LAHORE DIVISION.
119
XVI. Principal causes of sickness.— The principal cause of sickness was intermittent
fever, which gave 349 admissions, or 52 . 3 per cent. of total admissions. A great many men were
admitted more than once. Next in frequency came blistered feet, which gave 54, or 8 . 09 per
cent. of total. A greater portion of these were due to the regiment being on the line of march
during the month of December. Some were very intractable. I found the best treatment when
first seen, if the blister were not broken, to pass a seton through it, and let out the serum.
Next in order came respiratory affections ; bronchitis giving 41, or 6. per cent., and
pneumonia 18, or 2.68 per cent. of total admissions ; the greater number of these occur-
red on the line of march and the remainder at the beginning of the year. These men are
very susceptible to the change of temperature such as occurs in the nights and early morn-
ings. This on the line of march is the more marked, as, being in tents lying on the ground
with no grass or other bedding under them than their small durries, the change of tem-
perature in the early mornings must be most acutely felt, causing a tendency to conges-
tion of the internal viscera which rapidly runs on to acute inflammation, the lungs being
the organs which suffer most, and from affections of which we have such fatal results with
these men. This will always be the case as long as the present system lasts of only allow-
ing men a certain small weight for Government carriage, and not giving them straw or grass
of some sort to lie on. Complaints are constantly made by inspecting administrative medical
officers that the men have not sufficient clothing ; but how are they to have more if they are not
allowed carriage for it ? Each man is only allowed 15 seers' weight to include every thing.
Dysentery caused 19 admissions, mostly of a mild type ; rheumatism 10.
XVII. Causes of mortality— The principle cause of mortality during the year was
pneumonia which caused six deaths ; of these five occurred in the last month of the year on the
line of march to Morar ; one occurred at head-quarters at Meean Meer at the beginning of the
year. This disease presents some peculiarities with natives of this country which are worthy
of remark. First, the absence of pain and the apparently slight amount of uneasiness the
patient experiences at first, that is, the real seat of disease does not seem to trouble him at all,
but merely the constitutional symptoms of fever, as almost every patient I have treated in
India for this disease has only complained, when asked what was the matter with him, of fever ;
he would then, on being interrogated, say that he had a slight cough but no pain, his breathing
being slightly faster than usual ; but some of them have said that they have perfect ease in
their chests. At this time, perhaps one lung is in a state of active congestion and the other
labouring to perform the duties of both ; yet with apparent ease they are able to do their duty
and keep out of hospital until the last moment.
Dysentery
Rheumatism.
Causes of
mortality.
Pneumonia.
Peculiarities
of pneumonia
in natives.
Absences of
pain.
Prevalent
diseases.
Fever.
Blis-
tered feet.
Treatment.
Their causa-
tion.
Chest diseases.
2ndly.—The rapidity with which a case progresses towards a fatal termination.
Rapidity.
3rdly. —The absence of demonstrative chest symptoms renders the diagnosis more difficult,
as added to it there is the comparatively common absence of diagnostic sputa, which at first
is apt to mislead ; I mean the absence of what is commonly looked upon as diagnostic. The sputa
are, however, although not rusty, still very characteristic of the disease as seen among these men ;
it is a colorless, viscid glairy sputum in the midst of which air bubbles are seen confined by its
viscidity ; this is not only seen when first spat up, but after it has been standing some time.
The tongue presents the common characteristics. The urine shows rapid diminution of
chlorides.
Absence of
symptoms.
4thly.—It is the most plastic form of pneumonia, that is, consolidation almost seems to
have a tendency to become organized, and, in cases that recover, convalescence is very lingering,
the lung being for a long time left in a dull state ; cough also remaining for a very long time after,
showing presence of irritation in the lungs.
Plasticity of
exudation.
The great danger to patients is change of temperature, as, with their great want of heart,
force or vis a tergo, most of them having feeble circulations and a great many fatty hearts, there
is the great liability to congestion of the healthy lung before the active symptoms have passed
away from the diseased one. I have seen men on the line of march going on perfectly well with
one lung hors de combat and the other doing the work of both in the day time ; as soon as
evening sets in, the breathing became affected, and by the morning they were in a moribund
state. To avoid the change of temperature affecting them on the line of march is quite impos-
sible. Now with regard to the causation of this disease so very fatal to natives, I don't think
that on the line of march with the present allowance for carriage per man anything can be
done. I was in charge of a Punjab regiment on the march down from Peshawar and bad some
severe cases. This, I was told on my arrival at Meean Meer, was solely due to want of
clothing; although each man had his usual allowance. I then left Meean Meer with a
regiment which I presumed was deemed to have sufficient, and with the result that, before I had
been three weeks on the line of march, I had some 15 cases and two deaths. I took every precaution
to keep the men warm, had the hospital tent heated at nights periodically, plenty of grass for
them to lie on, but the result was the same, because in my opinion the men are not allowed
carriage for a sufficient amount of bedding, and have not grass supplied to lie on in their
tents ; also that on the march in the morning they are more or less exposed to sudden changes
which are always so fatal. With regard to the supply of grass, as soon as they have got their
fatal disease, then they are taken care of, but not before. I think this is a most fertile cause of
disease. Then, again, these men's Hindoo custom of sitting naked to cook their food has, I think,
a good deal to do with their not only getting the disease, but more particularly in causing those
Effect of
change of
temperature.
Deficiency of
carriage.