¦HI // REPORT /f/ f ON THE CHOLERA EPIDEMIC OF 1872 IN NORTHERN INDIA. B\ C J. M. CUNINGHAM, M.D, 11l SURGEON MAJOE, BENGAL MEDICAL SERVICE, SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. CALCUTTA: OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING. 1873. NOTE. This Report on the Cholera Epidemic of 1872 in Northern India, as will be observed, forms the first section of the Ninth Annual Report of the Sanitary Commissioner with the Government of India. In addition to the usual distri- bution of the complete annual volume which will be made as soon as it is ready, some copies of the Cholera Section are now issued separately. J. M. CUNINGHAM, m.d., Sanitary Commissioner toith the Govt. of India 3rd September 1873. CALCUTTA PRINTED BY THB SUPERINTENDENT OF GOVERNMENT PRINTING, 8, HASTINGS STREET. TABLE OP CONTENTS. SECTION I. REPORT ON THE CHOLERA EPIDEMIC OF 1872 IN NORTHERN INDIA. PAGE Para. . 1 Mortality caused by the epidemic 2 Questions suggested 3 Their great practical importance 4 Sketch of the cholera of 1871 5 Increased prevalence and signs of movement in the end of 1871 6 Cholera in 1872. Statistics of general population, although defective, of great value 7 Statistics of cholera in Bengal Proper 8 Borne out by the statistics of Calcutta 9 Statistics of cholera in Orissa agree with those of the contiguous Madras Districts 10 Immunity of Chota Nagpore in connection with the history of the epidemic in the Upper Provinces ... ••• ••• 11 The epidemic in Nepal 12 In the North-Western Provinces 13 In Oudh 14 In the Punjab 14 Escape of the Western Districts 15 Beyond the Punjab, in Cashmere 16 Afghanistan escaped, Bokhara suffered 17 Cholera in Persian Khorassan and Astrabad, &c, &c. ... 18 The Central Provinces generally free 19 Cholera in Berar slight 20 Cholera in the Bombay Presidency chiefly in the south. Scinde escaped ... 21 In the Central India States widely distributed, but severe in only a few places 22 In Raj pootana prevalent in a few places 23 In the Madras Presidency more circumscribed than in 1871 24 In British Burmah few deaths from cholera ... 25 The broad facts shown in the map ... ... ••• ••• ¦•• 26 Even in the epidemic area the proportion of places attacked was small 27 In the European Army of India confined chiefly to Bengal ... ... •¦• ••• 7 28 Statistics of European Army generally bear out the history of the epidemic among the general if population 29 Among the Native Troops ... 30 Among the Prisoners 31 Necessity for careful investigation into the circumstances of outbreaks ... ... ... 8 32 Notes on 108 outbreaks given separately 33 Facts only recorded in them, not opinions 34 Mode of arrangement of Notes 35 Section ll.— Details of the outbreaks : points deserving attention ... ... 9 36 Isolated cases early in the year 37 Periods of prevalence 38 Prevalence among different communities at the same station ... ... ... ... 10 38 Evidence of a general influence at Allahabad ... 39 Illustrated by the cases of Deyrah, Meerut, Meean Meer ... ... ... ... 10 40 Illustrated at Peshawur and Kohat ... ... »• ••• ••• ••• ••• 10 41 Exceptions to this rule 42 Diarrhoea generally prevalent during outbreaks ... — ••• ••• ••• **• 43 Cholera conferred no immunity from fevers ... ... ... ••• ••• ••• ¦*•* II CONTENTS. Para. p«.ge 44 Many questions must be deferred. Age of children attacked ... ... ... ... 11 45 Discrepancies in minor details ... ... ... ... ... ... ... 11 46 Sections 111. — Facts regarding importation and communication ... ... ... ... 12 47 Importation could not be traced in any one of the 100 communities under careful observation... 12 48 Districts and towns generally left out of consideration, as it is almost impossible to ascertain the facts in them ... ... ... ... ... ... ... ... 13 49 Examination of the facts regarding supposed introduction into the Jubbulpore district ... 13 50 Into Goojranwalla ... ... ... ... ... ... ... ... 13 51 Into Goojrat ... ... ... ... ... ... ... ... ... 18 52 Into Peshawur ... ... ... ... ... ... ... ... ... 14 63 Supposed spread by pilgrims from Hurdwar ... ... ... ... ... ... 14 54 Some confusion as to what constitutes evidence of importation ... ... ... ... 14 55 Special danger from cholera to pilgrims and travellers ; but Hurdwar has very rarely suffered 14 56 The general distribution of the epidemic does not accord with the idea that it was spread by man ... ... ... ... ... ... ... ... ... 16 57 It was not propagated along highways of communication ... ... ... ... 15 58 The disease did not travel more rapidly than it used to do when there were no railways ... 15 59 Evidence derived from the dispersion of the boys at St. Peter's College, Agra, who in no instance spread cholera ... ... ... ... ... ... ... 16 60 European soldiers sometimes the first persons attacked ... ... ... ... ... 17 61 Is there any evidence that the disease was communicated from the sick to the healthy? ... 17 62 General immunity of the attendants ... ... ... ... ... ... 17 63 The apparent exceptions at Allahabad and Kohat do not support the contagion-theory ... 17 64 Remarks on cases of supposed communication ... ... ... ... ... 18 65 Nature of the evidence required to prove contagion ... ... ... ... ... 18 (^6 The doctrine of contagion acted on to an extreme extent during the epidemic ... ... 18 67 Section IV. — Meteorology. Information scanty ... ... ... ... ... 19 68 General meteorological characteristics of the year in Upper India ... ... ... 19 69 Want of a normal standard of comparison ... ... ... ... ... ii( 19 70 Section V. — Local conditions. Their importance in relation to the localization of cholera ... 20 71 Drainage generally defective ... ... ... ... ... ... ... 20 72 Defects in "Water-supply, and the water theory ... ... ... ... ... 