epidemics must be concluded from observing the irregularity in months during which they reach their acme. Thus, out of twentv observations, the number of admissions reached its height four times in October, three times in September, and thirteen times between April and July. These fevers, again, occur severely in a station during one year, and lightly the next. The point, however, of practical importance in regard to this fever is the relative numbers of admissions into hospital from review. among the different bodies of men under Thev stand thus : ?
Europeans Prisoners
REMITTENT AND CONTINUED FEVERS. Br T. These are the in Dr.
Bryden's
Farquhar, Esq., given to two classes
statistical returns
are
of
disease,
which
made to include all the
forms of fever (except intermittents) to which the army and prisoners are subject in India. The principal differences between the symptoms of the three fevers are well expressed by their names, and the belief lia3 been generally entertained that they are nil of malarious origin, and of a non-contagious character. This idea is strongly supported by the observation, that intermittent fevers, which are certainly produced by marsh miasm, sometimes appear to pass into fevers identical in their symptoms with remittent and continued fevers ; and again that, during convalescence from these severe forms, symptoms of ague will shew themselves. These fevers, too, are more or less curable by quinine, the great antidote, and at the same time indicator, of malarious types of fever. Dr. Br.yden's valuable tables for the last four years, however, give us data on which to- found an opinion that these fevers
epidemic form. Tliev either then assume specific form of fever, or, under the cloak of the names of remittent or continued fevers, another distinct type of disease i3 developed. That a specific fever of a mild type does frequently occur sometimes occur in
an
the characteristics of
a
than probable from the observation that severe fevers abundant at those seasons of the year when, from the comparative absence of intermittents, we know that marsh is
more
are
most
poison
..
.
?
?
Native soldiers-..
M D.
names
..
is not most abundant.
small-pox and epidemic cholera, this specific fever chooses a particular season of the year, (usually the hot or beginning of the rains,) at which time it is most freely developed. Like these, too, it lasts in an epidemic form for only three or four mouths at a time, though exceptions to this rule are not unfrequent. Again, one regiment or body of men at a station is seen to suffer, while the rest have comparatively very few Like
cases.
Sometimes, again, the disease seems to stick to particular corps impairing their efficiency materially ; and a regiment frequently carries the fever apparently from one station to another, or an unaffected regiment will pick the fever up at a station where it prevailed immediately before their arrival. An instance, of the former was seen in II. M.'s 55th Foot, which
for successive years,
had 499 cases of severe fever at Dum-Dum in 1865, and 103 cases next year at Lucknow ; of the latter, an instance occurred in II. M.'s 90th Foot, which in 1865 had 13 cases at Jubbulpore, and 104 cases at Dum-Dum in 1866, just after that station had been vacated by the sickly 55th Regiment. Another observation in regard to these fevers is interesting ;
?
..
3,518 2,429 519
Per cent.
or
10-17 4 42
or
133
or
This remarkable difference between the sufferings of these is seen to occur in men is not confined to the year 1867, but much the same proportion during all former years of which we have record. It is the more remarkable as we see the same classes of men suffering in the very opposite ratio from malarious fevers. Tbe cause of this remarkable difference must be
sought probably in the modes of life of the classes referred to. The susceptibility of the European to the effects of extreme heat must not be overlooked; but that something else must be blamed is concluded from the fact, first, that we see this form of fever among Europeans living in cool hill stations as well as in the plains, and in the comparatively cool month of October as well as in May ; and, second, from the very large disproportion between native prisoners and sepoys who suffer attacks. The differences in habits of the three classes are seen principally in this, that Europeans and prisoners live always in barracks, and use common latrines. The latter of these have been conclusively shewn in England to be a dangerous element in the propagation of typhus and typhoid fevers, and others probably resembling the one we are now noticing. The sepoys, on the other hand, live only partially in barracks, and these commonly very open : besides this, at the season when this fever prevails, most of the men usually sleep outside. The sepoys, again, can with difficulty be got to frequent the public latrines, which are provided for them at a few of the Bengal for most
stations. There is in addition case
of sepoys,
but
dependent binding than
on
a great amount of segregation in the This is independent of military regulation, their habits and caste prejudices, often more
any other law; instances of this need not be on exuminatiom they tend to explain the such men have always had from contagious diseases.
