230 



NATURE 



[Jan. 8, 1880 



says : " It has no geography ; and it is a matter of 

 popular observation that no regiment or battery escapes 

 enteric fever in the first year, whatever cantonment of 

 India may be selected." " Out of seventy-three bodies of 

 men two regiments and seven batteries only returned no 

 case of enteric fever in the first year.'' And he gives the 

 following analysis of 368 deaths that occurred between 

 1823 and 1S76':— 



Ages. Total deaths. 



24 and under ... 255 



251029 co 



3°t°34 '7 



3Sto39 4 



40 and upwards ... ... ... ... 2 



Seventy-five of these deaths occurred within three years 

 after landing in India, and 94 per cent, of the total were 

 among men under thirty years of age. In a memorandum 

 received only a few days ago Brydcn says, out of 132 

 deaths from enteric fever in 1S78, 90 occurred in men 

 who had been under twenty-two months in India. All 

 this shows that youth and the first year of service in 

 India are the great predisposing causes. 



Now is this the same disease as that which might be 

 contracted in London, Dublin, Windsor, or elsewhere in a 

 town or barrack ? from a watercloset, drain, sewer, well, 

 or, it may be, from a milk-can ? I have little doubt that 

 very frequently it is exactly identical ; but I believe also 

 that perhaps as frequently, or more so, it is not ; and 

 this, I believe, not in regard to young European soldiers 

 only, but of the whole population of India. In short, I 

 am, and long have been, of opinion that a form of fever 

 exactly like European typhoid, except in its etiology, 

 exists in India and other hot and malarious countries ; 

 and that it is due to climatic causes, not to filth or 

 specific causes such as give rise to it in Engbnd and 

 elsewhere, and recent reports from India and ether 

 parts of the world seem to show that this view is gaining 

 ground. 



Be it clearly understood, however, that I do not for a 

 mo nent dispute the existence of genuine_/?///7 typhoid in 

 India. The official returns, which cannot be gainsaid. 

 and my own experience alike leave me in no doubt about 

 it. But I do believe that many cases now recorded, and 

 rightly recorded, as typhoid in India, are not caused by 

 the same specific agency as that which gives rise to 

 typhoid here, and also in India, where the necessary 

 conditions are present. There are, in fact, two, per- 

 haps more, forms of typhoid, or perhaps, I should say, 

 different causes for a disease presenting the same 

 phenomena, one being specific, the other climatic; if so, 

 it is obviously very desirable to discriminate between them 

 — not merely as a matter of nosological or pathological 

 interest, but in regard to the hygienic measures that are 

 necessary in either case. This question is of great 

 interest to epidemiologists, and is just one of those 

 subjects that should come within the scope of our inquiry. 

 A remarkable instance occurred near London lately, 

 where an epidemic of typhoid was traced to its origin 

 along the track of a particular water-supply by a dis- 

 tinguished member of our Society. Our lamented 

 colleague, Murchison, also traced a similar outbreak to 

 contamination of milk by polluted water. The explana- 

 tions of these outbreaks were exactly in accordance with 

 these views, no doubt rightly held in Europe. Typhoid 

 in India, however, would not always be similarly 

 explained. 



We know but little of the nature of the causes of 

 epidemics such as cholera, or of malarious diseases, 

 but we know something of what may be expected in 

 regard to them, when and how they will appear, and 

 how sanitary work may be made most effectually to 

 avert, prevent, control, mitigate, or remove them j nor 

 is it too much to say that we hope, if not to banish 

 or stamp out, at all events still further to mitigate 



their ravages. This, I think, is warranted by experience, 

 for certainly the past twenty years have witnessed great 

 progress, and we already see that not only is the value of 

 life increasing, but that the virulence of, and mortality 

 caused by, epidemic disease are being controlled, whilst the 

 vexatious and purposeless restrictions and restraints of 

 quarantine are diminished if not altogether removed, in 

 our dominions at least. Science that has enabled us to 

 reduce the death rate among our troops from i7'9 to 8"56 

 per 1,000 in Europe, and from 69 to 17-62 per 1,000 in 

 India, speaks for itself, and were there no other result this 

 alone is a triumph such as has been achieved by no other 

 department of knowledge. Pray do not suppose that I 

 claim all this for Indian workers. We all know that 

 these great steps in social and sanitary progress began 

 here, but I do say that the torch then lighted has since 

 been worthily and firmly borne in Indian hands. 



This Society, young as it is, can remember the com- 

 mencement of systematic sanitary work in the East, and 

 may claim some share in the origination of the good 

 work ; for among its earlier members were some who 

 advocated the study of epidemiology and hygiene in 

 India. I cannot now stay to dwell on this, but I may say 

 briefly in regard to its progress and work that until the 

 sanitary department was formed, less than twenty years 

 ago, comparative, I might almost say complete, ignorance 

 on the subject of epidemics, and of the diseases that pre- 

 vailed among the people, existed. An epidemic might 

 carry off thousands, but we knew not where it commenced, 

 where it ended, or what area it occupied. Now, thanks 

 to the continued and careful statistics, we know all that 

 and more, with fair accuracy, and are gradually collecting 

 facts which make the study of epidemiology possible. 

 Before organised sanitary work in India began our know- 

 ledge of the general population — nay, even of the 

 European troops and prisoners — was most imperfect. 

 Now, thanks to that department, and especially to Bryden, 

 whose name cannot be too prominently mentioned in con- 

 nection with the subject, we have, in his most elaborate 

 and valuable statistical reports, facts and figures, as well 

 as deductions, which deserve the closest attention. We 

 have, in short, the most complete details of sickness and 

 mortality in all classes over the whole of India. It is 

 impossible, how'ever much any one may differ from his 

 conclusions, not to recognise the great value of his work, 

 for these reports contain a vast and continued array of 

 authenticated facts which will serve as a mine of infor- 

 mation to epidemiologists ; and there is every reason for 

 believing that it is but an earnest of more, for if, as 

 Bedford said, the circumstances of India were such as to 

 favour the acquisition of knowledge in 1850, when the 

 precise conditions of life of the population generally, and 

 even of our troops and prisoners were imperfectly known, 

 what must it be now when a system of observation, 

 carried out by a body of trained observers under a head 

 such as he contemplated, is in full and daily improving ope- 

 ration ? One can only wish that, considering the magnitude 

 of the work, it were more extensive still, and that obser- 

 vations, already of the greatest value, could be rendered 

 still more so by being concentrated on certain limited 

 areas so as to enable the inquiry to extend to details with 

 a precision that at present can hardly be practicable. 

 The results of epidemiological knowledge and sanitary 

 work are seen in the effect already produced in reducing 

 the mortality from cholera and other epidemics, and from 

 malarial fevers. For instance, among our European 

 troops, the circumstances of which are well known, there 

 has been the following alteration in the general death- 

 rate :— 



1861 to 1S65 

 1865 to 1870 

 1870 to 1875 

 1S75 t0 ,8 7 6 

 iS76to 1877 



Q'02 per 1,000. 

 6'98 

 3'23 



2-3 >. 



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