PREDISPOSING CA USES 



1373 



Added together, these give — Europeans, 13-3 per cent.; Sin- 

 halese, ig*g per cent.; Tamils, 21-8 per cent. The incidence of 

 enteric fever among these peoples is probably more nearly approxi- 

 mating the conjoint figures than those given solely under Enteric 

 Fever. Tamils are labourers on estates, and cases of fever among 

 them are generally lumped together under the heading of Malaria. 



Age is another predisposing cause, for there appears to be a 

 general consensus of opinion that twenty to twenty-five years of 

 age is a period more susceptible to the disease than the other 

 periods of life, but no age period is free from attacks. 



During the first journey from the Temperate Zone to the tropics 

 the metabolism of the young resident in the Temperate Zone is 

 possibly somewhat disturbed, leading to a weakening in the anti- 

 bacterial and phagocytic reactions, as some authorities maintain; 

 and hence, perhaps, his great liability to attacks of enteric fever 

 and other complaints. It must not be forgotten that the young 

 new arrival is apt to eat too much, to drink too much, and, being 

 stimulated by the heat — the bad effects of which at first he does 

 not notice — is apt to work too hard and play too hard, or, in other 

 words, to attempt to exhaust his system in every possible way, 

 and to thoroughly disregard the evil effects of the sun; and we con- 

 sider these indiscretions play a certain role in the relative frequency 

 with which these young new arrivals become infected. 



Young people often live together in what are called ' cimmmeries * 

 — i.e., several of them live together in a house, while one of them 

 runs the messing. These houses, having no proper supervision, are 

 allowed to become most insanitary, especially with regard to the 

 servants' quarters, which are naturally the nearest to the kitchen 

 and the places in which food is stored. The pollution of food in 

 these places is often self-evident to the naked eye, while the whole 

 place teems with flies. Moreover, the weakening of the system by 

 venereal disease may play a part in producing the heavy incidence 

 of enteric fever in new arrivals. In Bengal 50 per cent, of the cases 

 in Europeans occurred within one year of arrival from Europe. 



In India the disease is believed to be common among native 

 children and among Europeans born in India; thus it was notioed 

 by Rogers that 41-67 per cent, of the cases were under fifteen years 

 of age, whereas in Europe and America only 9*45 of cases are under 

 fifteen years of age. 



As regards sex, we have already drawn attention to the apparently 

 special incidence upon women between fifteen to forty-five years 

 of age. 



With regard to the conditions of life, the poor whites living in 

 insanitary conditions are very liable to be attacked, and this may 

 account for the prevalence of the disease among Europeans born 

 and living in India, as may the natural habits of children playing 

 among earth and rubbish, which are often more or less faecally 

 polluted. But of all predisposing causes, that of bad sanitation 

 stands out pre-eminently first; thus Europeans are apt to get the 



