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Joseph Fayrer.

Tropical dysentery and chronic diarrhoea : liver abscess, malarial cachexia, insolation with other forms of tropical disease and on health of European children and others in India online

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THE LIBRARY

OF

THE UNIVERSITY

OF CALIFORNIA



PRESENTED BY

PROF. CHARLES A. KOFOID AND

MRS. PRUDENCE W. KOFOID



H



->



t



TROPICAL

DYSENTERY MD CHRONIC DIARRHOEA

LIVER ABSCESS — MALARIAL CACHEXIA — INSOLATION
WITH OTHER FORMS OF TROPICAL DISEASE



HEALTH OF EUROPEAN CHILDREN AND OTHERS IN INDIA



SiK JOSEPH FAYREE, K.C.S.I., LL.D, M.D., F.R.S.

PRESIDENT OF THE MEDICAL BOARD, INDIA OFFICE,

HONORARY PHYSICIAN TO THE QUEEN AND TO THE PRINCE OF WALES,

ETC. ETC. ETC.




LONDON
J. & A. CHURCHILL, NEW BURLINGTON STREET

1S81






TO

SIE WILLIAM MUIE MTJIE, K.C.B., M.D.

HONOEAEY PHYSICIAil TO THE QUEEN
DIEECTOE-GENEEAIi AEMY SCEDICAL DEPAETMENT

THIS VOLUME
ON TROPICAL DISEASE

Is SebUateb

IN TOKEN OF THE

AUTHOR'' S SINCERE REGARD ANB ESTEEM



iViS5n971



PEEFACE.

This volume consists of Lectures and Papers that have,
from time to time, been read, or have appeared in the
medical journals.

Those on Tropical Dysentery and Chronic Diarrhoea were
the Lettsomian Lectures of 1881, and are published in
accordance with a desire expressed by the members of
the Medical Society of London, before whom they were
delivered.

The subjects are treated clinically. The descriptions of
Dysentery, Diarrhoea, Liver Abscess, and Cachexia will,
I hope, be useful at home as well as abroad, for the
chronic forms and sequelae of these diseases are frequently
met with in England.

I desire to record my sincere thanks to all who have
assisted me to prepare these Papers.

London, July, 18S1.



CONTENTS,



VAGE



TROPICAL DYSENTERY AND CHRONIC DIARRHCEA.



Lecttjee I. — Dysentery: Histoeicax Retrospect — Geograph-
ical Distribution in Indian and other Foreign
Stations — Etiology— Symptomatology .... 1

Lecture II. — Dysentery {continued) : Pathology and Morbid
Anatomy — Treatjient of Acute Dysentery — Cases —
Dysentery with Liver Abscess and Cases A^^TH other
Complications 46

Lecture III. — Chronic Dysentery: Pathology — Treatment
— Tropical Diarrhcea — Symptomatology — Morbid Ana-
tomy—Treatment — Cases of Chronic "Dysentery and
Diarrhoea 118



II.

ON THE BAEL FRUIT AND ITS MEDICINAL PROPER-
TIES AND USES 172

IIL

LIVER ABSCESS.

Single and Multiple— Question of Relation to Dysentery
— Etiology — Pathology — Symptoms — Treatment — Punc-
ture UNDER Antiseptic Precautions — Cases . . . 192



X CONTENTS.

IV.

PAGE

ON THE MALARIAL SPLENIC CACHEXIA OF TROPICAL
CLIMATES.

Etiology — SrirPTOJiATOLOGY — Pathology — Teeatment . . 221

V.

ACUTE MALARIAL (EDEMA : BERI-BERI.

Etiology— Pathology — Symptomatology — Morbid Anatomy —

Treatment 231

VL

BRONCHOCELE.

Etiology — Symptomatology — Geographical Distribution —

Treatment 248

VIL

ELEPHANTIASIS ARABUM.

Etiology — Symptomatology — Morbid Anatomy — Relation to

Filaria Sanguinis Hominis — Treatment .... 258

VIIL

ON THE RELATION OF FILARIA SANGUINIS HOMINIS

TO THE ENDEMIC DISEASES OF INDIA . . .275

IX.

SUNSTROKE.

Varieties — Symptomatology — Pathology — Treatment —

Sequels — Cases 294



CONTENTS. XI

X.

