fares and bazars, aud a mass of intricate uubetween houses and huts of all sizes and sorts. Into the latter escapes, or is throvvu, all the filth and waste the residents do not retain within their houses. From constant traffic, and from wind and weather, these lanes become hollow and undrainable. The usual family or caste enclosures exist? small open spaces surrounded by mud-huts closely crowded together. One or more Mahommedati mohullaha consist of a large number of su(;h enclosures surrounded by a high wall with but few entrances, so that effective ventilation is an impossibility. The census of 1884 gives a population of 94* to the square acre, or a density cf 60,000, f nearly double that of London, which is stated to be 32,512. This is a serious degree of overand one likely to enhance mortality crowding, to a great decree. This overcrowding is conTheir huts consist fined entirely to the poor. usually of a very small room longer than broad, low in the roof, and with little or no provision for light or ventilation beyond the entrancedoor. Even in the better class of huts, built of sun-dried bricks with skilled labour, this is the plan of construction, with the addition often of a sort of porch which further obstructs the entrance of light and air. Such houses and hovels open info the common yard, in which all sanitary laws are really set at defiance. In them and even in the houses are lodged the domestic auimals?oxen, cows, buffaloes, ponies, and what not, aud the excreta of these are allowed to sink into the soil. The solid excreta of the cattle indeed are collected and economised, the fluid remain, and the only cleansing is a fresh washing over with mud or cowdung and mud. In spots more or less retired, are found the family latrines, in which most of the excreta are left to dry aud fiud their way into soil or air. The villager generally resorts to the fields, where his excreta are valuable as manure for certain crops, such as tobacco, poppy, &c.; the townsman, on the other hand, is not at all particular so long as the spot is fairly secluded and nearat hand. Public latrines are by no ineaus to his taste.
paved lanes, running
?
?
*
1872,
the town
or a
area was
density
...
...
IJ/i
tvmlmllna
nva
?
193 acres with 99 people to of 63,360. The number of enclosures was 1>730 688 (a) Hindu (population 8,614) 16.042 (&) Mahommedan (population 1,034) Iu
the acre,
REMARKS ON FEVER MORTALITY AT DEOBUND IN 1884. By Bbigade-Sukgeon A. GARDEN, M.D, (Continued from page 323.)
i
???
...
...
The number of houses was (a) Built with skilled labour Hindu 725, Mahommedan 539. ...
...
(b)
Mud-huts...
???
???
Hindu 1,137, Mahommedan 1,678.
...
...
???
5,079 1,264
2,815
The poorer aud more miserauie moniuuva aic f The density of a population is the number of persona built on the outskirts of the mound in close residing in a square mile. It is well known that, after the of the population exceeds a certain limit, the deathproximity to the excavations. The plan of density rate begins to increase, so that the density of the populaconstruction is that of all such towns, if plan tion must be regarded as one of the causes of death-rate, there can be said to be where the growth is though only a secondary cause:?(Address on Public MediS. at of Revd. British cine Haughton Meeting Medical by entirely one of accidental accretion. There Association 1887. are two or more fairly broad maiu thorough46
358
THE INDIAN MEDICAL GAZETTE.