enumerated, but
immunity
Tae system of herding men together in large barrack rooms must, from the data afforded by this fever, be condemned as unwise?a conclusion which is strongly supported by the unlooked-lor effect ot
moving Europeans
of cholera.
was
into camp during epidemics found that the exposure in tents was not followed by the bad effects anticipated. On the contrary, the fevers of the hot season were greatly diminished in numbers from the change into camp, and the sanitary effect of abundance
It
of fresh air and the return to clean barracks. Another
subject
of
deep
interest is
an
,
examination of the
death-rate during 1867 from these fevers. This reveals the fact that the ratio of deaths to admissions among Europeans was far less than among either prisoners or sepoys. The
figures
for 1SG7 stand thus
:?
general
Percentage
impression that they are simply the result of increased heat, especially in the case of Europeans, for it cannot be doubted that heat favors the development, and certainly intensifies attacks of this disease. That it is not, however,- tho only cause of these
admission. l-88
the season of the year at which
they
occur
gives
the
strictly
of death
Europeans
Native Soldiers Prisoners
???
-..
...
..
..
...
771
...
...
..
7*57
to
REMITTENT AND CONTINUED FEVERS.?BY T.
I860.]
Mat 1,
showing that, in tho last year, the Europeans died at the rate of
only
one-seventh of the ether two classes.
The records of the three
nity
from death is
no
previous
years shew how this immu-
feature in
new
to
regard
Europeans
:
Died per cent, of
1S64.
Europeans Native Soldiers Prisoners ...
1SG5.
Europeans Europeans
...
...
...
...
...
1'86
...
... ...
...
...
...
7"89 1326
...
...
Native Soldiers Prisoners
...
...
???
Native Soldiers ... Prisoners 18G6.
...
6-4? 1S59
1383
attacks. A reference, however, to the preceding years shews that this will not account for the whole of the difference iu the mortality. "SVe see that in the jails a continuous high rate of mortality for three years, 1864-65-66, but fell to one-half in We are told in a note to Dr. Bryden's tables, that what he
prevailed "
Jail fever" prevailed in a number of the jails, especially up-country, and to this he attributes the high rate of mortality. This so-called
jail fever, however, passed as a scourge over the upper provinces among the village population ; it had only then to be introduced into the barrack of a prison to find a ready means of extending its deadly influence. The heavy mortality of the sepoys may probably be put down to this fever also, for. from mingling freely with the population, they would readily catch it; as to Europeans, from their mingling so little, they are necessarily cut oft' to a great extent from contagion, and thereby escape. Other fevers, as the spotted typhoid and typhus, have shewn themselves lately in India, and are a formidable addition in the classes of disease to be combated. The mortality from the present fevers among Europeans speaks of the mildest type being as yet in their ranks. Even the mortality iu prisons in this last year is less than the death-rate of in England,* but we have the ratios doubtless fevers
prevailing lessened by the presence purely malarious.
in jails of milder types,
including
tho
The conclusion from the above is, that those continued and remittent fevers which during the last decade have sent 122,019 Europeans
Admissions from rernttent uud continued fevers m the lollowmgyears. 1
???
???
25,316
183oi I860
]2 334 ???
1862
9'339
""
???
1805
jnto hospital, are very 3erious evils, the prevention of which demands the most serious attention. A' the same timo
we rejoice to see margin, that the general measures adopted during the decade for the housing and improving
from the table in the
???
3'51?
1867
ol0
the condition of tho soldier have -worked an increasing change for the Percentage
of *
Thomas, London Georges, London King's College ... Newcastle St. 8t.
Nottingham Birmingham Bristol...
Edinburgh Glasgow Aberdeen
... ... '
...
???
...
...
...
...
...
???
?
JO'O J
...
...
??? -
...
...
...
?.
-
...
?"
???
death from fevers.