PAGE

DENGUE.

Etiology — GEOGRAPniCAL Distribution — Symptomatologt —

Treatment 314



XL

ON THE HEALTH OF EUROPEAN CHILDREN IN

BENGAL 322



XIL

ON PRESERVATION OF HEALTH IN INDIA.

Lecture to the Students of the Royal Engineering College,

Cooper's Hill 347



XIIL
ON THE RAINFALL IN INDIA.
Relation to Climate and Influence on Health and Disease . 382



TROPICAL DYSENTERY AND DIARRHCEA.



LECTURE I.

Mr. President aiv^d Gentlemen,

Wlien tlie Council of this Society did me the honom*
of inviting me to deliver the Lettsomian Lectures this year,
I hesitated to undertake the duty, as I did not feel assured
that I possessed sufficient special knowledge of any subject
to justify me in appearing as a lectm-er before an audience
of such large and varied experience as that of the Medical
Society of London ; but, on reflection, it seemed to me that
I might, without presumption, fulfil the object of the founder
of these lectures, and at the same time turn the experience
' gained during my service in India to account, by submitting
some practical observations on certain forms of disease whicli,
whilst common in that and other tropical and sub-tropical
countries, are not unknown here in their chronic forms ;
and this seemed the more appropriate, because the sequelae of
the diseases I propose to describe are to be observed in oiu-
own coimtry as well as in the tropics, in the case, chiefly, of
persons who, returning from India, China, or the Colonies,
are gradually becoming more numerous, and consequently
more interesting to medical men at home.

The subjects, therefore, that I have selected are dysentery
and diaiThoea, as observed in their acute and chronic con-
ditions in India and the tropics, and in their chronic stages,
and consequent visceral lesions, which are met ■with at home,

B



Z TKOl'UAI. DYSEXTKHV AND 1)1 ARKira-;A.

and are frequently the cause of serious deterioration of
health, protracted suffering, and occasionally of death ; the
treatment and management also being often tedious and
difficult — an assertion that I believe will be borne out by
medical men who have been brought in contact with a class
of cases which may now be met with in almost every part of
the United Kingdom and at continental health-resorts ; for,
almost dail}', invalids are returning to Europe in quest of
recovery from this or some other form or sequel of climatic
disease. The influence of change of climate on the progress
and termination of these comj)laints is a subject of consider-
able interest, and well vt'orthy of consideration ; for our
rapidly extending relations with India, China, Africa, and
other foreign countries, and the consequent increased inter-
communication, facilitated by imj^roved means and channels
of intercourse, are causing closer approximation of interests,
and are bringing home to us also in this country the im-
portance of the part played by climate in regard to its effects
on the health of Europeans, not only in respect of their
fitness to encounter its influences, but as regards the proba-
bilities of future health for those who are compelled, in the
course of duty or business, to return to the country in which
they have abeady suffered. From this point of view I think
the subject may be of interest to the members of this
Society, whose indulgence I ask whilst I endeaA'oiu' to lay'
before them some observations, which, being the outcome
of personal experience, will not, I triist, be devoid of in-
terest.

In the course of my remarks I shall have to speak of much
that relates in common to dj'sentery and diarrhoea ; but that
which is peculiar to each will be considered and described
separately as I proceed.



HisTORicAi, Retrospect.

In the ancient system of Hindoo medicine of the Ayur-
veda and the commentaries of Dhanwantari, Charaka, and



LECTURE I. O

Sussutra, wkich carry us back nearly 3,000 years, and in
later Sanscrit writers, dysentery is described by the name of
Atisar, under two forms — Ama-apaka, or acute, and Pak-
itsar, or chi'onic ; these again are subdi^■ided into six varie-
ties, ascribed by those ancient sages to changes in air, bile,
phlegm, food, or to perturbations of the emotions and
passions ; whilst the symptoms and treatment are detailed
according to their notions of disease.