Iii such dwellings and amidst such surroundthe natives must under certain conditions live. Little, or comparatively little, harm can or need arise as long us the weather is fine, and 110 great sickness prevails. They can and do live alfresco, the houses and huts being used merely as store-rooms. But during the rainy and cold seasons and in the time of sickness, they are compelled to occupy the huts, crowded together, and breathing and re-breathing the same air ladeu with impurities from lung and skin, the hitter never being cleansed for days and weeks together. From poverty more than will also, but often too from preference, large numbers, if not the majority, lie on the ground, which is often damp, not being able to afford so cheap a luxury as a four-anna charpoy. Ruled by a municipality exercising apparently no control over the conservancy establishment paid by it, the town was and is now remarkable for its general dirtiness and accumulations of filth, when once the main thoroughfares are left. Individual rights and claims to collect manure and filth within the enclosures, and even in the open public places, have been respected, aud in no ways interfered with. Divided as the land thereabouts is into small holdings, each supporting its proprietor and dependents, manure is a valuable commodity to be well safeguarded. Formerly Deobund, I believe, was a fairly flourishing place of business. The many good buildings going to ruin show this. Railways have made a complete change, and the extern trade has been lost. It has the appearance of a town out at elbows, as it were, that has seen better days.* The meteorology of Deobuud is much the same as that of the rest of the district: Six mouths of temperate and cold weather from October to March ; three months or rather less of hot aud dry weather from April to the end of June; and three of wet, damp and hot weather from the commencement of the monsoon to the end of September. The chief point of interest is perhaps the annual rainfall. During the ten in which are included years from 1875 to 1884, two years of heavy fever, 1879 aud 1884, the fall was as follows :? 1875 Total fall 38'7 inches, Monsoon fall 34*4 inches.
ings
1876
,,
?>
?
?
?
31*4
?
>,
?
?
37-8
?
?
?
?
28-8
?
?
?
,,
?
39-4
?
?
>?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
1879
? ?
1880 1881 1882 1883 1884
40'5 33-4
?
?
1877 1878
28 29-3 47
37 6 29 6 17 28-1 28-3 36
? ? ? ? ? ?
?
21-9
2J-7
?
??
463
?
?
* In 1872 Mr. Jenkinson divided tJie population 11110 o classes : (a) well-to-do. 3000 ; (5) indifferently well off, 3000; (e) poor,13,000?(N. W. P. & O. Gazette.) Matters have not mended since. The population has increased, but not the means of main* tainihg it.
[Dec.,
1887.
The most important point is the fail during the monsoon, as it is essentially during and after this season that the annual outbreak of fever occurs. During these years there were two of excessive fever prevalence, 1879 and 1884. In the former, the rainfall was moderate; in the latter, excessive ; and this caused the country around to be flooded and swampy during weeks. Iu the search for some cause ready to hand to account for the fever and mortality iu Deobund, this was accepted, oblivious that the rainfall in 1879, was very moderate, and that the heavy fall in 1876 was not followed by any excessive amount of fever. Each of the two years was, however, preceded by one of deficient fall. In 1878 it amounted In 1883 it was fair, but the to only 17 inches. monsoon ceased suddenly with a deluge early in September, and from that to the end of June, there was a long drought of ten months, for the small quantities that fell in November 1883 and March and May 1884, were mere sprinklings, and were inoperative for good or for evil. It is reasonable to suppose that this long spell of dry weather may have increased the insanitary conditions of Deobund without iu itself being the immediate cause of any sickness. As before stated, Deobund lies in a portion of the country where an average fall does not exceed, as a rule, one foot in the mile, with difficult or defective natural drainage, aud liable to be swamped and to remain so for weeks after heavy rain. In this it does not stand alone. Nananta, a large village, 20 miles to the west, is in a similar position, as well as the intermediate and adjoin-
ing country. The
masses
are
malaria-stricken,
nourished, ill-clothed, fever is
always
seasons
and
leads to
a
more
poor, illMalarious less prevalent at all
ill-housed.
or
times, and directly or indirectly great portion of the ordinary heavy
mortality.
Severe at all times, malarious fever is still during the monsoon and autumn months, and the mortality is then greatly iucreased. This increase in the number attacked usually begins at the end of July, and that of the mortality two or three weeks later.
more so
This is the usual annual condition of things, and is looked on as the inevitable aud irremediable. It is only every few years that outbreaks like that of 1884 occur. They appear to be an exaggeration of the ordinary autumnal fever, extending over large areas, and within a few weeks or months sweep off masses of the people. These outbreaks of fever-plague come at intervals, by no means regular, and correspoud with no cycles of natural phenomena, such as sunspots, &c. There is an obscurity about their origin and the conditions that lead to them, which still
Dr. GARDEN ON FEVER IN DEOBUND.
