PUNJAB FRONTIER FORCE.
159
pernicious influence had been engrafted on the original disease ; the symptoms much resembled
those which are described as having occurred in epidemics of pleuro-pneumonia in former
times. In many cases the patients, although they affirmed that they had been in good health
a few hours previously, already had the appearance of men smitten by a fatal disease ; their
faces wore an anxious look, and they seemed to have lost the power of self-control, tossing their
limbs about, and talking in an excited, half-rational manner. In some cases there was active de
- l i r i u m , i n o t h e r s u n c o n s c i o u s n e s s m o r e o r l e s s c o m p l e t e , a n d i n s o m . e v i o l e n t c o n v u l s i o n s . T h e
pulse was invariably very quick, 140 or thereabouts, generally weak and compressible; the
respiration was much accelerated, about 40 or 50 ; and the breath often had a peculiar cadaveric
odour at an early period of the disease. The temperature seldom rose above 103°. The tongue
was generally dry and brown, sometimes almost black, and the teeth covered with sordes at the
time of admission. The chief symptoms complained of were pain in some portion of the chest,
with difficulty of breathing. The character of the expectorated matter varied ; in some of the
worse cases there was none at all, in others it was thin and frothy, but in a considerable num-
ber it was viscid and tinged with blood or rust-coloured; these cases usually did well.
With regard to treatment, nearly every reputed remedy, short of venisection (which did not
appear suitable to any of the cases) and aconite (which was not procurable), was tried. The internal
medicines included stimulants in moderate and few quantities; calomel, tartar emetic, in a few
cases ipecacuanha, carbonate of ammonia, quinine, inhalations of steam and of steam impregnated
with carbolic acid. The external remedies were :—cupping, both wet and dry, according to the
stage of the disease, turpentine stupes, sinapism and blisters. The most successful treatment
seemed to be the hypodermic injection of quinine, neutral sulphate, with simple diaphoretics,
and sometimes a moderate allowance of stimulants. The local abstraction of a small quantity
of blood was of great service in relieving pain. One of the greatest difficulties to contend
with in the treatment of these cases was the utter loss of appetite ; it was almost impossible to
get the patients to take any nutriment, and both they and their attendants were so imbued
with fatalistic ideas that it required considerable pressure to get them fed at all, and suitable
articles of diet, such as milk and meat, were procurable only with much difficulty.
During the whole duration of the epidemic there were 131 admissions and 50 deaths, being
in the proportion of 38.1 per cent. of cases. This is a very high rate of mortality, but it must
be remembered that in addition to the extremely malignant type of the disease, the patients.
were placed under very unfavourable circumstances, the weather was very cold and the tents
draughty. The thermometer was often as low as 25° Fahr. inside the tents at night, and on the
march the patients had to be taken out before sunrise, when the cold was most intense; more-
over, as above said, proper nutriment was frequently unprocurable. During the latter part of
the period, as the weather grew milder the disease became of a milder and more tractable
character, with a larger porportion of recoveries. It was impossible to make post-mortem exami-
nation in all the fatal cases ; but on one occasion, a suspicion having been promulgated that
the disease was typhus, an examination of three bodies was made by a medical committee. The
appearances Were almost precisely similar in all these, the pleura of the affected side (both
lungs seldom suffered) was smeared with purulent lymph, the substance of the lung was infil-
trated with pus to a greater or less extent, completely solidified, and in some spots seemed to be
on the point of liquefaction ; the spleens were enlarged and unnaturally soft; the intestines were
carefully examined in each case, but no trace of typhus or typhoid lesions were found, in two
o t h e r c a s e s w h e n e x a m i n a t i o n s w e r e m a d e , t h e s a m e c o n d i t i o n s w e r e f o u n d i n a l l . T h e c a v i t i e s
of the heart and great vessels contained the ante-mortem fibrinous clots usually found in fatal
cases of pneumonia.
As soon as the infectious nature of the disease was perceived, and means to prevent its
further propagation became available, the following measures were taken :—the patients suffering
from pneumonic affections were separated from the rest and treated in two tents in which fires
were kept at night, and as in several cases relapses, probably due to re-infection, had taken place,
they were divided into two classes,—those who were in the acute stage of the disease, and those
who had passed the febrile stage and might be regarded as convalescents. The sick attendants
were not permitted to remain in the tents, except when their services were actually required,
and they were frequently changed. No attendants were allowed to sleep in the tents, but men
were told off for night duty and relieved every two hours. The tents were thrown open when
weather permitted, and every fourth or fifth day fumigated with sulphur, as were also the
clothes and bedding of the men who died.
The following tables show the incidence of the disease according to season and caste, the
second demonstrates the greater liability to the affection of the non-flesh-eating Hindoo castes in
comparison with Mussulmans, who indulge in meat freely. The comparatively smaller amount
of mortality among the camp-followers, who are mostly Hindoos, 36 to 39, is probably due to
their being exempt from night duty, which was one of the chief factors of the disease.
NOVEMBER.
DECEMBER.
JANUARY.
FEBRUARY.
TOTAL
Admissions.
Deaths.
Admissions.
Deaths.
Admissions. Deaths.
Admissions.
Deaths.
Admissions. Deaths.
15
8
54
25
35
12
27
5
131
50