J-?
accommodation,
must
bo considered when
"pernicious"
fevers ; a reduction of tho French troops in
Algeria. The percentage
explanation that naturally occurs of this is, that the European is probably more carefully nursed in his attacks of bad fevers than either the sepoy or the prisoner, as also that his more stimulating food enables him more effectually to resist their
1807.
increased
like result followed the
1 "97
...
army, ignorant of the country and unattack of severe levers. The gradual
account for tho reduced amount of
we
The first
tails
caused
diminution, too, of the British force in the countiy, and the
consequent
8'88
...
...
newly-arrived English
1456
...
91
better in regard to these fevers ; especially is it observable that this last year has had the fewest number of admissions. From the first half of the decade we see how much the privation and exposure in the field, and in bad barracks, of the largos
acclimatised,
admission. 2*1C
FARQUIIAR.
...
of deaths to admissions from remittent and continued fevers is seen in the table in 2-J5 tho margin; it has varied little, but has 1-23 been
1862
...
...
isoi
;;;
...
1805 1868 1867
1*27
1-97* l-07
1*84
higher
in the four
for the last four years than
preceding.
We learn from all this the
necessity
for having: barracks, and the value ? good b ; of peace ; we see also how many baa fevers must be the result of extremes
of heat, and the necessity there is of keeping tho soldiers as cool as possible in their barracks. Tho question now is whether the very to
?us
large barrack rooms keep the temperature
are the best arrangement for enabling in them down to a reasonable degree.
The answer to this is, without doubt, that it is fur more difficult down, and keep cool, a body of air 30,000 feet in extent,
to cool than
one
of 7,200 feet; the former is the total of the latest built
barrack room for 20 men, the other would be this room subdivided to hold four in each division. The smaller rooms would be kept the coolest by the means at present employed, the tattie, and would also enable doors to bo more closed and kept so, for tho doors of large barrack open at all hours allows the building to get thoroughly heated, and thus the soldior lives in a IKgh temperature to which his officer is not exposed.
certainly
On looking over the list of fevers in every month, remittent and continued fevers mentioned in each ; now
2nd. see
wo we
know that some, if not most of these fevers, are exaggerated of intermittents. Ilere sve liavo miasm to deal with, and
cases
know that sub-soil
drainage
is our best
hope
of
freeing
tho men
of this influence. 3rd.
Specific fevers, mild and severe, are no doubt in and barracks; segregation is no doubt our chief means of avoiding these. When they do enter a barrack, the same means on a small scale a3 are employed in epidemic cholera, are called for here. We have seen the success of moving into camp, Minor means unattended by the privation of a campaign. should, however, be first tried to free the barracks of tho contagion before the dispersion of camp life is enforced. Much could doubtless be done by turning the men into tents* for the night, from tho barracks, and on the parade-ground or a short distance having these and the Spare clothes of the men fumigated with sulphur fume3, while the licen, wood wjrk, and the walls are washed and whitened. The latrines should also fce thoroughly cleansed and fumigated in the same way, and kept under the influence of the fumes while traces of specific fever existed. A revised and more distinguishing nomenclature of fevers in the medical returns would give a far more correct idea of the nature of the diseases that have to be dealt with, and tho means around
our
.
required
for their relief.
As
an
instance of this wo see in the
* out-break of fever in the Lahore jail in 1863; I saw this tried in while in tents, the men continued to suffer from tho contagious fever, because they were huddled Tery closo together. Tho cleaning of tha barracks seemed, however, to stop tho fover at onco on the return of th?
prisoner after
a
few days' abscn&o from the jail.
92
THE INDIAN MEDICAL GAZETTE.
returns an extraordinary number of remittent and continued fevers put down as occurring in the three months at the beginning of the year. This is quite different from the period they are
jail
Europeans. If there had been any doubt, preplexing. but in a note, Dr. Bryden tells us this was the so-called jail fever, or a typhoid bilious fever referred to before, which occurs in the cold season, and which insidiously entered the jails in these years, but in 1867 either died out, or was excluded by careful quarantine. The new register sheets supplied to the native as well as European troops will greatly aid accuracy, especially if the medical authorities insist on all diseases being entered on them in the hand-writing of medical officers, and if these sheets are extended to jails we shall have an accuracy of record in the case of fevers that Dr. Bryden says we have not at present.
wont to occur among this would have been
[Mat 1,
186fl.