Dec., 1887.]
359
in this matter most DeIt has been sought people to be cleared up. fective rain means deficient rain crops, of the to trace them to excessive canal irrirainfall,
unfavourably.
requires
and inferior grains, As these epidemics are widespread mukka, murrhoua, bajra, which are the staple diet of the poor. local affairs confined to one district mere or portion of a district, the question of the con- The daily range during such seasons does not nection between them and the rainfall must be increase, probably decreases. As the price of investigated with reference to the whole area grains during such seasons rises, work is more invaded, and not treated as a mere parochial difficult to procure, so that in years of scarcity, the masses suffer in the quantity if not iu the matter. from the evidence I have quality of their ordinary food. They lose iu Judging, however, health iu consequence, and become more liable at command, it appears to me that heavy rainfall has been assigned as the cause on insufficient to infection and less able to withstand the grounds. Certainly the record of rainfall in this ravages of disease. district runs counter to there being any direct Canal irrigation also has been assumed to be the cause of these epidemics. connection between the two. Not for one moment would I have it supposed the 40 this district has been During past years that I deny or ignore the probable or possible visited by six severe outbreaks of fever, and deleterious effects it may have in making dry the rainfall in these and the years immediately but badly drained spots swampy, and places preceding was as follows :? already marshy more so, or that it has raised the level of the subsoil water over large areas. Year ofse- Rainfall in Year pre- Rainfall in Remarks. These are facts beyond dispute. ceding vere fever. inches. inches. One must grant that with its numerous blessepidemic. ings, it has also brought the opposite, that with 45-8 1843 1844 No record. freedom from the fear of famine aud with increased wealth from high cultivation has come 1849 1 28 3 1848 200 1850 j an increase of malaria with its horde of evils, 44-8 1861 18-2 1860 cachexia, impotency, apathy, &c. Still these 42-5 1862 are not exceptional conditions of any one year 20-7 1869 1868 15-4 30 amongst many. They are always and continu1870 26-0 1878 18-0 1879 ously operative. In irrigated tracts the amount 13-6 1883 45-75 1884 of ordinary fever has probably increased, but of this ordinary fever, there is no question as to cause. It is not so with occasional outbreaks Heavy rainfall (local) thus went hand-in-hand of which, within a few months, fever-plagues, 1861-62 and with severe fever in 1844, 1884, off of the people. numbers large whilst it was moderate or defective in the re- carry These over the country before canals swept mainder. On the other hand, the heaviest falls and still invade tracts to which the blesswere, in and 52 inches inches 1856, recorded, viz., 53 and the curses of canal irrigation have not in 1871, were not accompanied or succeeded by ings as yet been extended. and the same was any unusual amount of fever; In thinking over such a mortality as that of the case in eight other years, in which the fall the thought naturally occurs that Deobund, varied from 36 inches to 48 inches. there may have been something more than further Without going into detail, enough local insanitary has been stated to justify my opinion. It is malaria, something more than conditions at work, and that much or most of it different with a year or years preceding the epihave resulted from some other form of demic. With one exception (1879) the fall may fever such as enteric or relapsing. during the previous years was very deficient. as we are for most of our informDependent of doctrine the If we accept the modern depen- ation during these outbreaks on the death redence of malaria on heat, continuous moisture, turns and on rumour, it must be confessed at and plentiful air supply, it is difficult to see how once that the knowledge so gained is unsatisin this home of malaria, the scanty rainfall of and deceptive, and that arguments based factory one year could tend to increase its production criticism. Still on it are open to unfavourable doubt be that in little in the next, for there can there own from experience, personal my these years of violent fever, there is excessive judging is a sufficient basis of truth iu the death-returns production of, and strength for evil in, the to justify one in dealing with them seriously. poison, apart from any secondary conditions that As all deaths from diseases accompanied by may or do lead to increased susceptibility and fever are registered as "Fever", whatever tlieir increased mortality. true nature, the returns, even if correct numeriThat the weak and ill-nourished are more cannot be accepted as an accurate index cally, liable to take the fever and to succumb to it is of any orie kind of fever, 'nialariamouut to the admitted, and there are grounds for the opinion ous; or othei-j iirevailing. These remarks arethat defective rains influence the mass of the.