Herodotus refers to it in his writings ; Hippocrates de-
scribed it and gave it the name of " Dysenteria," by which
it is now known. Thence to the close of the sixteenth
century by Grreek, Roman, Arab, and later by nimierous
writers down to our o^^^l day, medical literatui'e abounds
in descriptions of the disease, some of which, even
by the Fathers of Medicine — Areteeus, Celsus, Gralen,
Coelius Aurelianus, Alex, de Tralles, and others, — are so
precise as to leave little to modern description ; showing,
too, that it had even then, according to the know-
ledge of the time, been the subject of careful clinical
observation and pathological research. My object being a
practical exposition of some of its clinical aspects, I shall not
attemj^t any detailed historical account of the disease, or do
more than indicate some of the most important authorities,
especially those who in recent times have added so much
to our knowledge of its treatment.

Until after Hippocrates, the term dysentery was applied
to other diseases accompanied by discharge of blood from
the bowels ; but early in our era it began to be restricted to
a single disease, which was ascribed to a variety of causes —
acid bile, acrid secretions, and so on — whilst bloody stools,
mucus, and ulcerated bowels were recognized as its cha-
racteristics. The views of the classic writers — Coelius
Am-elianus, Archigenes, Aretasus, Galen, and Alex, de Tralles
— continued to be held doAvn to the time of Fabricius and
Fernel (the modern Galen), in the seventeenth centmy,
about which period new opinions began to obtain as to
causation and classification, whilst the experience of frequent
epidemics gave opportunity for fmiher investigation into the



4 TROPICAL DYSENTERY AND DIARRIKEA.

uatiu'e and origin of tlie disease. The writers of the seven-
teenth centmy are numerous ; among them Boutins,
Boerhaave, Arnold, Chouet, Willis, and Sydenham, who
studied it during the London epidemic of 1669-72, and
regarded it as intestinal irritation produced by a fever
localized in the large intestine, are conspicuous. In the
eighteenth century the wiiters are more numerous still,
whilst knowledge of the disease was increasing, with more
frequent opportimity of stud}dng it. StoU, Pringle,
Morgagni, Zimmerman, Degner, Lind, Grilhert Blane, and
many others have left faithful descriptions of dysentery in
all its forms, and various theories as to its origin. In
the present century, and notably dimng the last twent}'-
five years, marked progress has been made, especially in
the method of treatment.

The -^Titers are too nimierous to mention, and I would
simply say that to them we are indebted for more accurate
knowledge of the pathology and therapeutics of dysentery
as a specific disease. Desgenettes, Eollo, Annesley, Baly,
Cruveilhier, Bamfield, Parkes, Hu'scli, Bleker, R. Martin,
Morehead, Docker, Chevers,. Macpherson, Goodeve, Ewart,
Aitken, and Maclean have done much by their teaching or
"WTiting to advance our knowledge of the subject. I might,
did time permit, cite many others, but these are sufficient to
show that a copious literature of dysentery, from the earliest
dovra to the latest times, exists.

Though now chiefly a disease of tropical and sub-tropical
climates, it neither is, nor has been, restricted to such geo-
graphical limits. It may appear sporadically any^vhere, and
has prevailed wherever men have congregated imder certain
unfavourable hygienic conditions of climate, locality, food,
drink, and occupation, often in the form of severe and
destructive epidemics. Few parts of the world, except
the polar regions — and I am not sure that they are an
exception — have been exempt fi-om it. Accounts of its
ravages in various regions abound in the autliors I have
mentioned.



LECTURE I.



Since the account of it by Herodotus as it affected the
Persian army in Thessaly, down to the present day, it
continues to be a source of danger and weakness to armies,
camps, garrisons, and fleets, and also to the general popula-
tion. It was as destructive to om- men at the siege of
Harfleiu' and at Agincourt, in 1415, as it was in the Crimea
in 1854, or in Afghanistan in 1879.

Fernel says that in 1538 it was so general throughout
Europe that neither village nor town escaped, notwith-
standing that the seasons had been regular. — (Copland's
"Dictionary.")

The Plague of London of 1665 was followed in the autumn
of 1G66 by an epidemic of dysentery, which was infectious,
and was considered to have been due to contamination of the
air by the plague victims buried in and about London the
previous year. — (Copland's " Dictionary.") Other epidemics
of it visited London in 1669-72, in 1762, and 1768.

