10
REPORT ON THE
it may and does, that we are apt to term it enteric? Is it not likely that the
remittents which are tending towards a fatal issue,—in other words, those whose
symptoms become typhoidal,—are often termed enteric, and those cases which
run a mild course are termed remittent ? If there be not some confusion of this
sort, how are we to account for a 90 per cent. rate of mortality ?" All the
patients were under 31 years of age. The length of time, however, each
patient had been in India is not given.
26. Typhoid fever in the east is viewed by some medical men as ever
present, and traceable—without a vestige of proof—to a specific germ, an
entity, something which can be held in the hand, or to a mephitic gas ; and
who see enteric in almost every case of "cynanche tonsillaris," or fever, which
may come before them ; while there are others—and by no means a few—who
question the accuracy of the diagnosis in such cases, and are inclined to doubt
the frequent occurrence of true enteric, if they do not actually deny its
presence at any time in this country altogether. I do not pretend to be able
to decide the vexed question between these two schools. I have no precon--
ceived opinion on the subject,—no hobby to ride.
27. I can only take a common sense view of the matter. If the enteric
fever of this climate is not caused, as it is supposed to be in Europe, through
defects in sewers or by exhalations through ill-trapped water-closets or privies,
then I would ask, why not ; for do not the conditions needful for its introduc-
- t i o n a n d h a r b o u r i n g e x i s t e v e r y w h e r e i n t h i s c o u n t r y ?
28. To affirm, without positive facts in support of the assertion, that
enteric fever is confined to certain localities, to certain latitudes, is a fallacy ;
for throughout Europe and the United States of America, from north to south,
and from east to west, the disease is seldom absent; moreover, it is met with con--
stantly enough in situations—take New Orleans for example—where the climate
in the summer months is quite as unbearably hot and humid as that of Calcutta.
If, on the other hand, as some aver, enteric in India is the result of sun-heat
and atmospheric phenomena, then we are simply left where we were. Merely
to say so, affords us no tangible proof of the real latent cause or causes of the
disease. It simply assumes that the conditions tending to its activity and its
simultaneous appearance over wide areas are more general at certain seasons
than at others : and from experience we were thoroughly aware of that before.
29. It is sufficiently apparent, nevertheless, that the present classification
is not altogether a satisfactory one ; yet it is undoubtedly a step in advance when
the remittent fever of this country hitherto deemed of purely a tropical original,
and enteric fever are declared by competent authorities to possess some of the
most prominent features in common, and which as a class are seemingly identical.
Complicated questions are involved in this title, or single term enteric. However
most medical men, it is presumed, quite understand the nature of the two
diseases; and, as far as therapeutics are concerned, I have noticed that the
opposite schools treat both precisely alike. Really, therefore, whether of
malarious or specific germ origin, signifies very little. But when we come
to consider the different interpretations medical men of experience, and in
large practice, place on the true causes of these diseases—the several grounds on
which the various opinions are based—
I think that the nomenclature is inadequate,
and as a statistical record is apt to lead to error and confusion.
30. The affinity between other acute diseases, peritonitis for instance,
and an infected atmosphere is a question of great importance. There
are other special diseases deserving of notice, but of which I fail to find
any mention in the annual reports. I will draw attention to one only now,
and a very fatal one too, viz., cerebro-spinal fever. This disease is frequently
met with among the very poor of this city, yet not a single case was, or ever
has been, as far as I can discover from the records, admitted into hospital.
Some medical writers attribute the complaint to the consumption of dis-
- e a s e d g r a i n s . I t w o u l d i n d e e d b e a g r e a t g a i n t o o u r p r e s e n t k n o w l e d g e c o u l d
we trace out its existing cause or causes in this country. Perhaps khassari
dhal, which is consumed largely by the poor, is a true factor in the causation
o f t h e d i s e a s e .