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Surgeon General Cuningham, who has for so long been the Sanitary Adviser
to the Government of India, in speaking of enteric fever in his Annual Report
for 1877 says:-" There can be no question as to the practical action required-
the sanitary improvement of every station and the removal, as far as possible, of
every defect or other evil calculated to cause disease".
Among the most prominent local causes of disease malaria stands first, and
all sanitary experience teaches us that that due to the condition of the ground
under and near barracks and in other parts of the station itself as well as in the
villages immediately adjoining it is a much more potential source than that deriv-
ed from the surrounding country, although there is no doubt that marshy
or sub-marshy ground to windward of cantonments is also productive
of disease. It does not necessarily follow that the greatest number of admis-
sions from enteric fever takes place in stations where the admission rate for
malarial fevers is highest, because the incidence of enteric fever depends on the
number of men present who are predisposed to it: but the tables from the vital
statistics of the Army in India show that at Neemuch and Ahmedabad, where the
rate for malarial fever is very high, that for enteric fever as well as for diarrhœa
and cholera is also very high; and they also show that in Belgaum, where the
malarial fever rate is lowest of all the stations, the rate for enteric fever is lowest
but one, whilst the rates for cholera, dysentery and diarrhœa are also very low.
Next to malaria come the filthy conditions which are ordinarily met with
everywhere in India, and these must be considered as potent exciting causes of
enteric fever and other diseases. The filth, inseparable under present circum-
stances from Sadar Bázárs and immediately adjoining villages, is an unceasing
and ever active source of danger to troops. I fully recognize, as I have
said in a preceding chapter, that the Cantonment Magistrates do all they possibly
can, with the limited means at their disposal, to keep the Sadar Bázárs as clean
as they can; but the evils they have to contend with are so numerous, the customs
of the natives are so filthy, and the means for effecting real improvement so
imperfect, that they can do little else than see to the removal of the grosser
impurities. It thus happens that soldiers visiting these places breathe tainted
air and foul air blowing over a foul population group is frequently carried into
barracks, whilst foul dampness under and near barracks, damp barracks,
wrongly constructed and imperfectly ventilated latrines, cesspools, &c., are
sources of great danger. Food exposed to emanations from night-soil, &c.,
water accidentally polluted with filth, milk mixed with impure water, &c., are all
potent exciting causes; whilst anything that tends to lower the general health of
the men must also powerfully predispose to disease.
It will now be my duty to indicate the measures which in my opinion are
desirable to reduce the great mortality and the greater loss of service entailed
by enteric fever on the State.
It has been shown that soldiers who by their young age are peculiarly pre-
disposed to this disease are sent out with every draft in spite of the Queen's
regulations that only men who have attained the age of 20 years should be sent
out from England to India.
The action necessary to stop this injurious practice must be put in force in
England; but it is very hard that the express directions of Her Majesty are
so systematically set aside.
I presume according to the regulations medical officers are consulted before
each draft is sent out; but I have no doubt that they pass the men for service in
India under the impression that there is a great demand for their services ; and
in my experience soldiers, when asked their age, frequently, if they have an
object in doing so, make themselves out older than they really are.
If I were asked what single measure would be best calculated to prevent
the occurrence of enteric fever in the Army in India I should say : Do not let men
land in the country until they have attained the age of 25 years. This advice has
been repeatedly given by the Army Sanitary Commission, and in the report on the
causes of reduced mortality in the French Army serving in Algeria it is said ;
"Experience in Algeria has confirmed the recommendation of the Royal Commis-