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CHAPTEK VI.
From the evidence I have been able to gather there seems to be no ground
for believing that the enteric fever which annually attacks and destroys so many
young soldiers shortly after their arrival in India is in all, or even in the
great majority of cases, due to a specific poison derived from the intestines
of a previously affected person. If this source had been a common one, we may
be sure that the many able officers of the Army Medical Department who have
devoted such earnest attention to the subject would have succeeded in tracing
such a connection. That enteric fever is met with among the native popula-
tion is established beyond a doubt by the reports of the Sanitary Commis-
sioner with the Government of India as well as by Sir Joseph Fayrer, and
now, as regards the Bombay Presidency, by the interesting cases recorded by
several medical officers.
Indeed it is extremely probable that this disease
will eventually be found to be much more widely spread among the natives
than is at present recognized, and, in fact, in my opinion there are grounds
for believing it to be endemic in many of, if not in all, our large Sadar
Bázárs and native towns. That it has not hitherto attracted the especial attention
of Civil Surgeons is not conclusive evidence that it does not exist. The young
rarely seek admission into hospital until the disease has far advanced, and there
are very great difficulties in the way of obtaining a distinct account of their
antecedent history—a history, it must be remembered, which should embrace a
period of at least a fortnight before the patient was first taken ill; whilst the
residences from which they are brought are never visited by the medical officers,
who also labour under the extreme disadvantage of being unable in fatal cases,
except on rare occasions, to verify their diagnoses by post-mortem examinations,
so that in cases diagnosed as continued or remittent fever there may have been
enteric lesions which, in the absence of an autopsy have escaped notice.
There is no doubt however that the causative agent which produces these
lesions among British soldiers is very widely diffused, and is present in every
station though it has attained greater virulence in some than in others. From
the evidence adduced by Sir Joseph Fayrer, Dr. Morehead, and others, it would
appear that there are more exciting causes for the disease in India than are re-
cognized in Europe. Even those who deny malaria to be an exciting cause allow
that it materially modifies the symptoms. Dr. Aitken, who strenuously denies
the identity of the poison of the two diseases (enteric and malarial fevers), says :
" We have to grapple with enteric fever and with malaria in all its forms in
India, and it is so much the worse for the chances of recovery of the enteric
patient if he is at the same time suffering from malaria in any form".
For my own part I cannot help thinking that during the putrefactive changes
which accompany the decomposition of nitrogenous vegetable as well as of nitro-
genous animal matter ' a something' (whether a minute fungoid body or whether
a bacillus I do not know) is generated, which under certain conditions of tem-
perature, and especially of humidity, &c., in either air or soil assumes activity and
may thus find its way into air, soil or wells, and which, if introduced into the body
of any one susceptible to its influence, and especially if taken directly into the
stomach and alimentary canal with food or drink, is capable of causing those
lesions which are considered in Europe pathognomonic of specific enteric fever.
It is a matter of observation that a water containing much albuminoid ammonia,
solely derived from vegetable sources, will cause diarrhoea among any community
which partakes of it, and I think that it is probable that in India the poison which
produces malaria is in many cases, though not in all, the causative agent of
these lesions.
For practical purposes however the question as to whether this poison
is of specific or non-specific origin is not of such supreme importance as the
recognition of the fact that, of whatever nature it may be, it is connected with
insanitary conditions, and that without doubt the surest way to prevent its
development is to correct in every station all sanitary defects, whatever or where
ever they may be.
B 357—40