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fever. The natives dreaded the disease very much and declared that from its great mor-
tality, its prolonged duration and the bowel complication it was different from any fever
they had ever seen before.
4. Of the five undoubted cases all were young men; one was a student residing in the
Government Training College, and the other four, of whom three were students, resided in
various parts of the city.
5. In one of the cases the fever came on within a fortnight after the death from fever
in the same house of a sister-in-law. This female I saw, but she had no enteric symptoms,
and the pulmonary and cerebral complications which caused death were so urgent that I did
not at the time suspect typhoid fever. She died after an illness of between three and four
weeks.
6. In all the five cases the fever was ushered in by slight shivering attacks resembling
ague and after invasion there were no intermissions. The fever gradually increased in in-
tensity till a temperature of about 105° was reached in the evenings. In the mornings the
temperature was less by one or two degrees. From the begnning also there was, except in
one case in which constipation existed for about a month, looseness of the bowels, the
motions being characteristic of the typhoid fever. With the diarrhoea there were marked
tenderness and gurgling on pressure over the right iliac region, and as the disease advanced,
there was tympanitic distension of the abdomen. In one of the cases between the 20th and
30th day of the fever there were several slight attacks of hœmorrhage from the bowels.
In one also hœmorrhage from the nose occasionally took place. In none of the cases could
any eruption be seen on the body. The febrile state lasted for about six weeks and ended
by gradual decline with free action of the skin; but even during the height of the fever
profuse perspiration, especially about the head and neck, was not uncommon, but without
any fall of the temperature. During the height of the fever quiet delirium was common,
and one of the patients became quite deaf and continued so for weeks after the subsidence
of the fever. One of the patients died suddenly after the fever had subsided, appa-
rently from failure of the heart's action following an attempt to walk. The other four
recovered.
7. I hope I will be excused from referring from memory and in so general terms to
these cases of which I possess no notes. I did not see them so frequently as to enable
me to note minutely the progress of the disease, but I looked on it as quite different from
remittent fever and was strongly impressed with the belief that it was typhoid fever.
8. Prom the reputed number of cases amongst the better classes and higher castes
in the city I was of opinion that the disease was spread by contaminated water; but how
this contamination of the water—if the fæcal matter of typhoid patients be essential in the
production of the disease—had originally taken place, I could form no opinion. If, however,
simple organic matter alone or the products of decomposing organic matter be sufficient
to cause typhoid fever, then the explanation is very easy, for the water-supply of Dhárwár
is probably more scanty and more polluted than that of any large city in the Bombay
Presidency. The large tank and the few wells in its vicinity (which obtain their water
partly by filtration from the tank) on which the city chiefly depends for its water-supply,
were almost dry before the commencement of the rains, and as the tank receives the whole
drainage of the large market place which stands on its banks and also part of the drainage
of the civil station, besides all the filth which accumulates in the water-courses during
the dry season of the year, it is little better, after the first scanty fall of rain, than an
ordinary cesspool.
9. Although I now believe that typhoid fever does exist amongst natives, I do not
recollect any hospital case shown as remittent fever which would have been more
correctly returned as typhoid fever; and I am unable to give any evidence in favour of
a connection between infantile remittent fever and enteric fever.
I have the honour to be,
Sir,
Your most obedient Servant,
JAMES DAVIDSON, M.B., Surgeon Major,
Civil Surgeon, Surat.
" Report on two Cases of ' Enteric Fever' in the Shikárpur District Jail.
I.
1st Prisoner, No. 969, Dossoo valad Nawad. Caste.—Mussalmán. Male; age 30 years.
Entered Jail.—16th February 1882, Occupation in Jail.—Canal clearance. Admitted into
Hospital—9th April 1882.