20 73 The water theory irreconcilable with the geographical distribution of the epidemic ... ... 20 74 With the experience of the same Provinces in different years ... ... ... ... 21 75 And of individual stations ... ... ... ... ... ... ... ... 21 76 With the facts of outbreaks ... ... ... ... ... ... ... ... 21 77 Or the experience of the camps ... .. ... ... ... ... ... 21 78 No evidence that the disuse of any particular water was attended with disappearance of cholera 21 79 The almost simultaneous attack of different sections of the community ... ... ... 22 80 Meean Meer, Peshawur, and Kohat, no exception to the difficulty ... ... ... ?. 22 81 The general rise and fall of the outbreak in different sections ... ... ... (>i 22 82 Its disappearance from among them all about the same time ... ... ... ... 23 83 The pollution of the water-supply is always supposed to occur at the time when it is least likely ... ... ... ... ... ... ... ... ... 23 84 The water theory opposed to varying intensity of the epidemic in different years ... ... 23 85 Difficulty of explaining the facts at Peshawur and Kohat by the water theory ... ... 24 86 At Kussowlie parties changing locality, but continuing to use the same water-supply, shook off the disease ... ... ... ... ..„ ... ... iti 24 87 The severe outbreak at St. Peter's College, Agra, not explicable on the water theory ... .. 24 88 No case in India ever recorded in which the^e is good reason to believe that cholera discharges have caused cholera ... ... ... ?. ... 25 89 The importance of good water not to be confounded with the " water-theory" ... 25 90 Section VI. — Preventive measures ... ... ... ... .. ... ... 26 91 Quarantine in cantonments ... ... ... ... ... ... 26 92 The facts examined at Roorkee, Umballa, and Jullundur ... ... ... >j(i 93 At Mooltan, Sealkote, Rawul Pindee, Attock, and Nowshera ... ... ... ... 26 94 At Peshawur ... ... ... ... ... ... ... ... 27 95 Escape of Umritsur without quarantine ... ... ... ... ... ... 27 96 Impossibility of enforcing strict quarantine even in cantonments ... ... ... 27 97 Great evils attendant on it ... .., ... ... ... ... ... 27 98 Still greater when it is applied to the population generally ... ... ... ... 28 99 Now prohibited in the Punjab ... ... ... ... ... ... ... 28 100 No evidence that in any instance quarantine did good ... ... ... ... 28 101 Practical nature of the question to be determined ... ... ... ... t 111 CONTENTS. PAGE. Para. 102 These remarks do not apply to the system of isolating new arrivals in Jails ... ... 29 103 Nor to the special case of pilgrims ... 104 Enforced isolation of cases of cholera very hard on the people ... ••• ••• ••• 29 105 Movement from the infected locality generally advisable ... ••• - - 3o 106 Little benefit followed short moves at several of the stations worst attacked ... »• 30 107 More decided moves for the troops at these stations recommended in June 1872 ... ... 30 108 Probable effects of such movements, if they had been made ... ••• ¦•• ¦¦• 31 109 Good followed even the partial movement at Meean Meer 110 Principle on which movement is founded 111 Theoretical objections interfered with movement ... ... ¦•• ••• ••• 31 112 Rules generally approved. Suggestions for trivial modifications ... ... ... ... 32 118 Section VII. — Previous history 114 Any remarks apply only to cholera in India ... 115 Improvement of mortuary statistics required ... ... ¦•• ... ••• — 3-116 Accurate and unprejudiced record of facts ... ... — ••• ¦•• ••• 33 117 Danger of reasoning from analogy ... — - ••• ••• ••• ••• 33 118 Necessity for careful induction ... ... — •¦• ••• ¦¦• — 33 119 Sanitary improvements the only protection against cholera ... ... ... ... 33 120 Illustrated by experience ... — ¦•• ••• •¦• ••• ••• ••• '^ 121 Direction of further enquiries ... — ••• ••• ••• "«* 122 Pettenkofer's views deserve special attention .. ... ... ... ... ... 36 123 Many questions unconsidered ... ••• ... ••• ••• ••• ••• »6 124 Acknowledgments to medical and other officers ... ... ••• — — 30 NOTES ON INDIVIDUAL OUTBREAKS. For particulars vide Table 37 ANNUAL SANITARY REPORT FOR 1872. SECTION I.—REPORT ON THE CHOLERA EPIDEMIC OF 1872 IN NORTHERN INDIA. Another epidemic of cholera has swept over Northern India. Nor has the Mortality caused by the e P i- disease been confined to this portion of the continent ; demic. it has prevailed anew m the West. In the 0011 th also, where it seemed to be dying out at the close of 1871, it continued during 1872, and although its severity in this direction was more circumscribed than it had been in the year previous, the mortality which it occasioned was but little less. In Bengal Proper, moreover, cholera showed a greatly increased activity not only in the regions which comprise the endemic area, but also in those which lie beyond it. The deaths registered as due to cholera in 1872 numbered in — Bengal Proper ... ... ... ... 46,901 North- Western Provinces ... ... ... 50,565 Oudh ... ... ... ... 26,566 Punjab ... ... ... ... 8,727 Central Provinces ... ... ... ... 1,592 Berar ... ... ... ... 1,578 Bombay ... ... ... ... 15,642 Madras .. ... ... ... 13,247 British Burmab. ... ... ... ... 640 Total ... 