Chapter III. ] EPIDEMIC FEVERS OF INDIA AND THEIR RELATION TO JAIL MORTALITY.
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(rarely more than half an ounce) of florid blood in small coagula, is expectorated. In such
eases buboes are not commonly observed, though they do occasionally co-exist with the in-
flammation of the lungs. The mortality has been so great among those in whom the lungs
were affected, that a person now on seeing blood in his sputum gives himself up for lost."
Native reports mention, that at Rampore the people attacked threw up blood almost at
the first onset of the disease, and died a few hours afterwards.
If this account can be depended on, then we have here the
description of the "black death," or worst form of plague, described by Hecker in his" Epidemics
of the Middle Ages." *
"A severe and mortal disease is prevalent among the natives. A shivering fit is succeeded
by a hot skin, and then hæmorrhage from the nose and vomit -
ing of dark-coloured blood takes place, and death rapidly
supervenes. I have examined this disease, and am of opinion
that it is a severe form of fever occurring in patients who have scurvy, in whom the mucous
membrane allows the blood to pass through during the hot stage. This state of scurvy is
now very common, and I think it is owing to the poor not having had their usual and neces-
sary supply of green vegetable food in consequence of the very dry season which has passed.
A vsat number are dying daily from the disease: generally 24 hours suffice to kill."
"A very curious and fatal type of fever is most prevalent among the natives of the
entire district,—intermittent fever accompanied by chest affec-
tions, and profuse epistaxis and hæmoptysis, and also vomiting
of dark grumous coffee-coloured blood. I find that if you can
get the patient to perspire profusely before the epistaxis comes on, that he usually recovers."
"Typhus fever of a low asthenic type, is exceedingly prevalent among the civil population
throughout the district, especially in the vicinity of the Lushkur
and city of Gwalior, where as many as 50 deaths a day are
reported to have occurred."
While this fever of Central India was in progress in April and May 1865, the north of
the Bombay Presidency was affected by a typhus epidemic.
The accounts were very alarming, and were taken to imply
the existence of the buboe plague. The outbreak, however,
was evidently yellow relapsing fever. The swelling talked of was the sudden enlargement
of the liver, which causes the characteristic pain over the epigastrium, and was not either
buboe or carbuncle as reported. But here also, as in Central India, the typhus had died before
the medical officer sent out from Deesa arrived. He reported that the fever had been a mala
-
rious remittent, giving rise to enlargement of the liver, and that the mortality had been excessive.
In one village visited, 100 out of 1,200 inhabitants had died within a month; but there
was nothing, according to his statement, to indicate resemblance to a contagious or mortal
pestilence.
For clinical details regarding the typhus characterised by buboes and other glandular
swellings, often accompanied with petechiæ and complicated
with the spitting of blood as in the last-mentioned variety, I
must refer to the Bombay reports and Ranken's work, and to
the Mahamurree reports of Rennie, Stiven, Pearson and Francis. In our time, Mahamurree re -
appeared along with the typhus of the jails in the end of 1859, and was epidemic over
Ghurwal in the spring of 1860. At the time that Dr.Ewart treated typhus in the Ajmere
Jail, the appearance of the bubo variety of typhus was officially reported by the Rajpootana
Political Agency. On 26th April 1836, Dr. Kirk again reports its appearance 40 miles
north-east of Ahmedabad. He adds: "I must bring to your notice that there has been no rain
to affect the climate for nine months, not since July of last year, and this circumstance might
have lessened the produce of the cold-weather crops."
Typhus seems always imminent in this situation. As late as 1871 we read in a report
on the hilly tracts of Meywar, that in April the Guzerattea rogue had appeared—an affection of
the chest, never entirely absent from the district.
I wish, in placing side by side the two cases which follow, to show how the fever poison
in the same station, operating at the same time on Europeans
and Natives, produced varying results. In the Europeans pete-
chiæ and vibices were remarked, and the Surgeon, although he
does not call the disease relapsing fever, and returns his fatal cases as pneumonia, says that
the men relapsed during convalescence from remittent fever and died with pneumonia as the
chief complication. The other report is valuable as showing the difference in manifestation
in a free as distinguished from a jail community; and it analyses well many of the leading
features which are often lost in consequence of the intensity of jail ontbreaks.
The native regiment and the European regiment stationed at Ferozepore in the spring
of 1864, were simultaneously affected and this was the history in the two bodies.
The relapsing fever of the native regiment is described by Mr. Veale as under:—
"Relapsing fever affected the regiment in the months of
March, April, May and June.
" The cases which first came under my notice seemed to differ for the first day or two,
scarcely at all from common intermittent fever occurring in debilitated subjects. The first
circumstance which specially attracted my attention, was sudden and alarming exhaustion,
* This typhus was coincident with relapsing fever in the Bareilly Jail in May 1853.
3 A
Rohilcund epidemic of 1853.
Surgeon-Major Tresidder, Jhansi,
April 1865.
Assistant Surgeon J. H. White,
Jhansi, April 1865.
Surgeon Manifold, Her Majesty's
34th Regiment, Morar, April 1865.
Yellow contagious fever of the
north of the Bombay Presidency of
1865.
Bubo plague of Rajpootana and the
Himalayas.
How relapsing fever shows itself
in the European as contrasted with
the native. Pneumonic typhus.
Relapsing fever in a Native
Regiment.