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APPENDIX I.
Note upon the, non- malarial fevers of Bombay.
At one time it was customary to class almost all cases of febrile disease met with in
India as malaria, either under the head of " Remittent Fever " or " Intermittent Fever "
(Ague). No doubt many cases of non-malarial fever were thus included under the general
heading of malaria ; but now-a-days the tendency is to go to the other extreme and mild
and evanescent fevers, many of which are undoubtedly due to malaria, are placed under
another heading. By far the largest proportion of cases of fever met with in Bombay
during the present investigation have been cases of malaria. These cases have been almost
all of an intermittent type and very few cases of fever which would be generally called
"Remittent'' or "Continued", showed malarial parasites on examination of the blood. A
few cases of Enteric Fever have been met with and a rather larger number of cases of the
so-called "Bombay Fever", a continued fever lasting from 5 to 10 days. It has been
remarked that this latter type of fever very frequently attacks people who have gone to
reside in newly built houses.
In none of the 6,400 blood specimens examined during the investigation were the
spirilla of Relapsing Fever seen. This is interesting in view of the fact that in 1907 and 1908
there was a small epidemic of relapsing fever in Bombay, the occurrence of which was
recorded by Captain Mackie, I. M. S. A few cases of fever which had been reported as
"Relapsing Fever" on clinical grounds, turned out to be malaria (malignant tertian) upon
examination of the blood.
Powell in his paper upon " the Blood Examination of cases of Febrile Diseases in
Bombay " (I. M. G. March 1901) records the following results in regard to 3,413 cases of
" Fever " :—
Diagnosed by the finding of parasites in the blood—
(1) Malaria parasites present in
(2) Spirilla of Relapsing Fever in
(3) Plague Bacilli (out of 117 cases)
...
(4) Filaría nocturna causing fever
...
...
...
2,542
94
15
1
2,652
Cases in which blood examination was negative, subsequently diagnosed on other
grounds—
(5) Plague (except 15 mentioned above) ...
(6) Pneumonia
...
(7) Tuberculosis
...
...
(8) Pleurisy, Influenza, Bronchitis
(9) Enteric Fever
(10) Gonorrhoea, Bubo and other form of sepsis
(11) Syphilitic Fever
(12) Lepra
(13) Liver abscess
...
102
92
94
77
29
78
6
4
9
(14) Small-pox, chicken-pox, measles, mumps, tonsil-
litis, etc.
60
Powell adds that "In 210 cases the diagnosis was reduced to unproved malaria (and
undoubtedly the majority were such) febrícula, or simple continued fever.""
There are strong grounds for assuming that tuberculosis, plague, pneumonia and
respiratory diseases are responsible for the largest number of so-called " Remittent Fevers "
met "with in Bombay. Tuberculosis is exceedingly common, many cases having been met
with during the investigation. It is also exceedingly fatal, especially when it occurs
among people of the poorer classes ; and there are good reasons for believing that a very
large proportion of the deaths recorded under the heading "Remittent fever " are due
to this cause.
As regards the non-fatal short-term fevers prevalent in Bombay, it has already been
pointed out that, the largest proportion show the presence of malarial parasites on blood
examination ; but it is probable that the existence of other specific fevers such as the
recently discovered " Sand-fly Fever " may account for a proportion of the non-malarial
fevers that are met with ; and it is possible that fevers of this kind may be not uncommon
in Mabim and other parts of the island, where malaria is prevalent to only a slight
extent.
Kala-azar does not appear to occur in Bombay, and no case has been met with in a person
belonging to the City ; but a boy from Bengal suffering from Kala-azar was admitted to one
of the hospitals in the City. The diagnosis was confirmed by the finding of Leishman-
Donovan parasites after splenic puncture.
B 136—40