35
REPORT ON THE WORKING OF THE KING INSTITUTE, GUINDY
cheri consists of one or more rows of huts not worth the name of streets. The huts are
thatched, low, ill-ventilated, badly lighted and overcrowded. Buffaloes and sheep are housed
in the hut side by side with human inhabitants. Refuse of all sorts was found strewn in the
streets in front of these huts. As regards personal hygiene, the members of this community
are in a very backward condition. Cloths, dirty and mostly in rags, form their only meagre
dress. They lead a half starved life rarely having a decent meal a day. But they never
miss their evening toddy. A bath is a luxury to them and lice abound in their matted hair.
Their source of water-supply is invariably from a filthy pond or well in ruins used alike for
drinking, bathing, cleaning utensils and washing animals.
The Panchamas are so ignorant and superstitious as to ascribe the prevalence of this
fever to the fault of one of their clansmen having bathed in the Mahamakam tank during
the last Mahamakam festival in 1921 and thereby incurred the displeasure of the Gods.
Mortality figures.
On an examination of the death registers of the villages inspected by us, it was found
that 1,415 deaths could be traced to this fever. The total number of attacks in these villages
was 2,716.
The records as to the number of attacks were not accurate; the figures above were
obtained from the statements given by the villagers after searching house to house enquiries,
whereas the number of deaths is more trustworthy, being based on the death registers kept
by the Village Munsif and we were able to classify the deaths according to age and sex
periods. The percentage of deaths to attacks varied in different villages from 15.09 to 95
per cent, the total average being 52 per cent. The percentage of attacks and deaths in
reference to population could not be calculated, as the population, hamlet-war was not
available in any office.
Clinical features.
No detailed and discriminate description is possible as the clinical notes were made under
adverse circumstances and no notes of any case were available from any hospital or dispen
-
sary. The most striking point was the severity of the infection in general. The disease
generally starts with a rigor, mild in a few cases but severe in very many. The patients
were not able to state definitely whether there were any premonitory symptoms, as general
malaise, etc. But headache was present in almost all cases and very often pain in the back
and limbs. With rigor the temperature rises rapidly, and may go up to 105 on the first day.
It is lower generally not attaining the maximum till the fourth or fifth day. The pyrexia
lasted for six days in most cases. There is intense prostration from the beginning, which
in severe cases, ends in a comatose condition.
The temperature ordinarily comes down by crisis, the drop taking place in a few hours,
leaving the patient cold, collapsed and bathed in profuse perspiration. Simultaneously with
the fall of temperature the pulse rate becomes reduced. The temperature is very often
subnormal after the crisis, 95 or 96, rarely 97. The apyrexial stage lasts four or five days,
when there is a rebound in the temperature which may rise higher than prior to the crisis.
The duration of this relapse may be prolonged from four to six days to be followed by a
second crisis, the temperature falling again to subnormal.
A slight icteric tinge of the conjunctiva is common, but graver types of fever were seen,
where the patient was deeply jaundiced from the beginning, the conjunctiva of deep yellow,
showing an advanced condition of toxæmia. In some villages, almost every other case
showed marked jaundice, while in others no cases were found (as in Tirutturaippundi), though
there were 83 attacks with 38 deaths there was not a single case with jaundice.
Vomiting and nausea were not associated with jaundice.
The tongue is usually flabby, but clean and moist. This appearance of the tongue has
very often been noted except in those severe cases of the icteric types, where the tongue is
dry and has a furred appearance. Parotitis was noticed in two cases.
Spleen and liver were neither tender nor palpable even during the acute stages. The
urine in many cases was reported. to have been deeply stained yellow.
Œdema of the lower extremities was common, especially after the relapse. A dull and
apathetic look has been noticed in almost all cases. Restlessness and insomnia were often
complained of. A good many cases had delerium. A most noticeable feature in this
epidemic was the loss of hair, the hair in many cases becoming thin and dry. An interest
-
ing point as showing the unusual severity of the epidemic was the appearance of the
convalescents which was so characteristic that one could easily pick them out from a big
crowd, thin, anæmic
'
a n d e ma c i a t e d , wi t h i c t e r i c c o n j u n c t i v æ, wa x y f a c e , v e r y t h i n h a i r , a n d
slight œdema of the lower extremities.
There were a few cases which did not report any relapse at all. The majority of the
cases which had relapsed reported only one and a second relapse was never noticed.