165,458 Altogether, among the people of British India during the past year, more than 165,000 deaths were ascribed to this one cause, and there is every reason to believe that this number falls very far short of the truth. In the European Army of India there were 888 cases among men, women and children, of which no less than 615 were fatal. But 817 of these cases and 559 of the deaths occurred in that portion of the army which occupied the Bengal Presidenc — a mortality all the more appalling in that it was in the main confined within two months of the year. 2. What is the history of this epidemic ? What are the facts connected with its spread, and how far do they tend to increase Questions suggested. ¦, T j n x i 1 j. • t r, T our knowledge ? Is cholera a contagious disease ? Is a specific poison multiplied in those who are attacked, which is capable of being transmitted to, and of producing like symptoms in, others ; and if this be the case, is this poison contained in the discharges, and is it usually disseminated by means of water ? Or setting aside the doctrine of contagion, both in the ordinary and modified acceptations of the term, is man the carrier of a specific entity from an infected locality which germinates and bears its deadly fruit wherever the local conditions are suited to its growth ? Is human intercourse the great and indispensable means by which cholera is borne from its home and spread over the earth ? 3. These are weighty questions — questions which affect the well-being Their great practical import- n °t on ty of India, but of every country in the world, questions which, in these days of rapid and constantly increasing communication between the East and the West, have a significance and a practical importance very much greater even than they had before. And how are they to be answered ? Not by theoretical discussions, however clever or learned, as to the nature of cholera and the mode of its diffusion, but by a [ Section I 2 NINTH ANNUAL "REPORT OF THE patient investigation of facts — of all the facts so far as they can be ascertained. No country in the world presents such a field for the study of cholera as India, where one portion is the home of the disease, and others are subject to such severe and frequent invasions. 4. What then are the facts regarding the epidemic of 1872 in India? But before attempting to reply to this question, it Sketch of the Cholera of 1871. ?, , { f *¦»,, ? , i> l. 1 will be necessary to glance at the history ol cholera in the year previous. Upper India was then singularly free from the disease. In the whole European Army of Bengal there were only 41 cases, fewer than they had been for a long series of years ; up to the end of October there had been only 16. In Madras cholera was widely spread, but the European troops can be said to have suffered only at Secunderabad. The outbreak there in May accounted for 74 out of the total of 76 cases in the whole Presidency. The Bombay Army furnished but two cases altogether. The statistics of the women and children showed the same comparative immunity as those of the men, and indicated the same geographical distribution of the disease, while these again were borne out by the history of the Native troops and prisoners within the same areas. In Eastern Bengal, where there is no European garrison, the sepoys suffered to some extent, and the disease also attacked several of the jails. Regarding the general population, the great facts noted in the Sanitary Report* for that year were " the remarkable immunity of the Central and Upper Provinces, the occupation of the eastern portion of the North-Western Provinces and Oudh, the epidemic prevalence extending from the endemic area up to the north-east of Bengal Proper, and the large expanse of country covered by the disease in both the Madras and Bombay Presidencies." 5, But in the history of the cholera of 1871, in its relation to the epidemic increased prevalence and signs of 1872, the points most worthy of notice are, that in of movement in the end of 1871. en( J Q f t ] mt year fo ere wag a mar ked increase of the disease within the endemic area and in the eastern provinces, while at or about the same time there were signs of movement further up. The mortuary statistics of Bengal Proper, lamentably imperfect as they are, show that in October, November and December of 1871, cholera was much more widely spread among the people than it had been in the previous months. In Calcutta the deaths from this cause attained a maximum in November, and remained nearly as high in December. In November an outbreak occurred in Her Majesty's 96th Regiment at Dinapore, and almost simultaneously in the jail at Patna, 7 miles distant. In some of the districts of Oudh, also, there was a great increase of cholera in October, which was more fully developed in November and was still prevalent in December. In November also the troops at Lucknow were attacked, and in the same month occurred the remarkable outbreak in the outskirts of Delhi, the details of which have been given in last Sanitary Report. f 6. In considering the history of cholera in 1872, it will be most convenient to take first the general population of the Cholera in 1872. Statistics of gen- -? i • i i 1.1.11 i c ± erai population, although defective, country, regarding which we have only the broad iacts depicted in the death returns, and then the troops and prisoners, in respect to whom there are much more exact statistics. The mortuary registration among the people is still confessedly imperfect ; at the best it shows only the deaths from cholera, and not the numbers attacked, and even the number of deaths cannot be relied on as by any means accurate — a result hardly to be wondered at when we remember the enormous difficulties which have to be encountered. No doubt, as a rule, they are much understated, and it is to be feared that in some parts of the country this defect has been aggravated of late by the fear of quarantine and other measures, which, although designed with the best intentions, have proved very irksome to the people, and have jn'ompted them either to conceal the disease altogether or return it under another name. But it would be a great mistake to imagine that, because these records are imperfect, they must therefore be of no use. On the contrary, there is ample evidence to show that they are of the greatest value, and that the general * Eighth Annual Report of the Sanitary Commissioner with the Government of India, 1371, page 26- t Eighth Report, page 36. Cholera I SANITAR y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 3 distribution of cholera over India which they represent agrees in a singular manner with the well-ascertained facts regarding the disease in those communities which are under careful observation. As will be seen hereafter the dailydetails of particular outbreaks in towns often accord in a remarkable way with those of the neighbouring cantonments — strong evidence that although the actual numbers may be incorrect, the general history of the outbreak recorded day by day contains a large element of truth. 