Chapter II.
ASPECTS IN WHICH THE DESTRUCTIVE DISEASES OF JAILS APPEAR.
175
retarded by diarrhœa. Although no eruption has yet been discovered, yet there is decided
desquamation of the cuticle in many cases during convalescence. Delirium is not a common
symptom, but it often accompanies cases which die within two or three days after being.
attacked. A post-mortem examination almost invariably shows inflammation of one or both
lungs ; these are sometimes infiltrated with pus. Thick layers of lymph attach the surface of
the lung to the walls of the chest. This white lymph on the surface of the lung is very charac
- t e r i s t i c i n s o m e c a s e s . I h a v e a l s o n o t i c e d i n f l a m m a t i o n o f P e y e r ' s p a t c h e s a n d s m a l l u l c e r s
about the ascending colon in cases that have had diarrhœa as a prominent symptom. Death
often takes place during recovery by the sudden plugging of some large vessel by cardiac
emboli composed of whitish yellow lymph."
In the Peshawar Jail the very same diseases broke out in the same month. The Civil
Surgeon of Peshawar appends to his monthly return for Novem
- b e r 1 8 7 3 t h e f o l l o w i n g : — " I d i o p a t h i c e r y s i p e l a s a n d t o n s i l l i t i s
are common among the surrounding population ; mild tonsillitis
prevails in the and erysipelas is more freouent than is
desirable." On 23rd November, a case, returned as laryngitis, proved fatal in three hours ;
and in December four deaths occurred ; tracheotomy, which was performed, giving no relief to
the symptoms. Two deaths from erysipelas occurred in December, and four in January 1874.
Contagious fever had been epidemic from January 1873, which died off in May after causing
34 deaths. Out of 11 deaths in 1873 returned under the head "All other Causes," 4 were
caused by er ysipelas, and 3 by hospital gangrene.
A third case is identical. The Rawalpindi Jail showed the same combination at the same
Erysipelas and diphtheria of the
Peshawar Jail. Possibly related to
the contagious fevers of the earlier
A third illustration. Jail at Ra
-walpindi. Association of typhus with
erysipelas and diphtheria.
time. On 27th October, the first death from laryngitis occur
- r e d , f o l l o w e d b y 4 i n N o v e m b e r a n d 2 i n D e c e m b e r . I n
October and November, 35 admissions were caused by tonsillitis.
22 by laryngitis, and 31 by erysipelas. From erysipelas 7 deaths occurred. Now, from
February to June, a continued typhus raged in this jail. It died at the usual date ; and three
months later a second epidemic of a contagious fever, of distinct clinical characteristics, made
its appearance, along with the erysipelas and throat affection.
The typhus outbreak ran thus, the last death being caused by gangrene of the thigh as a
sequel :—
1873
January.
February.
March.
April.
May.
June.
Died
3
23
10
4
2
The second outbreak ran the following course :—
1873
July.
August.
September. October. November. December.
Died
1
1
13
17
17
1874
January.
February.
March.
April.
May.
June.
Died
9
10
5
4
3
This is no chance combination of disease. I find, in my notes of 1865, a parallel in every
way perfect :—
All along the Punjab frontier in the early months of 1805 typhus was reported. From
Association of typhus with
typhoid erysipelas and dip theria
among the general population in
Northern India in 1865.
Murdan Mr. Bellew writes that typhus is prevailing as an.
epidemic in many of the villages of the district, rapidly fatal
in its tendency, and causing great mortality. Mr. Farrel.
mentions that a peculiar and fatal type of fever, distinctly con
-tagious, is occurring in the neighbourhood of Rajanpore. In
one village one-half of the inhabitants have suffered, and of those attacked one-half have died.
In the Dera Ghazee Khan District, Mr. Courtney fears many have died from neglect and
want of medical aid. Dr. Fairweather notes the prevalence of typhus in several villages in
the neighbourhood of Dora Ismail Khan, although not general throughout the district.
Mr. Neil reports relapsing typhus widely spread throughout the Ferozepore district, with a.
great tendency to death from acute adynamic dysentery.
But from Kohat, typhoid erysipelas, and not fever, is reported to be epidemic. Writing
in May, Mr. Verchere says :—"Most slight wounds and ulcers have a tendency to inflame, and
to become erysipelatous : the erysipelas is accompanied by a low continued fever. Several
cases have occurred in the regiment, and one camp follower has died from extensive mortifica
- t i o n o f t h e t h i g h c o n s e q u e n t u p o n e r y s i p e l a s . " M r . T a n d y , C i v i l S u r g e o n o f K o h a t , w r i t e s
that there had been an epidemic of erysipelas since April, not confined to any locality, but
attacking equally the inhabitants of the villages, town and cantonments. And so universal
was it that he preferred excluding cases of injury from the dispensary, in place of taking
special precautions to prevent its outbreak among the patients. This tendency to gangrene
was not confined to Kohat, for Mr. Lyons states that, in March, nine cases which had
been operated on in the Rawalpindi dispensary took on sloughing simultaneously, of
which the greater number were lost. In his Sanitary Report for June, Mr. Verchere
makes the statement that cases are occurring in the city of a disease which, from
the accuracy of the description given by those who saw the cases, was evidently a form
of diphtheria, and that the principal features were perfectly marked. The natives, he adds,
say that it is a new disease, and one which has not been known in Kohat before.