what ought to be a refreshing sleep. But, unfor- tunately, there is by this time a pronounced gap between his upper and nether garments whilst, in addition, both these and the skin are ahnost saturated with^w^piration. If only the abdo- men had been craped by the night suit (if of flannel), or by a woollen Kamr-band or a folded blanket, he would probably have escaped. As it is, the morning, breeze, gentle it may be, but greedy for moisture, produces rapid, but not too rapid (v. infra), evaporation from the sodden skin with its continually renewed supply of moisture, by which intense chilling of the ex- ternal surface is brought about, this, in turn, leading to violent congestion of the portal system — whether directly or reflexly is immaterial to our present purpose — the chief injury falling upon the weakest organ in connection therewith and finding its final expression in an attack of fever, hepatitis, colic and diarrhoea, dysentery, etc. In other cases resulting in very similar attacks, the individual concerned may sleep soundly enough through the night, the determining factor in this case being the intermittent somnolence of the panka-wala and the resulting erratic action of the panka by which the sleeper is alternately bathed in sweat and chilled.
Take, again, the case of a lady who has been lying down in the afternoon, clad, say, in a thin dressing gown over a cotton or linen nightgown. Originally she lay down cool and dry, and lias maintained that condition during her nap thanks to an effectively-pulled panka. If she has been wise she has had a light folded blanket placed loosely across the abdomen or has worn a Jcaynr- band. At four o'clock, the sun being 'off' that side of the house, the ayah comes and opens several of the doors and windows allowing the afternoon breeze to blow freely through the room As soon as the late sleeper rises she loses the benefit of the panka^ most probably, as the latter is generally hung over the bed, but makes up for this by sitting full in the breeze whilst she sips her hot tea (thus inducing still freer perspi- ration), and then proceeds to dress leisurely. Here, again, unless reasonable precautions are taken, the same risks are run and results similar to those in the previous case are only too liable to be produced. It may be a small matter that determines the disaster ; say, a clammy night- dress which clings to the freely-perspiring body and a dressing gown from which two or three buttons are missing whereby free play of the air currents over the soaking inner garment is per- mitted. There are of course many other condi- tions under which a chill may be caused : several of these will be alluded to subsequently.
As said before, if the air is very hot and dry, there is little or no danger of chill, for the body is very lightly clad and evaporation is so rapid that both clothes and skin are kept prac- tically dry. It is during weather of this kind that a man may sit with safety under a panka, for houra, with nothing on but a bath towel or
loongy% or sweat from head to foot at tennis or racquets and * sit out' till he is diy, without any harm resulting. But it is essential to take care that the conditions are really as above described. Many a man who has been accustomed to do this with safety during the hot weather in the Panjab, Central Provinces or the Deccan, finds out to liis cost, when too late, that the attempt to do likewise in the Carnatic, or on the Malabar Coast, or at Bombay or Calcutta, is fraught with grave risk. Only experience can teach the European resident in India to appreciate the conditions under which there is practically no danger of chill : the wise man and woman will take such precautions as are known to be advisable until it is quite certain that these can be relaxed with safety.
There is, I have found, a very prevalent idea that the Natives of India are exempt from the danger of chill. Without discussing the matter at length, it may be asserted that, like many commonly -accepted statements in regard to the dietetic and other habits of Natives gene- rally, this alleged immunity is very far from being absolute. Time and again I have had under my care privately or at the General Hospital, Madras, Natives whose illnesses, especially attacks of malarial fever and dysentery, were, beyond all question, determined by a chill. This was particularly noticeable amongst the students at the various Colleges, i.6., amongst those of them who indulged in games of various kinds. Amongst such, those who, wisely, as I believe, had adopted a flannel shirt, rarely suffered, but of the others who, clad in cotton only, got very warm and perspired freely and then, perhaps, took a dvink of water or lemonade and sat for some time with the evening breeze blowing over them, not a few suffered very severely, whilst a relatively large number got attacks of malaria, dysentery, etc. It must not be forgotten, also, that the average Native, excluding the Coolie class on the one hand, and the wealthy class on the other, leads an extraordinarily methodical, quiet life and but rarely exposes himself to the rink of chill ; nay more, it is in the cold season proper that he is specially liable to suffer, from cold not from chill, or when he is transplanted, perforce, to the hills, though one is obliged to admit that those of them who are able to obtain sufficient good food and to dress warmly are very diff^erent beings after a few month's residence at 7,000 — 8,000 feet above sea-level as compared with what they were on the plains.
DIPHTHERIA IN THE MADRAS PRESIDENCY.
J. W. CORNWALL, M.A., M.D.
Captain, I.M.S.,
Acting Professor of Hygiene and Practical Bacteriology, Madras Medical College.
Till now there has been a tradition to the f-yT/> effect that diphtheria is a disease that does not ^ *^^