gation,
&c.
and not
i ?}
360
THE INDIAN MEDICAL GAZETTE.
applicable to the mortality occurring before August than to that of the later mouths of the year. From the end of July malarious fever is always predominant, and the great factor in causing death directly or indirectly. The deathrates during these five months may be accepted as a true, if not exact, indication of the greater or less prevalence of malarious fever, as they do rise and fall in direct proportion to the severity of the season's outbreak. It is different with the deaths during the earlier months, especially during April, May, and Juue. One would expect during these months, from the excessive dryness of the air and hardness of the soil, that malaria production would be at its minimum, though it is quite intelligible that irrigation might lead to conditions favourable to the production of the poison even then. During these months pleurisy, pneumonia, and hyperasmic conditions of the liver and abdominal organs accompanied by fever distinctly intermittent are common and fatal. The intermittency of the fever may be interpreted by the accepted opinion that malarial fever once acquired impresses its characteristic of intermittency on all subsequent febrile attacks. Whether the fever that caused the immense mortality in Deobund after July was malarious alone, or whether some other fatal form of fever was present, it is by no meaus easy to decide. Evidence could only be gained second hand, and I can give no opinion from continued personal observation, such as would be necessary to decide such a question. In these epidemics, there is so much to be done on all sides, that there is no time to go long distances and make personal enquiries of this nature. The Hospital Assistant at Peobuml was a good specimen of his class, shrewd and intelligent, and much liked for his skill and attention to his duties. On the other hand, his knowledge of the subject of enteric or of relapsing fever was very slight, and his experience nil. He suffered severely from the fever himself, as also did his assistants, as many as I could send him. From close questioning of him, his assistants and patients, I could elicit no information that tended in the least to show that enteric fever had been present. After a few days' malaise, the onset of the fever was sudden. It was more remittent than intermittent in its nature during the first few days, but after that it was decidedly intermittent and amenable to treatment by quinine, but with a tendency to recur after intervals of longer or shorter duration, and after finally assuming the tertian or The hospital assistant declared quartan type. that lie had had to deal with nothing but malarious fever. It must be granted that his expemore
[Dec.,
1887.
rience was almost entirely gained from those who could seek aid at the dispensary in person, and this in itself would exclude cases of enteric fever in that stage of advancement, in which diagnosis could be made at once with tolerable certainty. His time was so occupied with his duties in prescribing and even in dispensing, that he had little leisure to visit patients in their
own
houses.
The subsequent excessive prevalence of quartan fever and large spleens, seems to me to corroborate the opiuion that the fever was essentially malarious. ( To be continued.)
paved lanes, running
?
?
*
1872,
the town
or a
area was
density
...
...
IJ/i
tvmlmllna
nva
?
193 acres with 99 people to of 63,360. The number of enclosures was 1>730 688 (a) Hindu (population 8,614) 16.042 (&) Mahommedan (population 1,034) Iu
the acre,
REMARKS ON FEVER MORTALITY AT DEOBUND IN 1884. By Bbigade-Sukgeon A. GARDEN, M.D, (Continued from page 323.)
i
???
...
...
The number of houses was (a) Built with skilled labour Hindu 725, Mahommedan 539. ...
...
(b)
Mud-huts...
???
???
Hindu 1,137, Mahommedan 1,678.
...
...
???
5,079 1,264
2,815
The poorer aud more miserauie moniuuva aic f The density of a population is the number of persona built on the outskirts of the mound in close residing in a square mile. It is well known that, after the of the population exceeds a certain limit, the deathproximity to the excavations. The plan of density rate begins to increase, so that the density of the populaconstruction is that of all such towns, if plan tion must be regarded as one of the causes of death-rate, there can be said to be where the growth is though only a secondary cause:?(Address on Public MediS. at of Revd. British cine Haughton Meeting Medical by entirely one of accidental accretion. There Association 1887. are two or more fairly broad maiu thorough46
358
THE INDIAN MEDICAL GAZETTE.
