Chapter III.
EPIDEMIC FEVERS OF INDIA AND THEIR RELATION TO JAIL MORTALITY.
197
"Sometimes these cases have merged into hæmorrhagic dysentery. The stools are large and
watery, of a brick-dust red colour, and finally assume a darker hue with black sloughs floating
on the surface. No patient has recovered in whom these gangrenous sloughs have persisted for
any time.
"Some of the patients have never suffered from intermittent fever."
Contagious dysentery of former
times not now met with.
Dysentery of Dinapore of 1849-50.
The possibility of dysentery, whether due to a typhus
source or not, becoming contagious, is apt to be overlooked in
these days when all is so much changed, and, therefore, I add
the following to impress the fact:—
Dr. Taylor, of Her Majesty's 80th Regiment, writing regarding the health of his regi--
ment at Dinapore in 1850, says:
"I cannot but consider this type of dysentery to be of systemic origin, and essentially of a
febrile nature. The febrile action determines upon the mucous membrane of the large intestines
and produces hœmorrhage and sloughing, as in yellow fever, and in the severer or epidemic
varieties of remittent fever. Stimulants and opium alone offer themselves as resources in the
severer cases. It is astonishing how much opium is required to produce any effect in these
cases; 15 to 20 grains may be given daily without producing stupor or even headache.
"Before concluding, I must again allude to the probability of this disease being of a con--
tagious nature. Of the two men who attended on Assistant Surgeon Murphy, one died shortly
after of this dysentery; and while I am writing, the Hospital Sergeant has died of the same
disease. In this case, however, the febrile symptoms having been predominant, the death has
been returned under Fever."
I find in my notes the remark that this contagious dysentery of Dinapore was a disease
of the hot months—April, May, and June. In an earlier part of this paper, speaking of a
spring dysentery of the Allahabad jail of 1870, I stated that the fact was sufficient to lead to
the conclusion that the dysentery was the manifestation of a contagious disease, and not pri--
marily a bowel affection.
I know of only one case in which it would appear that typhus of an enteric type was deve-
loped. In all reports on relapsing fever the fact is specially
recorded, that the lower portion of the small intestine was not
implicated. It was relapsing fever which was at the very same
time prevailing in many jails of Upper and Central India and
of Oudh. But in the Goojrat jail return for one of the spring months of 1865, I remarked
that the fever was described as attacking the lower part of the ileum.
Dr.Johnston, then in medical charge, states distinctly that the disease was a typhus,
and not a typhoid fever. It was contagious, for three of the hospital establishment were
attacked. In seven cases there was pleuro-pneumonia, and in two of these, which were fatal,
no enteric lesion was found. There was not a single case of relapse. There was no rash.
The aspect was that of typhus, not of enteric fever. Recovery and death were more speedy
than in enteric fever.
Dr. Johnston gives a typical case, fatal on the tenth day: age 34; ten months in jail,
and has never been in hospital. Admitted 12th May; died 22nd.
On admission, respiration natural: no thoracic dulness. Complains of pain and heat
about the umbilicus and right side of abdomen; liver enlarged; spleen normal. Yellow,
muddy countenance and injected conjunctivæ.
On second night, delirious. Delirium continued till sixth day, when the fever became
adynamic. The abdomen then became distended; rumbling in the right iliac fossa was dis-
tinctly audible, and yellow-green flocculent evacuations were passed in rapid succession, more
or less sanguineous. The pulse became depressed; the skin partially lost its arid feeling, and
there was a tendency to perspiration which was followed by extreme prostration. In this state
he continued, and death by coma occurred on the tenth day. During the last few days
h i s i n t e l l e c t b e c a m e m o r e a n d m o r e O b s c u r e d , b u t o n p r e s s u r e o v e r t h e r i g h t i l i a c r e g i o n h e a l w a y s
cried out."
On post-mortem examination, ulceration of Peyer's patches and solitary glands was found.
The upper portion of small intestines was healthy. The large intestines were normal in
appearance and consistency. There was no ulceration.
Once more I would urge the danger of the theory which holds that relapsing fever is pri -
marily due to the degeneration of a malarious fever, and caused
by evil local conditions. There may be a certain amount of truth.
in the theory, but practically the local observer has nothing to
do with such a consideration; and where active measures have
been delayed on such theoretical grounds, disaster has invariably followed. Relapsing fever
is the most insidious, and the most contagious of diseases. In the individual constitution it
may give not a single indication of its presence until the man is suddenly struck down as with
a blow. The inspecting officer ranges his prisoners and examines them with care, and, not -
withstanding, men healthy at the morning parade will be dying before evening. In a commu-
nitv the germ is introduced often in the spring, and is overlooked,—a mild and by no means a
deadly fever goes on through the rains, and before the medical
officer suspects. the entire body is saturated with typhus poison.
The same has occurred on boardship. A depot receives the
emigrants from up-country. With abundant air the fever puts on a mild type, but spreads
through the depot; the unsuspected disease is transferred with the emigrants, and as soon as
the ventilation on board ship becomes deficient, deadly typhus appears.
Enteric typhus (?), in which the
lower portion of the small intestine is
alone involved.
The specific character and insidi
- o u s n a t u r e o f r e l a p s i n g c o n t a g i o u s
fever.
The method of its introduction
into jails illustrated.