NOTES ON SOME OF THE DISEASES MOST FRE-

QUENTLY MET WITH AMONG THE NATIVES OF

TIRHOOT.

By K. N. MACDONALD, L.R.C.P., Lon. ; & L.R.C.S., Ed.

In a topographical point of view, Tirhoot resembles many other parts of Bengal in the abundance of its marshy and low lands, the' luxuriance of its vegetation, and the diffusion of its arti-

ficial springs or wells and stagnant waters ; hence its inhabi-

tants are more or less liable to the influences of malaria and

its results, the most remarkable phenomena of which are

hypertrophy of the spleen and goitre, the former often accom-

panied by that condition of the blood known as leucocythsemia; but having nothing new at present to promulgate regarding the

pathological state of the blood in this disease, I pass on to

make a few simple observations on some of the leading fea- tures of the principal endemic diseases peculiar to this part of the country.

In this district I have frequently noticed that a vast propor- tion of those affected with enlargement of the spleen, ranged between the ages of five and fifteen, and less frequent after

the adult period of life; this seems strange, and leads mc to infer that a great many cases of " spleen" recover without any treatment "whatever, unless, indeed, all those affected during childhood die off before arriving at the age of maturity, ?which is extremely improbable, since the disease?unless the liver is also affected, in which cases it ends in antemia and dropsy in many instances?appears to remain latent for years, and is easily or apparently cured by the administration of bromide or

iodide of potassium, with the ammonia-citrate or phosphate of iron. I have also met with exceptional cases where the spleen affection could not be retraced to an original attack of ague; and it does not seem to follow or result from any particular form of fever, the quotidian, tertian, quartan, or irregular forms being equally conducive to its development. When

the disease becomes chronic, the spleen, as every one knows, sometimes attains to an enormous size, filling almost the

whole of the abdomen, and in these cases it always proves fatal, though it does not necessarily follow that enlargement of the spleen should be accompanied by anaemia and leucocythsemia; it is only in the advanced stage that these conditions exist.

It is to be regretted the little progress that has yet been made towards the discovery of the true nature of malaria in all its

phases, and# I fear the day is still remote, unless we are actuated by an indefatigable zeal for Chemical and microscopical research. Next on my list comes goitre, which perhaps, of the two, is the

most prevalent, and can clearly be traced to the water used for

drinking, and can actually be tracked all over the district.

Wherever rice lands, clayey and saltpetre-yielding soils, and calcareous water are to be found, there goitre is suro to be prevalent, attacking male and female of all ages indiscri-

minately ; and, strange to say, all this evil could be frustrated

by a very simple procedure, if the natives would only but adopt it, viz., purification of their drinking water by passing it through sand and charcoal, but this they do not feel inclined to do, though they are perfectly well aware that drinking impure water causes enlargement of the thyroid gland. This system of purification might, however, be enforced upon a large scale in

civil stations in various ways and at a very small cost, which

would not only secure the health of the natives themselves, but also that of the public in general, especially in cholera times.

In the treatment of goitre I generally prefer using the com-

pound iodine ointment of the pharmacopoeia to any combina-

tion with mercury; a small proportion of the biniodide of mer-

cury with iodine is much in vogue with some, but I have seen

it give rise to profuse salivation, and it does not seem to possess

any specific virtue that is not to be found in the iodine when

used alone. It is a pity that this commodity could not be had

cheaper, as the natives have great faith in it, and will travel

any distance to procure some of it for their female relations.

Cholera.?This disease may be met with both as an epidemic and endemic; cases of sporadic cholera occur now and again, but, as a general rule, the worst months for cholera are May and June, and towards the close of the rains ; though these months

happen to be about the hottest in the year, I do not think that this

altogether accounts for the prevalence of cholera in these months. I would sooner attribute it to the consumption of unripe fruit

which the natives do to an enormous extent, especially of that

beastly stuff the jack fruit. In the treatment of this disease

I have noticed one fact, which is the utter helplessness of my art when called to the bedside of a cholera patient. The public have great faith in chlorodyne, and perhaps it is as well that

they should continue in ignorance; but for my own part, in a well marked case of cholera, I think it rather increases the vomiting than anything else, and I consider it suitable for cases of

diarrhoea only. The only remedies in which I place the slightest confidence are brandy, laudanum, and chillies. Bathgate's cholera

pills also appear to be very useful, especially in choleraic diarrhoea.