No part of Eiu-ope, from Spain to Norway, seems to have
escaped. Two hundi-ed years ago it was most prevalent
and fatal in London. It prevailed in Ireland in 1722,
dm-ing times of scarcity of food, and on subsequent
occasions, when it has been a scourge to that island, as in
1846, and always of an adynamic t}^e. France suffered
from epidemic dysentery in 1859. Melboiu"ne, in Australia,
was ravaged by a severe epidemic in 1853 to 1855. Norway
suffered in 1859. It is noticeable that it apparently visits
European countries with less severity now than in past times.
Two centuries ago it was as great a scourge in England and
throughout Europe as it is now anywhere in India; but with
the progress of civilization, amelioration of the conditions of
living, improvement in agricultiu-e, reclamation of waste and
uncultivated lands, better siu'face and subsoil di'ainage, paving
of towns, better dwellings and food, and purer diinking- water,
it has gradually diminished, or has so nearly disappeared, in
this coimtry at least, that few whose experience is confined
to our own islands have had the opportunity (beyond an
occasional sporadic case) of seeing it either in the acute
form, or as an epidemic. How far the extinction of dysentery



6 TROPICAL DYSEXTEKY AND DIARKHUiA.

is due to improved hygiene aud ameliorated conditions of
living, I cannot say, but it seems as though they stood to
each other as cause and effect. Like malarial fevers, with
which it has close affinity, it has almost disappeared from
our tables of sickness and mortality. Doubtless, were con-
ditions like those that developed it in Millbank in 1825, or
that recorded by Clouston in 1865 as having occurred in the
Cumberland and Westmoreland Asyhmi, in which scorbutic
dysentery, due to effluvia from sewage, accompanied by
a bad diet, defective in vegetable matter, affected the in-
mates, again to occur — a state of things now, we hope,
impossible — we should again have similar dire results. But
it seems improbable in these days of sanitary reform that
such should be the case, or that an epidemic of dysentery
should again desolate London like that described by Syden-
ham, which proved that our northern latitude is no safe-
guard when local insanitary conditions foster and favour
the spread of the disease, such as may have been the case
even so late as the middle of last centmy, when the death-
rate of London from all causes was one in ticenty-four of
the population, though even then the public health was
improving, and the average duration of human life was
slowly increasing. It is now one in forty-fom- or forty-
five, and there is no reason, except opposition to, or want
of faith in, hygiene, why it should not be much fui'ther
reduced.

Dysentery has always had peculiar interest for the naval
and military medical officers, for it is in theii* special field
of operation that it has caused the severest ravages, as the
history of om* own and continental military and naval cam-
paigns can tell. In Napoleon's Egyptian campaign twice
as many men died of dysentery as of plague — i.e., 2,468 of
dysentery, 1,689 of plague. Dewar graphically describes
the sufferings of the British Army in the same campaign.
Desgenettes says it killed more soldiers betAveen 1782 and
1815 than fell in action in the great wars of the empire.
The British Army in Holland in 1748 ; the Walcheren
campaign of 1809 ; the Peninsular campaign, in the



LECTURE I. /

Talavera campaigu King-lake says [vol. vi., appendix, page
473, "Invasion of the Crimea"], "The troops in great
numbers fell sick, went into hospital, and died from want
of necessary succoui' ; from dysentery alone 5,000 men
died " ; Napoleon's wars ; the Crimean campaign, where
between October 1, 1854, and March 31, 1855 — six months
— oiir army had 48,742 cases of sickness,* exclusive of
wounds, and of these 18,708 were diarrhoea, 4,441 dysen-
tery ; the Franco-G-erman, the Russo-Tm-kish, and the Civil
war of 1861 to 1863 in America, when one-foiu-th of all
the disease was dysentery or diaiThoea, with a mortality of
12-36 per 1,000 (Clymer), attest the fact that dysentery is
one of the greatest difficulties armies have to encounter even
in temperate climates, and how much it is attributable to
defective food, bad hj'giene, and climatic "sacissitudes ; whilst
Indian, Bm-mese, African, and Mexican campaigns declare
its severity in tropical climates.