Europeans Prisoners
REMITTENT AND CONTINUED FEVERS. Br T. These are the in Dr.
Bryden's
Farquhar, Esq., given to two classes
statistical returns
are
of
disease,
which
made to include all the
forms of fever (except intermittents) to which the army and prisoners are subject in India. The principal differences between the symptoms of the three fevers are well expressed by their names, and the belief lia3 been generally entertained that they are nil of malarious origin, and of a non-contagious character. This idea is strongly supported by the observation, that intermittent fevers, which are certainly produced by marsh miasm, sometimes appear to pass into fevers identical in their symptoms with remittent and continued fevers ; and again that, during convalescence from these severe forms, symptoms of ague will shew themselves. These fevers, too, are more or less curable by quinine, the great antidote, and at the same time indicator, of malarious types of fever. Dr. Br.yden's valuable tables for the last four years, however, give us data on which to- found an opinion that these fevers
epidemic form. Tliev either then assume specific form of fever, or, under the cloak of the names of remittent or continued fevers, another distinct type of disease i3 developed. That a specific fever of a mild type does frequently occur sometimes occur in
an
the characteristics of
a
than probable from the observation that severe fevers abundant at those seasons of the year when, from the comparative absence of intermittents, we know that marsh is
more
are
most
poison
..
.
?
?
Native soldiers-..
M D.
names
..
is not most abundant.
small-pox and epidemic cholera, this specific fever chooses a particular season of the year, (usually the hot or beginning of the rains,) at which time it is most freely developed. Like these, too, it lasts in an epidemic form for only three or four mouths at a time, though exceptions to this rule are not unfrequent. Again, one regiment or body of men at a station is seen to suffer, while the rest have comparatively very few Like
cases.
Sometimes, again, the disease seems to stick to particular corps impairing their efficiency materially ; and a regiment frequently carries the fever apparently from one station to another, or an unaffected regiment will pick the fever up at a station where it prevailed immediately before their arrival. An instance, of the former was seen in II. M.'s 55th Foot, which
for successive years,
had 499 cases of severe fever at Dum-Dum in 1865, and 103 cases next year at Lucknow ; of the latter, an instance occurred in II. M.'s 90th Foot, which in 1865 had 13 cases at Jubbulpore, and 104 cases at Dum-Dum in 1866, just after that station had been vacated by the sickly 55th Regiment. Another observation in regard to these fevers is interesting ;
?
..
3,518 2,429 519
Per cent.
or
10-17 4 42
or
133
or
This remarkable difference between the sufferings of these is seen to occur in men is not confined to the year 1867, but much the same proportion during all former years of which we have record. It is the more remarkable as we see the same classes of men suffering in the very opposite ratio from malarious fevers. Tbe cause of this remarkable difference must be
sought probably in the modes of life of the classes referred to. The susceptibility of the European to the effects of extreme heat must not be overlooked; but that something else must be blamed is concluded from the fact, first, that we see this form of fever among Europeans living in cool hill stations as well as in the plains, and in the comparatively cool month of October as well as in May ; and, second, from the very large disproportion between native prisoners and sepoys who suffer attacks. The differences in habits of the three classes are seen principally in this, that Europeans and prisoners live always in barracks, and use common latrines. The latter of these have been conclusively shewn in England to be a dangerous element in the propagation of typhus and typhoid fevers, and others probably resembling the one we are now noticing. The sepoys, on the other hand, live only partially in barracks, and these commonly very open : besides this, at the season when this fever prevails, most of the men usually sleep outside. The sepoys, again, can with difficulty be got to frequent the public latrines, which are provided for them at a few of the Bengal for most
stations. There is in addition case
of sepoys,
but
dependent binding than
on
a great amount of segregation in the This is independent of military regulation, their habits and caste prejudices, often more
any other law; instances of this need not be on exuminatiom they tend to explain the such men have always had from contagious diseases.
