Chapter III.] EPIDEMIC FEVERS OF INDIA AND THEIR RELATION TO JAIL MORTALITY.
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CHAPTER III.
EPIDEMIC FEVERS IN RELATION TO JAIL MORTALITY.
Putting aside febrile manifestations which may be classed. as purely climatic, we may
conveniently divide the epidemic fevers to be treated of in
this chapter, into three classes—( a) typhus and its allied
diseases, (b) relapsing contagious fever and its varieties, and
(c) epidemic malarious fevers.
Now, while all these fevers may show themselves individually and distinctly, it very
frequently happens that they appear over provinces in such combinations as to make the dis
-
crimination. of the different fevers almost impossible to the observer who has not previously
studied their natural history. Over one area, typhus, fostered by some special debilitating
condition of the population, will appear as a continued fever in different shapes ; while over
another area and simultaneously, relapsing yellow contagious fever will be prevailing, and this,
too, will show many variations in character. In a third province, a pure epidemic of malarious
fever may be cutting off the inhabitants by thousands—a fever which cannot be transmitted.
from man to man, and which has a natural history diametrically opposed to that of either
typhus or relapsing typhus.
By typhus I mean a fever such as I have described as prevailing on the Frontier in 1855,
and in the Rawal Pindi Jail in 1868-69 and in 1873. Relapsing fever and its varieties are
distinct in their characteristics, and are properly placed in a class by themselves; although
relapsing typhus is not an inappropriate term, and will constantly be used throughout this
chapter.
Typhus propagates typhus; relapsing fever propagates relapsing fever.
These fevers being propagated by contagion, it is not necessary that a man should be
scorbutic or famine-stricken in order to render him liable to the attack of typhus ; an indivi
-
dual or a community on which epidemic malaria has left no impress in the shape of intermit
-tent or remittent fevers, will succumb to relapsing fever if the germ of relapsing fever be
introduced.
Typhus fever or relapsing fever, is, in India, almost invariably an indication of antecedent
misfortune to the population of some province. it may, however, spread far beyond the limits
so affected, and invade areas which have never felt the famine or the debilitating disease
which introduced the epidemic. When once the poison has made head among the population,
these fevers persist through a series of years, and when introduced into a new province by
contagion, they continue to spread, irrespective of the general health of the people, which may
be in every other respect satisfactory.
I repeat again what I have said in the end of the last chapter. It is not essential that a
debilitating cause should be sought for in every case where typhus breaks out ; it is the germ
that is to be excluded or stamped out, which is an object having a distinct natural history,
and propagating its like.
But while typhus produces typhus in the human being, and relapsing fever the same
variety of fever, and while each of the varieties developed during the progress of an epidemic
of either fever also transmits its like, thus asserting the fact that these also when once originated
are true varieties in natural history, it may be asked whence arises primarily the phenomenon
of relapse so constantly found in the contagious epidemic fevers of Upper India.
I have given the subject much thought of late years, and reviewing the circumstances
under which the different epidemics of the past 60 years have
occurred, it seems to me that the association of epidemics of
malaria and relapsing typhus, so very often observed, is not
accidental. As far as I can judge, famine fever in India does not present the relapsing type
unless it be preceded, accompanied or followed by an epidemic of malarious fever.
Several epidemics of malaria in this century have had no typhus as a sequel, as far as
I can ascertain. But in most of our well-known epidemic epochs, the three scourges of the
population—epidemic malaria, famine and typhus—have co-existed or succeeded each other,
sometimes in one sequence and sometimes in another.
In my different cholera reports I have tried to show, that malarious fevers, apart from
fevers which are due to the varying meteorology of the
seasons in the various provinces, run in Upper India a
parallel course with epidemics of cholera : parallel in season,
showing the natural alliance between the two miasms ; parallel frequently in geographical
distribution, showing that the influences causing the spread of both miasms are the same and
natural agencies ; and parallel also in the fact, that the succession in which provincial areas
are covered is the same in each case.
The mere development of fever does not imply that the specific miasm of an epidemic of
malaria is necessarily present, any more than the prevalence of
diarrhœa implies the presence of the cholera miasm. But
while some have gone to the extreme of denying altogether the
existence of such a thing as a specific poison manifested in
malarious fever, my study leads me to infer, that the miasm of malaria is as specific as that of
Epidemic fevers—malarious, re
-lapsing, and typhus. How manifest
-ed in relation to areas and commun-
ities.
Association of different epidemic
fevers and possible connection one
with the other.
Parallel course of epidemic mala
-rious fevers and cholera.
All non-contagious fevers appear-
ing at the season when epidemic
malaria prevails are not malarious
fevers.