The saline treatment need only be mentioned to say that

324 THE INDIAN MEDICAL GAZETTE. [November I, 1865.

in this country it is totally useless. Since the commencement of

the famine, which at present is devastating many parts of Bengal, cholera has been very prevalent in some parts of this district,

and, I believe, has considerably decimated the civil station of

Mozufferpore. The widening of back-lanes, the removal of stag- nant waters, and the prevention of oily-looking natives deposit- ing all sorts of refuse into the filthy and open drains that run

along their verandahs, would do a great deal towards mitigating an epidemic of such severity ; but we require more energetic authorities than we have got to take matters of this sort into

consideration.

Dysentery.?This is one of the most interesting diseases

resulting from malaria, and it is the more so, that it can also

be produced artificially. It is very prevalent in this district during the fruit season, and

is sometimes very fatal. The natives dread it very much, es-

pecially in its acute form, and eagerly seek advice for it of any European.

Pathologists have designated this disease as a " specific in- flammation of the colon," and doubtless it is so; but why it should attack the colon and rectum, and not the small intestines, is a

mystery that, probably for the present, will remain in obscurity. I do not purpose to prolong these remarks, or to throw any further light on the pathology of dysentery by entering into minuter details. I shall leave that to our modern Galileo?

Dr. Hutchinson, of Patna, whose mechanical view of the

modus operandi of ipecacuanha in the treatment of this disease, is at present attracting the attention of some medical baboos.* I have not found the drug in question to possess such powerful curative effects as one would infer from the good accounts of its numerous advocates; and regarding it in the light of a

specific, I do not believe that it can hold any comparison with

quinine. It has signally failed in my hands in 20 per cent,

of the cases that I have had to treat in thi3 country, and I

have no doubt others have been equally disappointed with it.

Snake-bite.?Though snake-bite can scarcely be classed as an endemic disease, yet it occurs so frequently and is of such

importance as to demand especial mention; and the first question that suggests itself is?which is the most venomous snake?

The natives dread the kurait, which, by the way, is a species of snake I have never been able to procure more than any other; the reason for this I cannot say, but there can be no doubt

that the cobra-de-capello is the most venomous snake in India, and, with the exception of the rattle-snake, the most poisonous in the world.

I have never seen a case recover from the bite of the cobra, which generally proves fatal in half an hour, whereas that of the so-called kurait, and other poisonous species, require several

hours before coma supervenes; and when this last state does

occur, recovery is hopeless ; neither excision, ligature, cupping, eau de luce, or any other remedy are of any avail; the poison is a narcotic, and has entered the system, where it acts upon the medulla oblongata and spinal cord, as is instanced in the

difficulty of swallowing, foaming at the mouth, dilatation

of the pupils, and general relaxation of the sphincters, and all

we can do is to watch helplessly the flickering spark of life until it vanishes, and wonder how the marvellous phenomenon has been brought about. The application of a ligature on the cardiac aspect of the extremity bitten, is the best thing to do in the first stage ; but when the shoulder, or other inaccessible

part of the body, {sic) has been bitten, as is often the case, we must trust to excision, and the internal administration of

stimulants.

The above are about the most important endemic diseases to be met with among the natives of Tirhoot. but it is not to be

supposed that they arc the only ones; if time and space would

* 0 tempora! 0 mores i?Ed,, I, 2[, G,

permit, I might enumerate a great many more, each "very impor- tant in itself, hut since I have not noticed anything unusual in their course, I have purposely omitted them.

I have been hunting up cases of leprosy, hut I find that it is a rare disease in this district, most of the cases I have met with having come from the North-West Provinces. One word more, and I have done. Diseases of the generative organs, especially gonorrhoea and syphilis, are very common here, as everywhere else, and amenable to ordinary treatment, with the exception of the phagedenic iilcer, which sometimes eats away the entire

penis. For gonorrhoea the natives use an injection of pow- dered bone, that of the dog being preferred to any other, and

their futile treatment of chancre only too often leads to absorp- tion of the virus into the system, with its consequences, scaly and pustular eruptions of the skin, ulceration of the throat, and secondary buboes.

Tiriioot, 4tli October, 1866.