7. The 46,901 deaths from cholera registered in Bengal give but a small statistics of cholera in Bengal proportion out of a population of 66,856,859, and Pr °p er - even if the outlying tracts which are not yet included in the registration be deducted, the ratio of mortality is still insignificant. The returns are yet far too imperfect for any such calculations, but the history of cholera which they contain is important, and the details independently recorded in the different districts of each group afford evidence that this history presents a general truth. On reference to Statement A given at the end of this report, in which the statistics of Bengal Proper are detailed by months for each district, it will be observed that throughout the endemic area represented by the first group, there was generally a continuance in the early part of the year of the cholera which had prevailed in the end of 1871. As a rule, no great increase took place until November, when there was a decided rise in the deaths, which was still more strongly manifested in December. In so large an area, different parts of which are subject to very different conditions, variations may naturally be expected. The history of cholera in the alluvium, for example, can hardly be the same as what it is on the laterite, or where the ground rises towards the hills. The general and marked decrease of the disease in the low-lying tracts, coincident with their submergence by the rains, deserves attention. 8. The truth of this account of the rise and fall of cholera during the Borne out by tue statistics of year in Lower Bengal is borne out by the mortuary Calcutta. returns of the town of Calcutta, in which it may be fairly assumed that the registration is more accurate than it is in rural circles. The monthly deaths from cholera in Calcutta, which are taken from the report of the Health Officer, have been added to the general statement for Bengal already referred to, so that the figures may be seen side by side. Commencing with 80 in January and 81 in February, the disease may be said to have declined to 61 in September. In October it rose to 86, in November to 181, and in December to 248. The total deaths from cholera in Calcutta during 1872 were 1,142. In 1870 they had been 1,563, and in 1871 there had been a minimum of 800. 9. In the eastern districts also there was the same increase in the pre.. , , -. valence of cholera at the end of 1872 as was Statistics of cholera in Orissa •/. .. i • ? -?1 i , ? , agree with those of the contiguous manifested in Calcutta and throughout the endemic IVT *i( ivis Districts ••*¦?¦»# area. In the south-western direction, in the districts of Cuttack and Pooree, to which may be added Balasore, which lies immediately contiguous although it is within the endemic area, there is a wonderful similarity in the returns, all of which show a steady rise in the deaths from January to June, and then a steady decline until in the last month of the year it had almost disappeared. And the similarity is the more noteworthy, because it bears out the history of the cholera in those districts of the Madras Presidency, Ganjam, Vizagapatam and Godavery, which stretch to the south-west below Orissa, as may be seen by a reference to Statement H. 10. Again, if the districts of Behar be taken as a group, it appears that immunity of Chota Nagpore in th(3 H™** Vei T mUCh tlie Story in all, Z^^fnttV^^LoL the a A gradually increasing prevalence up to July or August, and then a gradual decline. But perhaps the most noteworthy point in the statement for Bengal Proper is the slight prevalence of cholera over Chota Nagpore and the other districts grouped with it, a fact which, taken in connection with the immunity of the Upper Provinces, stretching far away to the west of it, well deserves notice. 11. It will be convenient here to record the few facts which are known The epidemic in Nepal. concerning the cholera in Nepal, for it lies due north of the Behar Division of Bengal. The exact date of its appearance here is not stated. The first report is dated the [ Section I 4 NINTH ANNUAL REPORT OF THE 12th August, but by that time 60 deaths had already occurred in the town of Katmandoo. Erom the 12th to the 23rd the number was 211, from the 24th to the Ist September 347, from the 2nd to the 10th 515, from the 11 th to the 22nd it fell to 278 and from the 23rd to the Bth October to 166. After that date only one death from cholera was reported. The Resident mentions that " there is a rumour, which the Nepalese Government believes to be true, that Thibet has suffered from this epidemic," but on this point no further information has been received. So far as can be ascertained, the disease was confined almost entirely to the town of Katmandoo and its neighbourhood. It was not general in the valley of Nepal. 