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 93 THE INDIAN MEDICAL GAZETTE

[Mar. 1904.

recurrent head of “fever.” While 1 cannot believe that infants die of this much-abused malady, I cannot bring myself to believe that old men and women who have braved all the perils of life for from half a century to a century, and who, I may say, have got naturally immu- nised (for there is such a thing as natural immu- nisation following the law of adaptation and self-inoculation) against most of the ailments human flesh is heir to, should fall victims to such a disease as malarial fever, They die of age and notof fever.

But it is with figures such as these supplied by ignorant village chowkidars that our long mortuary returns are prepared. Their notes are taken down blindly by the writer constable. These men are not altogether ignorant or unin- telligent, but are very indifferent and careless. They care not to put a question or two to the chowkidars to verify facts. My point is that our statistics are grossly false, nay, ludi- crously so, based as they are upon notes furnished by a set of men belonging to the lowest and most ignorant class, and derived from another set of men who, though they doctor the people in the villages, are as much conversant with the nomenclature of diseases and the art of diagnosis as those whom they doctor. When we take into consideration the fact that in our jail the mortality under fever is only 2 per mille, and that among the free population is so high as 35 to 50 per mille, my point will be clear to all. The fact is that month after month, year after year, we are scattering broadcast our huge statistics heavy laden with terrible and ominous figures under the head ‘fever, 50 per cent. of which are in truth due to mal-nutrition and starvation, privation of food and clothing, and to the presence of grossly insanitary conditions. The majority of the people die of diseases born not of anopheles mosquitoes, but of poverty.

I have dilated on this point so much simply with a view to attract the notice of the author- ities, and so that steps may be taken at once to check the further flow of these false figures from our statistical department. Highly orga- nised though the department may be, facts manufactured with figures such as these must be as far from truth as the poles are asun- der. As to the remedy, nothing can be more simple—give a few lessons to the chowkidars ou the parade day as to which of the diseases are to be classed as fever and whick not. They all know what cholera, small-pox and dysentery are. Our present mortuary returns recognise only a few diseases, namely,cholera, small-pox, plague, fever, dysentery and diarrhoea, respiratory affec- tion, measles and chicken-pox. It is in distin- guishing cases of respiratory affections and chro- nic bowel-complaints from fever that mistakes are invariably committed. Most if not all “ general diseases ” characterised with febrile excitement are classed under fever as well; deaths from

diabetes, dropsy even, are put under fever. It is not possible to teach the chowkidar the diag- nosis of every disease. If they be taught which disease should go under fever they may put the rest under “other diseases” excepting cf course cholera, etc, which have got separate headings, and which are easily distinguished. Whenever I have been in the mofussil, I have made it a point to check the chowkidars’ hath- chittas, and to give afew lessons to them and the writer constables as well. If measures like these are adopted, we may be able in the course of a few years to produce statistics nearer the truth than they are at present.

Tue patient, a Mussulman of good family and social position, aged 55 years, was apparently in good health up to July 15th. For the preceding fortnight the weather had been excessively and unusually hot. On the afternoon of July 15th I was called to see him. He was quite uncon- scious, breathing stertorously, with somewhat contracted, equal pupils; the conjunctivee were slightly congested. The temperature in the axilla was 1072°F. The pulse was full, 132, and of high tension: no paralysis was detected. The skin of the body generally was dry; there was moderate cedema of the dorsal surface of hoth feet. The onset of. this condition was said to have been quite sudden,

The patient was douched with iced water: in about two hours’ time, the temperature had fallen to 102°K, and the man was semi-conscious and very restless. The next morning, the tem- perature was about normal. The blood was carefully examined, both in fresh and stained specimens; no malarial parasites were found. The urine was also examined : the reaction was acid ; the specific gravity 1022; there was no albumen, and the presence of sugar was doubt- ful.

On the following day, the urine was again examined ; the specific gravity was now 1012; no albumen, no sugar. The patient’s general condition was much improved ; he was perfectly conscious, and complained only of slight head- ache, dryness of the mouth, much thirst and frequent micturition. The morning temperature was normal, and the evening temperature about 102°F.

For the next three or four days there was steady improvement: the temperature remained normal, and the only fresh complaint made) by, the patient was of slight annoyance from a