Chapter III.]
EPIDEMIC FEVERS OF INDIA AND THEIR RELATION TO JAIL MORTALITY.
191
Dr. Rice was of opinion that the fever which he saw at Saugor in this year was in many
cases a typhus. From the report of the Deputy Commissioner I think it may fairly be con-
cluded that the fever affecting the district generally was purely a malarious fever. It is quite
possible, however, that Dr.Rice did see typhus in Saugor early in 1859. In the Raipore Jail
of the Central Provinces, I find that in the end of March a deadly fever broke out. Of nine
cases in this month eight were fatal, and 21 prisoners in all died. The Civil Surgeon, writing
in April, says, that although fever was very prevalent, the cases in the civil hospital did not
take on the same severe character. except in the case of two or three pilgrims.
The relapsing fever of 1859—66
probably received its main impetus
from the occurrence of famine in
1860-61: its geographical distribu-
tion.
Whatever was the cause of the commencement of this typhus, it got a direct impetus from
the events of 1860-61; and for six years from the end of 1859,
Northern and Central India and Oudh retained the epidemic.
There is an uninterrupted history of typhus, appearing, like
smallpox, with the cold weather and disappearing in the hot, year by year, from 1860 up to 1867.
The mortality from the typhus fevers of this period was not confined to the jails. We
have the record. all over Upper India of the same diseases among the population in these years.
No jail below Allahabad has localised this fever, for the 28 deaths at Calcutta in 1860 were
in a gang brought down for transportation. But in the Central Provinces, Nagpore, Raipore,
and Jubbulpore Jails were attacked in 1864—66; and the Oudh Jails suffered in the same
years. From Rohilcund and Agra up to Peshawar, year after year the pestilence showed its
presence, recurring in some of the great jails three times between 1860 and 1866.
Meteorology predisposing to the
development of diseases of the typhus
group in India.
It would seem as if in India the same meteorology which ushers in a famine predisposes
to typhus, even before want becomes manifest. In writing the
following sentences, Colonel Baird Smith had no idea of asso-
ciating contagious fevers with the famines which he is describ-
ing, and yet, as they stand, they almost appear as if written with this view. He says: "Between
1819 and 1837 there intervened a series of very indifferent seasons. The famine of 1837-38
was in fact the crisis of five or six years of great climatic irregularity. Such irregularity, indeed,
seems to be a characteristic preliminary sign of a complete suspension of the usual rainfall, and
I trace it more or less distinctly through the series of greater droughts. Similarly, 1858, 1859,
and 1860 gave cause to fear, from their very abnormal character, that a like climax might be
impending in 1861."
Typhus periods are characterised by the prevalence of various contagious fevers, each of which
is a true natural variety.
In all epidemic periods several dis-
tinct varieties of fevers of the typhus
appear.
The earliest accounts of the typhus of 1859-60 describe it as a relapsing fever. But in all
epidemic periods, while this type prevails, and may indeed be
regarded as the mainstay of the epidemic, many differing varieties
come forward. How or why these assume the forms which they
present, it is impossible to say. What to the epidemiological observer is of extreme importance
is, that when once produced, each variety of typhus produces its like.
The occurrence of epidemics of
malaria in connection with diseases
of the typhus class suggests the
necessity for keeping the fact in view
in studying pandemic fevers.
Were this etiological fact recognised in nosological arrangements, and were typhus
epidemics studied from this point of view, much unnecessary
difference of opinion might be saved. The pandemic appear-
ance of fevers, illustrated by Mr. Lawson, seems to be in epide-
miology nearly as consistent as the appearance of cholera
invasions. To this I have alluded in my Cholera Report of
1872, and I need not recur to it further than to say that in investigations into these pandemic
fevers, whether of Asia, Europe, or America, the grand distinction between fevers which are soil-
born and ærially distributed, and fevers spread through communities by reproducing their like in
the human constitution, must never be lost sight of. The ague of Russia as well as the
relapsing fever, may represent the epidemics of the same class preceding them in India; and the
same difficulty of discriminating between the two is not unlikely to arise and to give origin to
diversity of opinion, which with a proper appreciation of the actual facts would probably be
avoided.
The Aspects in Communities of Fevers of the Typhus Class.
A continued typhus occurring in
the spring may re-appear as a relaps-
ing typhus in the next cold season.
Continued yellow typhus.
Most of the reports on typhus fevers tell how, in many cases, the fever proved fatal in
two or three days. Such a case as the following, where the
man died two days and a half after admission, illustrates how
deadly typhus may prove. It occurred in 1867 in the Nimar
Jail. Three cases among the prisoners in. hospital immediately
followed, of which two ran a similar course, and the patients died within three days: "On the
evening of the 20th May, a man working in the jail buildings was admitted with fever. On
the following morning he was found lying quite helplessly on his side, breathing hurriedly.
He appeared heavy and stupid, but could be roused to answer when spoken loudly to. He
made little complaint. His eyes were dull and suffused, and even at this stage had a jaundiced
tinge. At this time he had been twelve hours only in hospital.
"On the following morning he was much worse, quite stupid, and delirious. The tongue
was dry, hard, mahogany-coloured and tremulous. He had vomited blood, and bled freely from
the nose. The heart's action was rapidly failing. The breathing was stertorous. The skin