12. After two years of comparative exemption the North- Western Provinces aarain suffered severely from cholera in In the North-Western Provinces. , o^r» t inhn j. n j? J.i • 1872. In 1870 the mortality from this cause was •44 per 1,000, in 1871 it was only *11, but in 1872 the deaths under this head numbered 50,565, equivalent to 1*64 per 1,000. As may be seen from Statement B, the disease fell most heavily on the eastern districts, which are collected together as the first group. In Jounpore and Bustee, in particular, the loss of life was very great, 8,251 deaths having occurred in the one, and 9,537 in the other. The epidemic was early in this part of the country — even in June it had begun sensibly to decline. The next group, comprising the districts south of, or bordering on, the River Jumna, suffered little. Banda, Humeerpore, Jaloun, Jhansie and Lullatpore almost entirely escaped. As regards Etawah, which shows 1,450 deaths, it is to be remarked that they nearly all occurred in that portion of the district which lies to the north of the Jumna. In all only 56 were reported from the two circles south of that river. In the third group, which comprises those districts lying to the west of the line of 80° east longitude, the epidemic w r as most severe in Shajehanpore and next in Seharunpore. The first seven months were comparatively free. It was in August, September, and October that the disease acquired force in these parts. Its appearance in the Terai Pergunnahs and in Kumaon late in the year is of interest in connection with its continuance in these quarters during the early part of the current year. 13. Statement C shows the distribution of cholera in the provinces of Oudh. The disease was widely spread here, but its violence was exerted chiefly in the south and west In Oudh. of the province on the one hand and in the north-west on the other. The Sanitary Commissioner remarks that " the cholera passed over the province from south-east to north-west in two belts, one south, parallel to the left bank of the Ganges, and the other north, parallel to the left bank of the Gogra, leaving the intermediate centre tract comparatively free." The first of these belts is represented by the districts of Sultanpore, Pertabghur, Rai Bareilly and Oonao, all of which impinge on the eastern districts of the North- Western Provinces, where, as already stated, cholera was very prevalent, and continued onwards to Barabunkee and Hurdui. The other includes Gonda and Baraitch. It will be seen that in all of these places the loss from cholera was heavy. 14. In regard to the statistics of the Punjab, as shown in Statement D, it is to be remarked that there was no excessive prevalence in any one district. I am inclined to In the Punjab. believe, as the result of enquiry in several places, that at least some part of the mortality from cholera in this province during 1872 was concealed by the people out of fear of quarantine and of separation from their friends when attacked with the disease ; but making every allowance for this source of error it may still be stated as a fact, regarding which there can be little or no doubt, that there was no very violent outbreak in the Punjab in 1872, such as those in Umritsur and Peshawur in' the epidemic of 1869. The vernacular statements for each village, which were supplied to me by Dr. Deßenzy, the Sanitary Commissioner, proved of much value in the course of my enquiry. To these frequent reference will be made hereafter; for the present, there is only one point in the history of the cholera in the Punjab dining the past year which is of special importance, Cholera 5 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic and to which attention must now be drawn, and that is, the escape of the districts lying to the west and north-west. It Escape of the western Dutnot.. be obseryed that in Montgomery, Mooltan, Mozuffergurh, Dera Ghazee Khan, Dera Ismail Khan, Jhung and Bunnoo the epidemic was represented by only a very few deaths, varying from a solitary one to a maximum of 22. 15. Of the epidemic in the countries beyond the Punjab little is known, Beyond the Punjab, in Cash- but the few facts which are available are of much interest. In the Cashmere territory cholera was mere. severe. It was first reported at Jummoo on the 22nd May, and was attributed to pilgrims who had returned from the Hurdwar fair. It does not appear to have invaded the valley till the 25th June, when it showed itself both in the city of Srinugger and the rural districts. From that date up to the 12th October 10,525 cases are returned, of which 4,190 were fatal. Lieutenant Colonel P. Maxwell, who was resident during the season, is of opinion that the reports were greatly exaggerated, but it was found impossible to obtain accurate information. 16. No mention is made of cholera in Cabul, but in Bokhara to the Affghanistan escaped, Bokhara north the epidemic was very severe. " Letters suffered. dated the 3rd August 1872 from Bokhara announce the appearance of cholera in great severity in the city of Bokhara and its neighbouring territories. It is stated that about 1,000 or 1,200 persons die every day in the city alone." In a further report it is mentioned that the " disease suddenly ceased at Bokhara wholly on the 17th." It also prevailed at Samarcand, but the dates of its appearance and cessation are not given. Little reliance can, I fear, be placed on the particulars of the outbreak, but there seems to be no doubt that early in August the people of Bokhara suffered severely from cholera. 