Iii such dwellings and amidst such surroundthe natives must under certain conditions live. Little, or comparatively little, harm can or need arise as long us the weather is fine, and 110 great sickness prevails. They can and do live alfresco, the houses and huts being used merely as store-rooms. But during the rainy and cold seasons and in the time of sickness, they are compelled to occupy the huts, crowded together, and breathing and re-breathing the same air ladeu with impurities from lung and skin, the hitter never being cleansed for days and weeks together. From poverty more than will also, but often too from preference, large numbers, if not the majority, lie on the ground, which is often damp, not being able to afford so cheap a luxury as a four-anna charpoy. Ruled by a municipality exercising apparently no control over the conservancy establishment paid by it, the town was and is now remarkable for its general dirtiness and accumulations of filth, when once the main thoroughfares are left. Individual rights and claims to collect manure and filth within the enclosures, and even in the open public places, have been respected, aud in no ways interfered with. Divided as the land thereabouts is into small holdings, each supporting its proprietor and dependents, manure is a valuable commodity to be well safeguarded. Formerly Deobund, I believe, was a fairly flourishing place of business. The many good buildings going to ruin show this. Railways have made a complete change, and the extern trade has been lost. It has the appearance of a town out at elbows, as it were, that has seen better days.* The meteorology of Deobuud is much the same as that of the rest of the district: Six mouths of temperate and cold weather from October to March ; three months or rather less of hot aud dry weather from April to the end of June; and three of wet, damp and hot weather from the commencement of the monsoon to the end of September. The chief point of interest is perhaps the annual rainfall. During the ten in which are included years from 1875 to 1884, two years of heavy fever, 1879 aud 1884, the fall was as follows :? 1875 Total fall 38'7 inches, Monsoon fall 34*4 inches.
ings
1876
,,
?>
?
?
?
31*4
?
>,
?
?
37-8
?
?
?
?
28-8
?
?
?
,,
?
39-4
?
?
>?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
1879
? ?
1880 1881 1882 1883 1884
40'5 33-4
?
?
1877 1878
28 29-3 47
37 6 29 6 17 28-1 28-3 36
? ? ? ? ? ?
?
21-9
2J-7
?
??
463
?
?
* In 1872 Mr. Jenkinson divided tJie population 11110 o classes : (a) well-to-do. 3000 ; (5) indifferently well off, 3000; (e) poor,13,000?(N. W. P. & O. Gazette.) Matters have not mended since. The population has increased, but not the means of main* tainihg it.
[Dec.,
1887.
The most important point is the fail during the monsoon, as it is essentially during and after this season that the annual outbreak of fever occurs. During these years there were two of excessive fever prevalence, 1879 and 1884. In the former, the rainfall was moderate; in the latter, excessive ; and this caused the country around to be flooded and swampy during weeks. Iu the search for some cause ready to hand to account for the fever and mortality iu Deobund, this was accepted, oblivious that the rainfall in 1879, was very moderate, and that the heavy fall in 1876 was not followed by any excessive amount of fever. Each of the two years was, however, preceded by one of deficient fall. In 1878 it amounted In 1883 it was fair, but the to only 17 inches. monsoon ceased suddenly with a deluge early in September, and from that to the end of June, there was a long drought of ten months, for the small quantities that fell in November 1883 and March and May 1884, were mere sprinklings, and were inoperative for good or for evil. It is reasonable to suppose that this long spell of dry weather may have increased the insanitary conditions of Deobund without iu itself being the immediate cause of any sickness. As before stated, Deobund lies in a portion of the country where an average fall does not exceed, as a rule, one foot in the mile, with difficult or defective natural drainage, aud liable to be swamped and to remain so for weeks after heavy rain. In this it does not stand alone. Nananta, a large village, 20 miles to the west, is in a similar position, as well as the intermediate and adjoin-
ing country. The
masses
are
malaria-stricken,
nourished, ill-clothed, fever is
always
seasons
and
leads to
a
more
poor, illMalarious less prevalent at all
ill-housed.
or
times, and directly or indirectly great portion of the ordinary heavy
mortality.
