160
MEDICAL AND SANITARY REPORT OF THE NATIVE ARMY OF BENGAL.
Fevers.
Accidents.
Phthisis
Causes of
death.
Malarial fevers occasioned 50 per cent. of the total admissions, which is a high average for
a healthy year. Mild quotidian fevers were so prevalent in June, July and August, as to give
rise to apprehensions of a severe autumnal outbreak. The admissions from this cause, which
were 41 in June, 31 in July, and 61 in August, fell to 26 in September and 25 in October. The
decrease of fever was coincident with early and complete cessation of the rains in September.
There is nothing specially interesting to record on any of the groups of disease from 2 to 5.
One case included amongst the accidents seems to merit notice from the rarity of its causation.
A fairly strong, wel-developed man, when at target practice, had the outer third of his right
clavicle fractured from recoil of his rifle. Previous experience led me to suspect that the same
cause might provoke even more serious lesions, and my suspicions are strengthened by the
occurrence of this case. In 1873, a sturdy, well-built Goorkha came to hospital on completion
of his musketry course with profuse hæmoptysis. Swelling and echymosis in vicinity of right
shoulder testified to the nature of his recent employment, and there could be no doubt that
the blood spat up issued from the apex of his right lung which was consolidated. The man
recovered and is still in the regiment, his general health is now excellent, but good respiration
has never become re-established in the apex of his right lung. Phthisis pulmonalis was not
so prevalent in the past as it has been of late years. Five cases were admitted, three were
invalided, and two died. I have freely availed myself of the facilities afforded by the neighbour-
ing sanitarium, Thundiani, for testing the effects of residence in lofty altitudes on sufferers
from phthisis. In the year under review, three cases so affected were kept at Thundiani, 9,000
feet high, during the greater part of the hot weather ; one of them recovered, and is now at
duty ; the second was much relieved, and a vast improvement took place in his general health;
and in the third, the disease was quite unaffected by change of climate. The man progressed
from bad to worse, and long before the expiration of his leave, had to be brought back to
cantonment, where he died shortly afterwards. The post-mortem examination in this case
showed in addition to cavities miliary tuberculosis of both kings.
XVII. Principal causes of mortality.— There were in all ten deaths during the year, eight
of which occurred in the head-quarters hospital at Abbottabad, and two at Gorakhpore in a
detachment of recently enlisted recruits; the cause of the latter was reported to have been
dysentery. The deaths at head-quarters were due to the following diseases : small-pox 2,
enteric fever 2, phthisis 2, hæmorrhagic purpura 1 and dysentery 1. Notwithstanding the
protection afforded by successful vaccination, both the small-pox patients had the disease
in a severe, although not quite confluent form. One of these men (both were young) was
a confirmed opium-smoker, and when nearly convalescent, and apparently making a good
recovery, was seized with diarrhœa, which quickly proved fatal. In the other case of small-pox,
that of a thin, weakly young soldier, the disease terminated fatally on the eigth day, the imme-
diate cause of death not being very obvious. It appears possible that one of the two deaths
recorded from enteric fever might have been due to tubercular disease of the intestinal glands,
and, unfortunately, circumstances were not favorable to the elucidation of the question by post-
mortem examination. The other case was identical, in all essential particulars, with the typhoid
fever of the young British soldier in India. In this case, the patient was a young recruit of a
few months' service. Fever, which was continued, was marked by evening exacerbations, the
temperature at 6 p. m. being generally from one to two degrees higher than that registered
in the morning. Pain was always marked on pressure in right iliac region, and diarrhœa
was present. The one link wanting to complete a perfect chain of symptoms was lenticular
spots, which, although carefully looked for, could not be detected at any period of the disease.
The duration of the case was prolonged owing to the occurrence of two relapses due to unsuit-
able food of which the patient partook in spite of my care and warnings. Death was eventually
caused by general peritonitis from perforations of the ileum, and the post-mortem examination
confirmed every essential point of the diagnosis.
The two deaths from phthisis do not merit special notice : one of them has been already
commented upon in paragraph XVI.
The disease which led to a fatal termination in the case of hæmorrhagic purpura was
febrile in nature, and suggestive of the pre-eruptive stage of a malignant fever. At the time
of its occurrence, neither small-pox nor other fevers liable to assume a hæmorrhagic type were
prevalent in the neighbourhood, and I therefore recorded it as one of purpura. The post-
mortem examination shewed the usual phenomena attending well-developed stages of that
d i s e a s e . H æ m o r r h a g i c m o t t l i n g s w e r e s o c o n s p i c u o u s i n t h e s t o m a c h a n d i n t e s t i n e s , t h a t
I sent the former to the Chemical Examiner, Lahore, for analysis, but no poison was detected
in it.
The death from dysentery was that of an old soldier, who returned from furlough in an al-
most moribund state; no post-mortem was held.
Epid emics.
Small-pox.
XVIII. Epidemics.—I believe that small-pox has been prevalent in the district since
the middle of last hot weather. The station authorities at Abbottabad were first warned of its
existence in the neighbourhood by the appearance in the 5th Goorkha regiment of three cases
which occurred in rapid succession on the 5th, 6th, and 7th of October. On the 10th of
October I ascertained by personal examination that the disease in a virulent form had been
prevalent for some months in two shepherds' hamlets, distant only a few hundred yards from the
front of the Goorkha lines. Inter-communication between hamlets and lines had been constant
and uninterrupted, and the shepherds gained their livelihood by selling milk in cantonments.