17. Prom Meshed, the capital of Persian Khorassan, the agent writes on cholera m Persian Khorassan and the B th September :—": — " It is about a month since Astrabad, &c, &c. the cholera has appeared here, and more than 200 persons die from it daily." Astrabad, which lies to the west of Meshed at the south-east corner of the Caspian, also was attacked. The disease was said to have been brought by a caravan of pilgrims who had lately arrived from Meshed ; no dates are given. Although widely distributed, the epidemic does not seem to have been severe. Prom newspaper correspondents we learn that cholera prevailed at Balk and Bamian and also at Tashkoorghan, all of which are marked on the map. 18. Leaving the north and the north-west, we may now turn to the history of The central Provinces generally cholera as illustrated in the statistics of the Central Provinces. The fluctuations in the disease, to which this part of the country is subject, are very remarkable. In 1869, nearly 60,000 persons died of it. In 1870, the number was 107 ; in 1871, it was only 19. In 1872, it was 1,592, but it will be observed from Statement E that in many of the districts the returns are blank, in 12 out of the total of 21 no deaths from cholera were registered. The disease was confined chiefly to the south and south-west. Only in Nimar did it attain any degree of severity, and here more than one-half of all the cholera deaths for the whole province occurred. 19. In Berar, as shown in Statement F, 1,578 deaths from cholera were _ . . _ M „, registered during 1872. In both 1870 and 1871 Cholera in Berar slight. ? ~ t i i i n -•¦*-' iv auu j.u ii /T(? 1 /•,_..-_ J-l, „ J ?-,,-« no,/-. i~\-n J-l->^> /> n v<^«n of them suffered from the disease. On the contrary, although there is evidence of the general prevalence of an epidemic influence, the proportion of places that suffered was often very small. In the notes of individual outbreaks which are appended to this report, many instances of this will be found and others have been supplied by the Sanitary Commissioners. Even where the disease was severe the same fact is exhibited. In the Pertabghur District of Oudh, for example, where over 6,000 deaths from cholera were registered, they were reported from 465 villages out of 2,175. In Rai Bareilly, of nearly 7,000 villages, only 855 recorded deaths from cholera. Or to take an illustration from the Central Provinces, in Nimar, where the people suffered most, cholera deaths were reported from only 78 out of 588 villages. This result may be due partly to imperfection in the registration, and partly also to the fact that only fatal cases are recorded, but it still may be accepted as a truth that even within the epidemic area cholera is often confined to particular localities. 27. In the European Army of India, out of a strength of 77,235, includm the European Army of India ™g men, women, and children, there were, as has confined chiefly to Bengal. been already stated, 888 cases of cholera, of which 615 were fatal. The details are given in Statement fully bear out the general accuracy of the history erally bear out the history of the f 11 j_i i ,i i • • epidemic among the general popu. °i ciioiera among the people over those portions of the country to which they refer. We have the prevalence in the eastern districts and the immunity enjoyed over the exempted [Section I 8 NINTH ANNUAL REPORT OF THE tract. One remarkable feature in the record is the occurrence of the disease at hill stations. In no previous epidemic have the troops quartered in them suffered so generally. Chuckrata, Subathoo, Dugshai, Kussowlie, and Murree were all attacked, and at the three last the outbreaks were severe. 29. Among the Native troops in Bengal, as shown in Statement X, there were 377 cases, of which 247 were fatal. The ratio Among the Native Troops. „ , - aaa hi* ii?in ar\ of admissions per 1,000 was 7 "5, and of deaths 4*9. The most severe outbreak was early in the year among the men returning from the Looshaie Expedition. At Meean Meer, Peshawur, and Kohat also there were many cases, but as usual the sepoys suffered very much less than the European troops. Excepting the places above mentioned, the cases in no instance exceeded ten. 30. The prisoners, as a rule, preserved a remarkable immunity during the year, as may be seen on reference to Statement L. The disease among them was most severe in Behar. Among the Prisoners. At Eyzabad there was a violent outbreak. The central jails at Meerut and Lahore also suffered to some extent, and there were smaller outbursts at Umballa and Roopur, but, as a whole, the cases equalled only B*B, and the deaths 39 per 1,000, a result which in an epidemic year must be regarded as very satisfactory and affording a pleasing contrast to the experience of former times. 31. So far, the facts have been stated very generally, but in order to afford means of replying to the questions suggested in Necessity for careful investiga- ? v, •-*- • ±- l i.? < . tion into the circumstances of out- the opening paragraphs, it is essential that the cirbreaks. , ? _ ?• j.i__ • j_i i 1 ¦, -, cumstances attending the various outbreaks should be carefully examined. In order to collect all the information that could be obtained, I visited during last cold season many of the places which had suffered and enquired into every fact which suggested itself as of importance. The medical officers, both civil and military, aided the enquiry in every way in their power, and I also received valuable assistance from the local Sanitary Commissioners who accompanied me through their respective provinces. Dr. Douglas Cunningham had at the same time an opportunity of joining in the investigation and of acquiring information regarding Upper India which cannot fail to be of value to him in the special cholera enquiry in which he and Dr. Lewis are engaged. Reports from medical officers have in some instances supplemented the information collected on the spot, and where I w r as unable personally to investigate the circumstances of the outbreak they contain all the data available. 