enumerated, but
immunity
Tae system of herding men together in large barrack rooms must, from the data afforded by this fever, be condemned as unwise?a conclusion which is strongly supported by the unlooked-lor effect ot
moving Europeans
of cholera.
was
into camp during epidemics found that the exposure in tents was not followed by the bad effects anticipated. On the contrary, the fevers of the hot season were greatly diminished in numbers from the change into camp, and the sanitary effect of abundance
It
of fresh air and the return to clean barracks. Another
subject
of
deep
interest is
an
,
examination of the
death-rate during 1867 from these fevers. This reveals the fact that the ratio of deaths to admissions among Europeans was far less than among either prisoners or sepoys. The
figures
for 1SG7 stand thus
:?
general
Percentage
impression that they are simply the result of increased heat, especially in the case of Europeans, for it cannot be doubted that heat favors the development, and certainly intensifies attacks of this disease. That it is not, however,- tho only cause of these
admission. l-88
the season of the year at which
they
occur
gives
the
strictly
of death
Europeans
Native Soldiers Prisoners
???
-..
...
..
..
...
771
...
...
..
7*57
to
REMITTENT AND CONTINUED FEVERS.?BY T.
I860.]
Mat 1,
showing that, in tho last year, the Europeans died at the rate of
only
one-seventh of the ether two classes.
The records of the three
nity
from death is
no
previous
years shew how this immu-
feature in
new
to
regard
Europeans
:
Died per cent, of
1S64.
Europeans Native Soldiers Prisoners ...
1SG5.
Europeans Europeans
...
...
...
...
...
1'86
...
... ...
...
...
...
7"89 1326
...
...
Native Soldiers Prisoners
...
...
???
Native Soldiers ... Prisoners 18G6.
...
6-4? 1S59
1383
attacks. A reference, however, to the preceding years shews that this will not account for the whole of the difference iu the mortality. "SVe see that in the jails a continuous high rate of mortality for three years, 1864-65-66, but fell to one-half in We are told in a note to Dr. Bryden's tables, that what he
prevailed "
Jail fever" prevailed in a number of the jails, especially up-country, and to this he attributes the high rate of mortality. This so-called
jail fever, however, passed as a scourge over the upper provinces among the village population ; it had only then to be introduced into the barrack of a prison to find a ready means of extending its deadly influence. The heavy mortality of the sepoys may probably be put down to this fever also, for. from mingling freely with the population, they would readily catch it; as to Europeans, from their mingling so little, they are necessarily cut oft' to a great extent from contagion, and thereby escape. Other fevers, as the spotted typhoid and typhus, have shewn themselves lately in India, and are a formidable addition in the classes of disease to be combated. The mortality from the present fevers among Europeans speaks of the mildest type being as yet in their ranks. Even the mortality iu prisons in this last year is less than the death-rate of in England,* but we have the ratios doubtless fevers
prevailing lessened by the presence purely malarious.
in jails of milder types,
including
tho
The conclusion from the above is, that those continued and remittent fevers which during the last decade have sent 122,019 Europeans
Admissions from rernttent uud continued fevers m the lollowmgyears. 1
???
???
25,316
183oi I860
]2 334 ???
1862
9'339
""
???
1805
jnto hospital, are very 3erious evils, the prevention of which demands the most serious attention. A' the same timo
we rejoice to see margin, that the general measures adopted during the decade for the housing and improving
from the table in the
???
3'51?
1867
ol0
the condition of tho soldier have -worked an increasing change for the Percentage
of *
Thomas, London Georges, London King's College ... Newcastle St. 8t.
Nottingham Birmingham Bristol...
Edinburgh Glasgow Aberdeen
... ... '
...
???
...
...
...
...
...
???
?
JO'O J
...
...
??? -
...
...
...
?.
-
...
?"
???
death from fevers.
J-?
accommodation,
must
bo considered when
"pernicious"
fevers ; a reduction of tho French troops in
Algeria. The percentage
explanation that naturally occurs of this is, that the European is probably more carefully nursed in his attacks of bad fevers than either the sepoy or the prisoner, as also that his more stimulating food enables him more effectually to resist their
1807.
increased
like result followed the
1 "97
...
army, ignorant of the country and unattack of severe levers. The gradual
account for tho reduced amount of
we
The first
tails
caused
diminution, too, of the British force in the countiy, and the
consequent
8'88
...
