REVIEW — TEOPICAL MEDICINE, ETC. 



65 



much in evidence. The other factors operative are diet, habits, general surroundings and 

 adaptation of the human organism to the disease causes which are most prevalent. 



As regards habit and dietary, he gives an interesting comparative table which in large 

 measure applies as much to the Sudan as to India, though in towns like Khartoum there is 

 no doubt that the habits and dietary of certain classes of the natives, and especially the 

 servant classes, has altered considerably within the past few years, and will continue to do 

 so as a direct result of increased prosperity, a higher standard of comfort and association 

 with, and imitation of, Europeans : — 



Enteric 

 Fever — 



eonlinued 



The Native 

 Cold and dry. 



Bulky and coarse. Much waste. 

 Vegetable grains. Cereals and pulses ; large 



cellulose content. Low proteid and fat content. 

 Very partially cooked, plain and monotonous 



from day to day. 

 Meals infrequent, twice daUy with long fasts. 

 Mastication generally good. 

 The majority eat to live. 

 Life and work in open air. 

 Fffical evacuations twice daily, large 10-12 oz. ; 



completer by squatting. 

 Strain on stomach and large bowel. 



The European 

 Hot and fluid. 

 Concentrated and soluble. 

 Animal food with high proteid and fat. 



Thoroughly cooked and sophisticated. 

 Very mixed and varied. 



Meals frequent, 4 or 5 times a day. 



Faulty in extreme. 



More often live to eat. 



Sedentary, indoor. 



Small 5-6 oz. ; constipation rife. Purg- 

 atives. 



Strain on stomach and small intestine. 



The influence of these dietaries and habits on toxic putrefactive processes in the 

 intestine is discussed in a very interesting manner. 



As regards the diseases prevalent, the author lays great stress on the liability of the 

 Indian to dysentery and other bowel complaints apart from enteric fever, and thinks that 

 the reaction of the tissues against B. dysenterise in its various forms may confer local 

 immunity against the closely allied B. typhosus. Indeed, when he considers the question 

 from the bacteriological point of view, he is inclined to favour the theory that B. coli under 

 favourable conditions may develop in the intestinal canal into the true B. ti/pJwsiis. It 

 must be admitted that this is a very engaging theory and that one sees cases of what are 

 probably B. coli infections which very closely resemble early enterics. Indeed, one has felt 

 that if such cases had not been promptly treated with calomel and appropriate dieting, they 

 would, in all probability have passed into a condition almost indistinguishable from typhoid 

 fever. On the other hand, there is no definite proof that this ever occurs, while Eoberts' 

 views on the rarity of enteric fever in the native Indian are opposed by Eogers,i who finds 

 that the disease is widely prevalent save in Eastern Bengal and Assam, where there is a 

 heavy and continued rainfall. Further, he states that the clinical picture in natives is 

 precisely the same as that in Europeans. Thus, while Eoberts believes that European 

 troops chiefly obtain infection in the cantonments themselves, owing mainly to faulty 

 conservancy methods, Eogers maintains that the native bazaars also present foci of infection. 

 His conclusions are chiefly based on the evidence obtained by the application of the Widal 

 test, but Roberts' book is so carefully compiled, his reasoning seems so accurate, and his 

 conclusions are so well supported by statistics from other tropical countries, that there is 

 much to be said for his attitude on the subject. It is, of course, possible that the native 

 sufi^ers from a mild and unrecognised form, but, so far as Khartoum goes, I do not think this 

 is the case, for, if the disease were at all common, the conditions governing our water supply 

 would assuredly have led to epidemic prevalence amongst the susceptible European 

 population. This matter, however, will be further discussed under "Sanitary Notes" 

 (Third Eeport). Eogers- explains the difficulty by pointing out the low incidence of typhoid 

 amongst persons over the age of 25 years in India. He believes this explains the com- 

 parative rarity of the disease in the native army and in jails, which, he says, led Eoberts to 

 conclude that natives of India were relatively immune because the majority of those in the 

 native army and in jails are over this age. He finds the disease not uncommon in native 

 children and in the poor Europeans of Calcutta reared under the same conditions as the native. 



However, there seems little doubt that the disease, in epidemic form, is rare amongst 

 natives in India, while in the Sudan I believe it is, so far, rare in any form. 



Stock^* believes that enteric fever is a common disease of tropical regions and mentions 



' Rogers, L., "Fevers in the Tropics," 1908. 



' Rogers, L. (August, 1907), "The Incidence of Typhoid Fever on Civilian Europeans and on Natives in 

 Calcutta." Indian Medical Gazette, p. 291, Vol. XLII. 



^ Stock, P. Q. (January, 1908), "The Etiology of Enteric Fever." Tramvaal Medical Journal. 



* Article not consulted in the original. 



