conditions which typhoid fever in
commonly associated Europe and are within the practical range of speedy removal. The most important point accordingly is to remove are
with
are
these local conditions which are so detrimental This may to the health of the young soldier. not be an easy matter as regards that part of it
which relates
adjacent no
difficulty,
once
or
from bazars but there should be
private supplies
to
to cantonments;
if there is
taken to have it
steps should be removed, in providing
at
iu
shows how necessary it is under the present army system obtaining in India, that every possible
protect the youug soldier
prisoners in jails enjoy in comparison with European troops. This is summed up in the following tabular statement:? native
the
military station a water-supply above suspicion, a pure milk-supply, and proper sanitary arrangements for the disposal of sulliage
special attention should be paid to the condition of the wells in military cantonments, that they should be properly covered and not open as at present; that their
waters
should be
periodically
on
The most curious, and so far inexplicable, fact noted in the report is the great immunity from enteric fever which the native troops and the
every
and the treatment of refuse and sewage. It is not asking anything extraordinary that
should be taken to his arrival in India.
sanitary precaution
1877
to
Admissions.
European troops
Native troops Jail population
188G.
Deaths,
Admissions.
Deaths,
3-15 ?10
22*9 ?2
?10
?4
6-11 ?07 ?16
.
The comments made
1889.
on
the Sanitary Commissioner
this are
peculiar fact by that it may be
212
INDIAN MEDICAL GAZETTE.
due to
ff
1st, racial peculiarity ; 2nd, tolerance acquired lapse of time, generation after generation living saturated in filth ; 3rd, comparative in
immunity
of native adults
as
a
result of pre-
valence of the disease among native children. This last explanation is put forward by BrigadeSurgeons Hamilton and Clegltorn and Surgeon-
Major Holmes, of Lucknow, as probable from facts in their experience. But the point cannot be settled till
more
is
accurately
known
regard-
ing the infantile diseases of natives." There is much to be said on the side of When
immunity can be inoculative processes, it opens up a wide field for speculation on immunity acquired by everything included under acquired gradually
the
tolerance. obtained
general
by
term of acclimatization.
[July
1891.