Severe at all times, malarious fever is still during the monsoon and autumn months, and the mortality is then greatly iucreased. This increase in the number attacked usually begins at the end of July, and that of the mortality two or three weeks later.
more so
This is the usual annual condition of things, and is looked on as the inevitable aud irremediable. It is only every few years that outbreaks like that of 1884 occur. They appear to be an exaggeration of the ordinary autumnal fever, extending over large areas, and within a few weeks or months sweep off masses of the people. These outbreaks of fever-plague come at intervals, by no means regular, and correspoud with no cycles of natural phenomena, such as sunspots, &c. There is an obscurity about their origin and the conditions that lead to them, which still
Dr. GARDEN ON FEVER IN DEOBUND.
Dec., 1887.]
359
in this matter most DeIt has been sought people to be cleared up. fective rain means deficient rain crops, of the to trace them to excessive canal irrirainfall,
unfavourably.
requires
and inferior grains, As these epidemics are widespread mukka, murrhoua, bajra, which are the staple diet of the poor. local affairs confined to one district mere or portion of a district, the question of the con- The daily range during such seasons does not nection between them and the rainfall must be increase, probably decreases. As the price of investigated with reference to the whole area grains during such seasons rises, work is more invaded, and not treated as a mere parochial difficult to procure, so that in years of scarcity, the masses suffer in the quantity if not iu the matter. from the evidence I have quality of their ordinary food. They lose iu Judging, however, health iu consequence, and become more liable at command, it appears to me that heavy rainfall has been assigned as the cause on insufficient to infection and less able to withstand the grounds. Certainly the record of rainfall in this ravages of disease. district runs counter to there being any direct Canal irrigation also has been assumed to be the cause of these epidemics. connection between the two. Not for one moment would I have it supposed the 40 this district has been During past years that I deny or ignore the probable or possible visited by six severe outbreaks of fever, and deleterious effects it may have in making dry the rainfall in these and the years immediately but badly drained spots swampy, and places preceding was as follows :? already marshy more so, or that it has raised the level of the subsoil water over large areas. Year ofse- Rainfall in Year pre- Rainfall in Remarks. These are facts beyond dispute. ceding vere fever. inches. inches. One must grant that with its numerous blessepidemic. ings, it has also brought the opposite, that with 45-8 1843 1844 No record. freedom from the fear of famine aud with increased wealth from high cultivation has come 1849 1 28 3 1848 200 1850 j an increase of malaria with its horde of evils, 44-8 1861 18-2 1860 cachexia, impotency, apathy, &c. Still these 42-5 1862 are not exceptional conditions of any one year 20-7 1869 1868 15-4 30 amongst many. They are always and continu1870 26-0 1878 18-0 1879 ously operative. In irrigated tracts the amount 13-6 1883 45-75 1884 of ordinary fever has probably increased, but of this ordinary fever, there is no question as to cause. It is not so with occasional outbreaks Heavy rainfall (local) thus went hand-in-hand of which, within a few months, fever-plagues, 1861-62 and with severe fever in 1844, 1884, off of the people. numbers large whilst it was moderate or defective in the re- carry These over the country before canals swept mainder. On the other hand, the heaviest falls and still invade tracts to which the blesswere, in and 52 inches inches 1856, recorded, viz., 53 and the curses of canal irrigation have not in 1871, were not accompanied or succeeded by ings as yet been extended. and the same was any unusual amount of fever; In thinking over such a mortality as that of the case in eight other years, in which the fall the thought naturally occurs that Deobund, varied from 36 inches to 48 inches. there may have been something more than further Without going into detail, enough local insanitary has been stated to justify my opinion. It is malaria, something more than conditions at work, and that much or most of it different with a year or years preceding the epihave resulted from some other form of demic. With one exception (1879) the fall may fever such as enteric or relapsing. during the previous years was very deficient. as we are for most of our informDependent of doctrine the