32. The materials derived from these sources have been thrown together Notes on 108 outbreaks given as " Notes on individual outbreaks," which will be separately. found at the end of this report. With regard to them it is to be observed that they are intended to be, as far as possible, an accurate record of facts. All the facts which seemed to be of any importance have been entered, and some, indeed, have found a place, not because they seemed to be of moment, but because stress was laid on them by the medical officers by whom they were narrated. These notes are intended to be a body of evidence, and as they relate to 108 different outbreaks, the facts recorded afford a fair basis for forming conclusions. The medical officers are the witnesses, and all I shall attempt to do is to sum up the evidence.* 33. But, before doing this, I must explain that mere opinions have not Facts omy recorded in them, not been collected or recorded as evidence. It has not opinions. unfrequently happened that opinions were expressed without any mention of the facts in the outbreak on which they were formed. But, even where this objection does not obtain, it seems very clear that the circumstances of any one outbreak are quite insufficient for forming any sound conclusions. It is of some consequence that the scope of the local enquiry should be understood and distinguished from that of the general enquiry. Both are important, both are in fact essential to complete the proper investigation of an epidemic, but it is quite impossible that both can be successfully * Except as regards the troops, it must bo understood that the " Notes" refer only to those places which I visited, and in which I was able to make Dersonal enquiries into the circumstances of the outbreak. The detailed history of cholera among the general population 1 must leave to be recorded by the local Sanitary Commissioners. Cholera I SANITAK y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J v performed by any one person. The great object of the local enquirer should be to observe and record facts with the greatest care. For this purpose he must commence before the outbreak, and he must continue his observations not only during the outbreak, but also after the outbreak has ceased. He has no opportunity for forming correct opinions, simply because he has no exact knowledge of what is occurring at the same time in other places. It is only when the histories of all the outbreaks have been put side by side and compared that any basis can be framed for forming right conclusions. And this can be done only when the general enquirer has collected all the facts regarding the epidemic in all parts of the country, so far as they can be ascertained. 34. As explained in the remarks which immediately precede the notes of outbreaks, the narrative regarding each is divided into seven different sections. Section I contains a very few words of description of the place where it occurred; in section II are given the details of the outbreak ; in No. 11l are related all the facts bearing on the questions of importation and communication ; No. IV is devoted to the little information which is available regarding the meteorology ; No. Vis a short account of the local conditions ; No. VI describes the preventive measures adopted and their apparent result, and No. VII embraces the statistics concerning the history of the place as regards cholera in former years. The various outbreaks are numbered from Ito 108. Any reference w T hich may be made can thus be easily traced, and the particular evidence discovered. An arrangement similar to that adopted in the notes may be conveniently followed in discussing the facts which they contain. Omitting the first sections in all of them as containing no matter requiring any further comment, the details of the outbreaks as given in sections II may first be briefly considered. 35. The points under this head which chiefly demand attention are the section ii-Detaiis of the out- dates of first cases, the periods of prevalence amon«; breaks: points deserving attention, different communities at the same station, and the statistics of diarrhoea and fevers both before and during the time of the outbreak. The facts regarding each of these, as they relate to different regiments and other bodies of men under careful observation, supply evidence of great importance. 36. Early in the year isolated cases occurred at many of the stations in Upper India. At Allahabad on the 25th March, the Isolated cases early in the year. o x , i -, -, ,->,¦. * •! * i ti j_i oj i 3rd and 19th April. At Benares on the Bth and 9th April in the Royal Artillery, and on the 11th in the Buffs. At Meerut on the 12th April, but the man belonged to the Peshawur Mountain Battery returning from the Looshaie Expedition. On the 14th another man of this Battery was attacked at Lahore. On the 22nd April one of the sth Lancers at Sealkote. In the week ending the 12th April a native soldier at Jhelum. In Agra on the 6th May, and at Cawnpore on the Bth May, but in both these instances the first case was the commencement of the outbreak. At Lucknow, on the 10th of May, in the fort. On the 16th a death from cholera in cantonments. In Lahore* a case in the lunatic asylum on the 12th May. In Peshawur on the 7th. In the fort of Shubkuddur on the Bth. In Murdan on the 26th. The nine cases in the 1- 1 lth Regiment at Morar, the only ones at the station, occurred on the 18th June. On the same day the first suspicious case appeared among the troops at Bawulpindee. At Abbottabad a sepoy returned from leave was attacked on the 7th June. 37. For the periods of prevalence at different stations, I must refer to the details given in the notes and to the statistical Periods of prevalence. tables showing the monthly admissions from cholera among both European and Native troops and also among the prisoners. It will be seen that the violence of the epidemic over a very large area fell in