6
population. In the records of the Native Army I do not know of a single death attributed
to typhoid which is not open to suspicion that it has been wrongly diagnosed or carelessly
returned,"
Again, in his report bringing up the Statistical History of the European Army
in India to 1876, Dr. Bryden says :—
" The sudden change to a tropical climate causes in the young and weakly-constitutionedt
the infarction of the intestinal glands which results in this fever of three weeks' duration.
Why the glands fill up and whence is derived the material which accumulates does not fall to
be considered here. On the statistical data given I hold every body of men coming from
England liable to the attack of this enteric fever, and the question to be determined by the
sanitary officer is how this liability shall be obviated or lessened. I need only repeat the
general assertion that certain localities will be found more suitable than others for new
troops in respect to enteric fever. After the 20th April in any locality too much care cannot
be taken of new regiments, for it is in this week that exposure is very certain to be followed
by the appearance of the fever; and, again, the tendency of the fever to reappear towards the
close of the monsoon season must be kept in mind. Above all it is for the sanitary officer to
determine whether the individuals first affected may originate an outbreak in the community.
The tendency of regarding this theoretically as a purely climatic fever is apt to lead one to
the extreme view that fevers of this class are not communicable from man to man. Judging
from the mere aspect of such cases as those of the 36th, 2/22nd and others, I should feel much
hesitation in subscribing to the theory of non-communicability; and while admitting that, as
a rule, the cases are isolated and the facies of an outbreak entirely wanting—outbreaks
which it is impossible to refer to any mere general influence, do occur. Witness the outbreak
in the E/Battery of the 4th Brigade stationed at Neemuch in 1876. The battery had no
enteric fever up to the last week in - August; throughout September eight cases and five
deaths occurred, and again in November a sixth fatal case was developed. These cases were
out of a body of 150 men who had been 18 months in India. That some local cause
originated or aggravated this fever it is impossible to doubt. With the proper appreciation
of the large body of facts regarding enteric fever in India now aggregated, we are not
driven to the resource of finding in every case a local reason for development; and that
contagion is contracted through intercourse with the native community is a suggestiom
warranted by no facts showing the presence of the fever among the general population with
which I am acquainted."
In the Report of the Sickness and Mortality of the European Army in India
during the 10 years' period, 1870—79, which has been lately published by
Surgeon-Major Stephen, the successor of the late Dr. Bryden, heat is again stated
to be the probable seasonal cause of enteric fever to which the local causes are
subordinate.
The literature on the subject is very voluminous, and there are many
valuable reports published in the Annual Reports of the Army Medical Depart-
ment expressing the views of most experienced and able officers in that Depart-
ment or connected with it. I need only refer to the annual reports on Hygiene by
the late Dr. Parkes and Surgeon-Major DeChaumont, the Professors of Hygiene
at Netley; the reports on enteric fever by Surgeon-General Ker Innes, C.B,,
in the volume for 1878, and that by Brigade-Surgeon Marston in 1879, the
latter being very valuable and suggestive. There are also the most instructive
and practical memoranda issued by the Army Sanitary Commission and the
reports by Surgeon-General Gordon of the Madras Army ; but one of the latest
additions to our knowledge on the subject is Sir Joseph Fayrer's work on the
Climate and Fevers of India, published in 1882, who says :—
" It is said by some writers that enteric fever is a common disease among the natives of
India; by others, that it is almost unknown. I think there can be little doubt that it is
common enough. The causes which influence the European equally affect the Native, and
unless it be a race peculiarity, there can be no reason why the Native should suffer less than
the European. I think that under certain circumstances Natives and Europeans are both
affected by fever with enteric symptoms. It is by careful study of such outbreaks of
isolated cases as regards the locality, water, sanitary conditions, previous history of the
sufferers and their personal attributes, age, race, temperament, time of year, &c., that we may
hope to discover the true causation.
" But while the returns of the Sanitary Commissioner, the statistics of the hospitals, and
other reasons place the existence of this form of fever among Natives beyond question, the
etiology is still uncertain. My own impression is that it may depend on specific organic
poisoning , but I doubt if this can be limited to human excreta, and believe that miasmatic-
poisoning may give rise to continued or coritinuo-remittent fever which becomes practically
indistinguishable from specific enteric fever. That enteric fever should have one specific form
in temperate climates is no proof that it may not have others in the tropics.