Sir R. Martin says, " It is the disease of the famished
garrisons of besieged towns, of barren encampments, and of
fleets navigating tropical seas, where fruits and vegetables
cannot be procured. During the Peninsular, the fii'st Biu'-
mese campaign (and I may add the second also), and the
late war mth Russia, dysentery was one of the most j)re-
valent and fatal diseases which reduced the strength of the
armies engaged " ; and I purpose to show you that it proves
most destructive in India, its prevalence and fatality there
depending apparently on climatic influences and defective
hygiene, and that, like fevers, it bears a marked relation to
the prevalence of malaria.

I have referred to it as a disease of tropical or sub-
tropical latitudes, but have abeady said that sporadic cases
occur everywhere, while severe epidemics have apj)eared in
northern latitudes. As it is endemic and most prevalent in
hot countries, and especially in India, I shall confine my
remarks mainly to experience derived from that coimtry,
and, as the time at my disposal is limited, I shall, after a

* This was exclusive of cases treated at Scutaii. Tlic deaths were —
dyseutcry G90, diaiTha?a 1,303.



6 TROPICAL DYSENTEllY AND DIARKIICKA.

brief reference to its distribution and prevalence in those
countries, proceed to consider it in its etiological, clinical,
pathological, and therapeutical bearings. Let me, then, ask
your attention to its prevalence in those parts of the world
where oiu- troops and sailors are serving. The information
is gathered from the official reports, and includes also the
gaol and some part of the civil population, which, from the
circumstances imder which tliey are framed, supply data
that may be regarded as reliable. I have said but little as
to the incidence or fatality of dysentery in past or even
in recent times, though sufficient to direct attention to the
universal character and prevalence of the disease. I pro-
l^ose, however, to enter a little more into detail in regard
to India, as I wish to bring you face to face, as it were,
with the complaint as it now occurs in a large portion of
our dominions.

As regards diarrhcea, I shall include it with dysentery in
the statistical returns, and shall conclude what I have to
say in the third lecture with some clinical remarks on the
pathology and treatment, especially of the chronic form of
the disease — to whicli, indeed, my remarks will be chiefly
confined — so frequently seen in old residents of tropical
climates, and which seems to be so nearly allied to
dysentery.



Geographical Distribution akd Prevalence in India
and other foreign stations.

Official retm-ns for 1878 show that in the European Anny
of India, with an average monthly strength of 56,475 men,
there were in that year 2,784 cases of dysentery and 3,972
of diarrhoea; of the former 98 and of the latter 4 cases
proved fatal, or 1-73 and 0-7 per 1,000. The greatest pre-
valence (314) occurred in September, the lowest (186) in
March. There were 49-3 cases of dysentery and 70*3 of
diarrhoea per each 1,000 of strength ; whilst 3-52 of dysentery
and -10 of diarrhoea died of each 100 treated; 125 were



LECTURE I.



9



invalided for dysentery and 30 for diarrhoea, or 2'75 per
1,000 of strength. Of 5,170 European women connected
with the European regiments, there were 164 cases of
dysentery, of which 7 were fatal ; and 299 cases of diarrhoea,
of which 8 were fatal — 1-35 of dysentery and 1'55 of diarrhoea
per 1,000 strength. Of 10,423 European children, there were
289 cases of dysentery and 1,033 of diarrhoea; 40 of the
foitaer and 149 of the latter, or 3-84 and 14-30 per 1,000,
were fatal. In the Native army of 117,272 men there were
9,622 cases of dysentery and 4,747 of dian^hoea ; 191 of
dysentery and 112 of diaiTlioea proved fatal, or 1*63 and
•95 per 1,000 respectively ; 82 per 1,000 of strength were
admitted for dysentery, and 40*5 for diarrhoea.

Of a gaol population of 127,914 persons, chiefly natives,
there were admitted 14,487 for dysentery and 12,998 for
dian'hoea. Of these 2,326 proved fatal from dysentery, 18G5
from diarrhoea — being a fatality from both combined of
32-76 per 1,000, or of 15-25 of each 100 treated.

Comparative statements show the relative prevalence and
mortahty of the diseases in different parts of India, and that
dysentery is more severe in Madras than in the other Presi-
dencies. I have taken these details both from the European
and Native retm-ns, to show the extent of its prevalence
among the native popidation, the seasonal prevalence, as well
as a comparison mth fever.