...
newly-arrived English
1456
...
91
better in regard to these fevers ; especially is it observable that this last year has had the fewest number of admissions. From the first half of the decade we see how much the privation and exposure in the field, and in bad barracks, of the largos
acclimatised,
admission. 2*1C
FARQUIIAR.
...
of deaths to admissions from remittent and continued fevers is seen in the table in 2-J5 tho margin; it has varied little, but has 1-23 been
1862
...
...
isoi
;;;
...
1805 1868 1867
1*27
1-97* l-07
1*84
higher
in the four
for the last four years than
preceding.
We learn from all this the
necessity
for having: barracks, and the value ? good b ; of peace ; we see also how many baa fevers must be the result of extremes
of heat, and the necessity there is of keeping tho soldiers as cool as possible in their barracks. Tho question now is whether the very to
?us
large barrack rooms keep the temperature
are the best arrangement for enabling in them down to a reasonable degree.
The answer to this is, without doubt, that it is fur more difficult down, and keep cool, a body of air 30,000 feet in extent,
to cool than
one
of 7,200 feet; the former is the total of the latest built
barrack room for 20 men, the other would be this room subdivided to hold four in each division. The smaller rooms would be kept the coolest by the means at present employed, the tattie, and would also enable doors to bo more closed and kept so, for tho doors of large barrack open at all hours allows the building to get thoroughly heated, and thus the soldior lives in a IKgh temperature to which his officer is not exposed.
certainly
On looking over the list of fevers in every month, remittent and continued fevers mentioned in each ; now
2nd. see
wo we
know that some, if not most of these fevers, are exaggerated of intermittents. Ilere sve liavo miasm to deal with, and
cases
know that sub-soil
drainage
is our best
hope
of
freeing
tho men
of this influence. 3rd.
Specific fevers, mild and severe, are no doubt in and barracks; segregation is no doubt our chief means of avoiding these. When they do enter a barrack, the same means on a small scale a3 are employed in epidemic cholera, are called for here. We have seen the success of moving into camp, Minor means unattended by the privation of a campaign. should, however, be first tried to free the barracks of tho contagion before the dispersion of camp life is enforced. Much could doubtless be done by turning the men into tents* for the night, from tho barracks, and on the parade-ground or a short distance having these and the Spare clothes of the men fumigated with sulphur fume3, while the licen, wood wjrk, and the walls are washed and whitened. The latrines should also fce thoroughly cleansed and fumigated in the same way, and kept under the influence of the fumes while traces of specific fever existed. A revised and more distinguishing nomenclature of fevers in the medical returns would give a far more correct idea of the nature of the diseases that have to be dealt with, and tho means around
our
.
required
for their relief.
As
an
instance of this wo see in the
* out-break of fever in the Lahore jail in 1863; I saw this tried in while in tents, the men continued to suffer from tho contagious fever, because they were huddled Tery closo together. Tho cleaning of tha barracks seemed, however, to stop tho fover at onco on the return of th?
prisoner after
a
few days' abscn&o from the jail.
92
THE INDIAN MEDICAL GAZETTE.
returns an extraordinary number of remittent and continued fevers put down as occurring in the three months at the beginning of the year. This is quite different from the period they are
jail
Europeans. If there had been any doubt, preplexing. but in a note, Dr. Bryden tells us this was the so-called jail fever, or a typhoid bilious fever referred to before, which occurs in the cold season, and which insidiously entered the jails in these years, but in 1867 either died out, or was excluded by careful quarantine. The new register sheets supplied to the native as well as European troops will greatly aid accuracy, especially if the medical authorities insist on all diseases being entered on them in the hand-writing of medical officers, and if these sheets are extended to jails we shall have an accuracy of record in the case of fevers that Dr. Bryden says we have not at present.
wont to occur among this would have been
[Mat 1,
186fl.
