Presidential address at the Epidemiological Society, delivered on November 5th, 1879 / by Joseph Fayrer.

  • Fayrer, Joseph, Sir, 1824-1907.
Date:
[1879]
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Licence: Public Domain Mark

Credit: Presidential address at the Epidemiological Society, delivered on November 5th, 1879 / by Joseph Fayrer. Source: Wellcome Collection.

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    malarious and specific) fevers, and that will, I hope, ere long further dis- criminate and rearrange the nosology of fevers in India and the tropics. Now typhoid or enteric fever is an important cause of mortality among our young European soldiers in India ; and it raises or suggests questions of great importance in regard to them—such, for example, as the right age, time, and seasons for sending them to India; to say nothing of the hygienic questions as to sanitary measures arising out of its causal rela- tions. The Sanitary Commissioner’s Report of 1877 says that out of 233 cases of typhoid, 92, or 39 per cent., proved fatal; the admission rate being 4*1 per 1000 of strength. It moreover appears that 2*45 per cent, occurred at or under twenty-four years of age ; 1*55 at twenty-five to twenty-nine ; 099 at thirty to thirty-four ; and a few or none above that age ; showing that the disease tells most severely on the younger men— in this respect resembling typhoid in England. Again, Bryden, in his Report of the Statistical History of the European Army in India up to 1876 (published 1878), 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 1876:— Ages. Total deaths. 24 and under 255 25 to 29 90 30 to 34 17 35 to 39 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 Bryden says, out of 132 deaths from enteric fever in 1878, 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 be- lieve, 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 England and elsewhere, and recent reports from India and other parts of the world seem to show that this view is gaining ground. I am indebted to Surgeon-Major A. Clark for the following note:— “ Typhoid fever has prevailed very extensively in Natal and Zululand during the war. Since Jan. 1st, 1879, to May 31st, no less than 267 admissions for enteric fever have been recorded. Many of these oc- curred in healthy camps on ground previously unoccupied (virgin soil), and in bodies of picked men. The water supply, as a rule, good; no