The extent of seasonal variation of prevalence in the hill-
stations is noted, and it will be seen that, although less
severe, the disease occui'S at those elevations of from 4,000 to
8,000 feet above the sea-level. It must be remembered, how-
ever, that the seeds of the disease may have been canied up
from the plains.



10



TKUl'ICAJ. DYSKMERY .VM) 1)1 A KltlUKA.



COMPARATIVE STATEMENT OF THE RATIOS OF SICKNESS
AND MORTALITY IN THE EUROPEAN ARMIES OF THE
THREE PRESIDENCIES FOR THE YEAR 1878.





Ratio per 1,000 of strengtli


.


For the year.


Army of


Army of


Army of


Army of




Bengal.


Madras.


Bombay.


India.


Admission-rate :


1

1






Dysentery


39-7 i 93-9


35-3


49-3


Diarrhoea


68-6 1 72-3


74-3


70-3


Death-rate :


!






Dysentei-y . . . .


l-ol 3-05


1-12


1-73


Diarrhcea


0-03 0-19


0-10


0-07


Mortality per 100 cases treated.








Dysentery


3-80 3-25


3-14


3-52



COMPARATIVE STATEMENT OF THE RATIOS OF SICKNESS
AND MORTALITY AMONG THE EUROPEAN TROOPS IN
THE PROVINCES OF THE BENGAL PRESIDENCY DURING
THE YEAR 1878.









Ratio per 1,000 oi


strength.




For the year.


C ft
(D p


Gangetic
Provinces.


Rohilcuud

and

Meerut.


Agra and

Central

India.


Punjaub.




Army of
Bengal.


Admission-rate :
















Dysentery


29-0


37-9


37-9


37-0


39-1


28-9


39-7


Diarrhoea


33-7


82-5


74-2


65-2


58-3


60-4


68-6


Death-rate :
















Dysentery


1-05


1-40


0-27


1-93


2-28


0-45


1-51


Diarrhoea










0-10




0-08


Mortality per 100 treated:
















Dysenteiy


3-34


3-68


0-71


5-13


5-84


1"55


3-80



COMPARATIVE STATEMENT OF THE RATIOS OF SICKNESS
AND MORTALITY AMONG THE EUROPEAN TROOPS SERV-
ING IN THE PROVINCES OF BOMBAY AND MADRAS
DURING THE YEAR 1878.





Ratio per 1,000 of strength.






For the year.


Rajpootana,

Mahva,

Scinde, Aden.


^ o


a 58

O ^
CD


a




° a


Army of
India.


Admission-rate :










D3^sentery


40-4 78-5


59-2 96-7


93-9


35-3


49-3


Diarrhoea


85-0 84-4


40-2 86-8


72-3


74-3


70-3


Death-rate :












Dysentery


1-43 2-11 j 1-09 4-16


3-05


1 12


1-73


Diarrhoea


0-14 0-22: ..


0-19


0-10


007


Mortality per 100 treated :


1








Dysentery


3-54 2-69 1-84 4-30

1 i


3-25


3-14


3 -.52



LECTURE I.



11



SICKNESS AND MORTALITY AMONG THE EUROPEAN TROOPS
SERVING IN BURMAH AND PEGU DURING THE YEAR

1878.



Causes


Admissions into hospital in
each month.


Total admitted

during

the yeai*.


Admitted per
1,000 of
strength.


O T3


of admission.


>-5




i


1
<


^

S


1-5


>>

"3

►-5


1"
<


p.

03


o


>

o


d

Q


°^2
to o

s s


Dysentery
Diarrhoea


21
20


18
15


15
8


13
20


17
14


25 25

1219

1


8
11


10
14


5
14


12
9


17
11


186
167


96-7
86-8


4-30



SICKNESS AND MORTALITY AMONG THE EUROPEAN TROOPS
SERVING IN THE PUNJAUB DURING THE YEAR 1878.





Admissions into hospital in
each moutli.




s

"^ 3 «

1


Admitted per

1,000 of

strength.


o -d


of admission.


1-5 f^


.a

o




03


1^


J


00


- 1

o ^2;


6


Died

ea(

100 tre



Online LibraryJoseph FayrerTropical dysentery and chronic diarrhoea : liver abscess, malarial cachexia, insolation with other forms of tropical disease and on health of European children and others in India → online text (page 1 of 37)