If we accept the modern depen- ation during these outbreaks on the death redence of malaria on heat, continuous moisture, turns and on rumour, it must be confessed at and plentiful air supply, it is difficult to see how once that the knowledge so gained is unsatisin this home of malaria, the scanty rainfall of and deceptive, and that arguments based factory one year could tend to increase its production criticism. Still on it are open to unfavourable doubt be that in little in the next, for there can there own from experience, personal my these years of violent fever, there is excessive judging is a sufficient basis of truth iu the death-returns production of, and strength for evil in, the to justify one in dealing with them seriously. poison, apart from any secondary conditions that As all deaths from diseases accompanied by may or do lead to increased susceptibility and fever are registered as "Fever", whatever tlieir increased mortality. true nature, the returns, even if correct numeriThat the weak and ill-nourished are more cannot be accepted as an accurate index cally, liable to take the fever and to succumb to it is of any orie kind of fever, 'nialariamouut to the admitted, and there are grounds for the opinion ous; or othei-j iirevailing. These remarks arethat defective rains influence the mass of the.
gation,
&c.
and not
i ?}
360
THE INDIAN MEDICAL GAZETTE.
applicable to the mortality occurring before August than to that of the later mouths of the year. From the end of July malarious fever is always predominant, and the great factor in causing death directly or indirectly. The deathrates during these five months may be accepted as a true, if not exact, indication of the greater or less prevalence of malarious fever, as they do rise and fall in direct proportion to the severity of the season's outbreak. It is different with the deaths during the earlier months, especially during April, May, and Juue. One would expect during these months, from the excessive dryness of the air and hardness of the soil, that malaria production would be at its minimum, though it is quite intelligible that irrigation might lead to conditions favourable to the production of the poison even then. During these months pleurisy, pneumonia, and hyperasmic conditions of the liver and abdominal organs accompanied by fever distinctly intermittent are common and fatal. The intermittency of the fever may be interpreted by the accepted opinion that malarial fever once acquired impresses its characteristic of intermittency on all subsequent febrile attacks. Whether the fever that caused the immense mortality in Deobund after July was malarious alone, or whether some other fatal form of fever was present, it is by no meaus easy to decide. Evidence could only be gained second hand, and I can give no opinion from continued personal observation, such as would be necessary to decide such a question. In these epidemics, there is so much to be done on all sides, that there is no time to go long distances and make personal enquiries of this nature. The Hospital Assistant at Peobuml was a good specimen of his class, shrewd and intelligent, and much liked for his skill and attention to his duties. On the other hand, his knowledge of the subject of enteric or of relapsing fever was very slight, and his experience nil. He suffered severely from the fever himself, as also did his assistants, as many as I could send him. From close questioning of him, his assistants and patients, I could elicit no information that tended in the least to show that enteric fever had been present. After a few days' malaise, the onset of the fever was sudden. It was more remittent than intermittent in its nature during the first few days, but after that it was decidedly intermittent and amenable to treatment by quinine, but with a tendency to recur after intervals of longer or shorter duration, and after finally assuming the tertian or The hospital assistant declared quartan type. that lie had had to deal with nothing but malarious fever. It must be granted that his expemore
[Dec.,
1887.
rience was almost entirely gained from those who could seek aid at the dispensary in person, and this in itself would exclude cases of enteric fever in that stage of advancement, in which diagnosis could be made at once with tolerable certainty. His time was so occupied with his duties in prescribing and even in dispensing, that he had little leisure to visit patients in their
own
houses.
The subsequent excessive prevalence of quartan fever and large spleens, seems to me to corroborate the opiuion that the fever was essentially malarious. ( To be continued.)
