SIND DISTRICT OF THE ARMY.
hospital from Surgeon R. Byramjee on the 9th April ; 9 deaths had already occurred.
Two companies of the Regiment accompanied the 1st Sind Horse out marching at the
commencement of November, and were in medical charge of the Assistant Surgeon 1st
Sind Horse. They were a month away, and from reports received, I found more than
half the number of men constantly on the sick list, and the occurrence of 2 deaths from
pneumonia. The total number of deaths during the year amount to 32 ; this large mortality I
can only account for to be due to the total want of stamina in the men, occasioned by long
residence, in this very unhealthy station. Of the prevailing diseases fever ranks first, every
human being, European or native, that came under my notice suffered from occasional attacks
of it. This being my first year in Jacobabad, I cannot compare the severity and type of fever
to those of the past. Ague of the quotidian and tertian varieties are very common; I have
had some very obstinate cases under treatment, both of the remittent and intermittent forms.
In the months of October and November several were brought to hospital in a semi-unconscious
state, and they turned out to be very serious cases. The disease prevails to a slight extent all
the year round, but most cases occur during what is called the fever season, viz., from August
to end of November ; this corresponds to the time when nullahs and masses of water about the
place begin to dry up. In the intermittent form of fever, the stages noticed by authors, and
which are well exemplified in the fevers of these parts of India, are not at all marked ; the hot
stage is the only one always present—I have seldom seen a sweating stage. Quinine is the
only remedy that can be relied upon, and even this in some cases of a very obstinate nature
seems to fail ; as much as 30 or 40 grains have been administered by me for days, occasionally
in conjunction with small doses of liquor arsenicalis without preventing the recurrence of a fit.
Derangement of the liver and irritability of stomach are the two common accompaniments of
the disease ; repeated attacks of ague occasioning, as is well known, enlargement of the spleen.
This latter affection prevails to a great extent at Jacobabad ; I am sure more than 90 per cent.
of men in the Regiment have spleni.c enlargements. This is not shown in the return, for the
men seldom come to hospital solely for this complaint. Applications of iodine with iron and
quinine internally prove useful ; I have in a few cases tried local application of the bin iodide
of mercury ointment, but was quite disappointed with the result. In one case a simple appli-
cation caused very obstinate salivation.
Affections of the chest .—These cause a very large mortality ; 18 deaths came under this
head ; more than one-third of the cases admitted die. Pneumonia of a very adynamic type is
the prevailing lung disease ; there were 29 admissions and 13 deaths from this cause. It occurs
most insidiously and very often in the course of intermittent fever ; the symptoms are in many
cases quite masked. On 2 or 3 occasions I noticed scarcely any cough. or difficulty in
breathing, but on examination of the chest, both. lungs were found diseased ; often the inflam-
- m a t i o n . e x t e n d s t o t h e p l e u r œ a s w e l l a s t h e p e r i c a r d i u m . O n t h ep
o s t m o r t e m
i n
a c o u p l e o f
cases, the contents of thorax were all found diseased, both lungs nearly solidified, and with
recent adhesions to walls of chest and appearances of pericarditis.
Intractable diarrhœa occasionally comes on during the course of this complaint ; this is
always a bad omen ; cases as a rule terminate fatally.
There was one death due to hydrothorax ; the deceased was once treated for pneumonia,
and when convalescent, was sent away to his native country on sick leave ; he returned after a
couple of months in a dying state, with complete hydrothorax of right side ; the poor man was
in great agony, suffering from intense dyspnæa. On consultation as a last resource, I had
recourse to paracentesis, removing 3½ pints of serous fluid, but as was anticipated with no good
result. Pulmonary affections chiefly occur from October when the cold weather sets in, and
there continues a large number of admissions up to April. The cold weather in Jacobabad,
although it sets up a European, acts very detrimentally to a native of India, especially when he
is enfeebled by fever and long residence. The men moreover expose themselves to an un-
necessary extent ; they have no idea of keeping themselves warm. Nothing can scarcely be done