Miscellaneous. 



40b 



[June 



on the first appearance of the symptoms of tropical diarrhoea or sore mouth, that 

 many cases would not progress to the acute disease. I may perhaps be pardoned for 

 having digressed somewhat, and in some instances for having invaded the domain 

 of the manager's illnesses rather than the coolies— as in the case of the treatment 

 given above — but I submit that on such occasions if I have outlined the proper 

 treatment for the manager, he can easily substitute for what is laid down as his 

 treatment, what should be the treatment for his coolie sick of the same disease. 



Infectious Diseases.— I have already laid down the advisability of isolating 

 cases of dysentry, diarrhoea, anchylostomiasis, and other intestinal diseases, the 

 necessity in infectious cases — strictly such — is absolute, and if it be remembered 

 that in the case ot cholera alone, the disease frequently commences as a simple 

 diarrhoea, the expediency is obvious. Of epidemic disease affecting bodies of coolies 

 the principal will, of course, be small-pox, cholera, chicken-pox, influenza, measles, 

 dengue, plague, to a minor extent enteric fever, and amongst the Chinese beri-beri 

 (which is perhaps not directly infectious). The majority of these diseases can be seen 

 coming, and arrangements made for the isolation of the cases direct they occur, the 

 estate should establish quarantine against infected areas in the vicinity, and every 

 endeavour should be made to prevent coolies visiting such infected areas. 



Small-pox.— The incubation of the disease is about 13 days, during this time 

 the patient feels quite well. Fever starts with shivering, and frequently vomiting, 

 children of ten have convulsions, pain in the back is severe. On the third day of 

 fever the eruption appears, in appearance like pimples, and with a shotty, hard 

 feel to the touch. 



The pimples next suppurate and matter forms, this period marks the com- 

 mencement of the secondary fever, and occurs about the eighth day, the eruption 

 appears on the head and neck first, gradually spreading. The secondary fever is 

 severe, and about the fourteenth day the patient become most offensive, and may be 

 quite unrecognisable. Delay in the appearance of the eruption is a favourable sign. 

 The rash comes out all at once, in contradistinction to chicken-pox which occurs 

 in crops. 



The infection lasts until all the crusts have fallen. Careful disinfection of 

 the hands, and of all material which has come in contact with the patient is im- 

 perative. Attendants upon the sick should be chosen from amongst those who have 

 already had the disease, or who have got vaccination marks. Strict qurantine for 

 fourteen days after the death or complete recovery of the last case is necessary. The 

 best form of isolation hospital — and the cheapest— is a shed of ataps, bound to 

 iron supports, the floor should be cemented if possible, and the " whole show " 

 burnt when the epidemic is at an end. 



Chicken-pox. — The rash comes out on the first day of the fever, all the 

 symptoms are less severe than small-pox, and the eruption comes out in crops. 

 The feel of the pimples is not so hard as those of small-pox. Suppuration occurs in 

 the pimples just as in small-pox, but the two disease are really unlikely to be 

 confused. 



Plague.— Perhaps the first remark to be made upon this disease to the lay- 

 man is, that there need not necessarily be any buboes, and indeed the most serioua 

 cases show no external sign of the terrible affection ; as is now well known the form 

 from which the disease obtained its name was the bubonic form, in which swellings 

 of the glands in various parts of the body exist (groins» neck, armpits) this form 

 of the disease—given the fact that cases have been occurring in the neighbourhood- 

 is at least easy to suspect, and the extreme depression and very acute fever, lead 

 one to isolate the case promptly, but the case which I wish to put you on your 

 guard against are s the pneumonic and the septiocemic forms. These occur with some. 



