Chapter III. ] EPIDEMIC FEVERS OF INDIA AND THEIR RELATION TO JAIL MORTALITY.
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of a peculiar tingling description, and discolourations of the skin were visible early in the course
of the disease, in some cases occurring as petechiæ simply, and in others as large bruises with
broad and painful bases.
" In some of the worst of these cases, there were regular symptoms of scurvy after the fever
had gone ; spongy and bleeding gums, ecchymosis, and anasarca of the lower extremities, and
hæmorrhage from the nose and bowels.
" Recovery was very tardy. Twelve of the sufferers were only capable of performing light
duty six months after their first attack, and a few are even yet unfit for duty of any kind, and
so they are likely to continue for some time to come.
"There was a great tendency to congestive inflammation of the lungs, liver, and spleen,
and to neuralgic affections : for months after the fever had disappeared, patients continued
to suffer from sciatica, and even now on the occurrence of any slight ailment, the tendency
becomes developed.
" In remittent cases quinine seemed to do more harm than good. It seemed that the fever
wore itself out, and the evident indication was to support the strength.
"In bad cases when the strength was gradually failing and symptoms of congestion of the
lungs were becoming daily more apparent, permission was obtained to send the patients to
Kasauli ; and although they travelled in the middle of June all ultimately recovered.
" In all four deaths resulted from this disease; one fatal case is shown in the
return as remittent fever; the other three patients relapsed after convalescence, and as they
presented marked symptoms of pneumonia, their cases were returned under that heading."
Another British regiment was similarly affected, while relapsing fever prevailed among
the native troops and in the jail; Her Majesty's 38th Regi
-ment suffered at Delhi from this fever. The fever is described
as of malarious origin, the symptoms being regarded as those
of remittent or continued fever. The report, however, proceeds to allude to the lung
complication as something not usually seen in the course of a malarious fever, in these terms :
" A very bad symptom, and one which I never before observed at any station in India, namely,
atonic inflammation of the lungs, appeared in many cases of this malarious fever, and nearly all
the fatal cases were consequent upon this complication. The symptoms in each case were
similar. A color sergeant aged 26, of most temperate habits, on the 5th day after admission
from simple febrile symptoms, was attacked by general pleuro-pneumonia. Four days afterwards
symptoms of typhus set in, delirium, sordes on the teeth, retention of urine, and involuntary
evacuations; and he died on the 21st day from admission." The appearance of the lungs as seen
after death, is described, and the report concludes :—" The above disease, although in some
respects resembling typhus fever, was entirely of malarious origin."
It is obvious that such a deduction, if erroneous, may lead to very serious results ; and in
future when typhus is known to exist among the general population such cases should be well
studied before such a conclusion is arrived at, and the possibility of contagion ignored.
I have already spoken of the pneumonic form of typhus as shown in the Lahore and
Mooltan jails. This pneumonic form was imported into the Montgomery jail in 1870.
These fever cases were thus described :
" Fifty-nine cases of fever assumed a remittent character with badly developed symptoms.
The paroxysms were masked ; the patient was restless, the hands tremulous, and the skin and
conjunctivæ yellow. In these cases I found pneumonia present ; and yet during the first and
second stages there was no difficulty in breathing, and scarcely any cough. This febrile pneumonia did not come on till from seven to ten days after the commencement of the fever."
Typhus prevailed in 1863 in the Amritsar district, and, in 1864, assumed a deadly
dysenteric type in the jail (see General Table illustrating jail
typhus towards the end of this chapter). With this typhus I
have always associated the following case. As far as my expe
-rience goes it stands alone ; I know of no parallel in the medical
history of the British Army within the last 20 years.
In the detachment of Her Majesty's 19th Regiment, stationed at Amritsar, in the week
ending 14th August 1863, epidemic dysentery was reported, and before it ceased 19 men died,
besides women and children.
The outbreak is thus described in the returns, week by week, from 14th August to 4th
September, when it terminated :
" Acute dysentery has assumed an epidemic form during the week Of the seven cases
remaining from last week two have died, one on the 4th and the
other on the 7th day of the disease. Both were treated by large
doses of ipecacuanha when first admitted, but no decided advantage was derived from it. It
did not alter the character of the stools which were chiefly blood and vitiated dark fæces. A low
typhoid condition was observed in these cases from the beginning, with brown tongue, quick and
feeble pulse, insomnolency and a tendency to low muttering delirium. The latter symptom
generally set in 24 hours before death; the patient previously telling you he is quite well,
passed gradually into coma. Of the other cases at present under treatment, one man and one
woman are almost in a moribund condition, although all kinds of remedies have been tried. The
post-mortem examination revealed extensive ulceration of the whole tract of the colon. In one
case there was diffused peritoneal inflammation, and the rectum was also perforated ; there was
no ulceration of the small intestines. The liver in both cases was extremely enlarged, and the
structure completely disintegrated. The spleen in both cases resembled the spleen of remittent
fever ; it was as large as the right lobe of the liver, and as soft as clotted blood.
Pneumonic typhus of the 38th
Regiment. The same variety in jails.
Epidemic dysentery ( ? typhus) of
H. M's. 19th Regiment, Amritsar,
1863.
Week ending 14th August.