the months of August and September. This remark applies to Eyzabad, Lucknow, Allahabad, Meerut, Phillour, Jullundur, Meean Meer, Dugshaie, Murree, and Kohat. At Kussowlie the outbreak which commenced in July continued severe in August. At Cawnpore and Agra the greater number of cases occurred much earlier — in May and June, while in Peshawur the troops did not suffer till October. [ Section I 10 NINTPI ANNUAL REPORT OF THE 38. The fact that the epidemic over so large an area attained its greatest prevalence among different com- violence at or about the same time in many places, munities at the same station. separated from each other by hundreds of miles, is of great interest in an epidemiological point of view, and has an important bearing on the question of its diffusion ; but I shall not dwell on this, but rather consider what is perhaps of even greater practical importance, — the history of different communities at the same place in relation to the outbreak. In the course of the notes, several tabular statements are given, showing that, as a rule, the incidence of the disease was confined in all of them to much the same period, and that its rise and fall seemed to obey one general law. In some the phenomena are more striking than in others. At Eyzabad the Infantry were attacked first, but the Artillery suffered most during the few days when the Evidence of a general influence disease was most active in the 26th Regiment. At at Allahabad. Allahabad the general influence of the epidemic is illustrated by the cases which occurred in the 2-19 th Eoot on the 25th March, the 3rd and 28th April ; by those in the Royal Artillery on the Bth, 9th, 12th, 13th, and 16th April, which, though not recorded as cholera, were of a very suspicious character ; and by those in the district jail on the 27th and 28th of the same month. In May again there are cases on the 3rd, 4th, 6th, and 17th in the 2-19 th ; in the Royal Artillery on the 11th; in the 33rd Native Infantry from the Ist to the 14th, and one case in the Central Prison Guard on the 16th of the same month. The general character of the influence is illustrated just as strikingly by its absence as by its manifestation. Erom the 17th May to the 27th July not a case is recorded among the troops or other communities under strict observation. On that date the outbreak commences in the railway barracks ; on the 30th July there is a suspicious case in the Royal Artillery, followed by others on the 3rd, sth, 17th, and 22nd of August and 22nd September. On the 4th August the second outbreak in the 2-19 th commences. On the 6th August the district jail is attacked ; on the 12th commences the second outbreak in the 33rd Native Infantry. Between the 12th August and 21st September nine deaths occurred among the civil European residents. 39. Or take the case of Deyrah, where, as may be seen from the tabular illustrated by the cases of Dey- statement, the disease commences in the city and rah, Meerut, Meean Meer. cantonments, and ceases again on almost the same day. Or the case of Meerut, where the outbreak in the different regiments, the bazaar, and the city is circumscribed within very much the same time, and the rise and fall of the disease in the cantonments accords in a singular manner with its rise and fall in the city. Or not to multiply instances, take the striking facts recorded in the statements for Lahore and Meean Meer. At Anarkullee, which is a populous suburb of Lahore, the disease appears first ; one or two cases are reported early in May, some of them doubtful. But when the outbreak is fairly established, it is singular to observe that the two places continue to suffer side by side until on one and the same day the last deaths ascribed to cholera are recorded in both. The second of the two statements regarding Lahore and Meean Meer supplies other very striking facts, bearing on the distribution of the disease among the different regiments in camp and cantonments, and also the bazaars of Meean Meer, as compared with the deaths in Lahore and Anarkullee. In all of them when the disease ceased in the city the outbreak was practically at an end. 40. But evidence of a general influence is, if possible, even more strikingly exhibited at Peshawur and Kohat, as may be seen Illustrated at Peshawur and Kohat. ¦> n i j_i ± ± 1 • • ,1 by reference to the statements given m the notes regarding them. In all sections of the community at Peshawur the violence of the disease is confined to 20 days. In Kohat the same fact is shown. On the 20th August it shows itself in three different quarters. By the end of September it had disappeared from six different corps which had been attacked, from the sudder bazaar, the city, and the jail, not to mention the neighbouring villages. The violence of the outbreak here also is limited to a period of little over 20 days. 41. No doubt there are exceptions to this rule. In some cases particular sections of the community escaped even in the same place where others suffer heavily. There is nothing Exceptions to this rule. more remarkable regarding cholera than its localization in particular quarters Cholera 1 SANITAR y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic. J 11 of a place and even in particular buildings. Again it may happen that one body of men suffer at one time, while another body, at or near the same place, does not suffer till some time afterwards. Instances of this have been rare in the past epidemic. The only one that occurs to me is that of the Fyzabad Jail, which was not attacked till 25 days after the disease had left cantonments. 42. As regards the prevalence of diarrhoea during the outbreaks, Diarrhoea generally prevalent dur- experience somewhat varies. In most of the ing outbreaks. places where cholera was severe cases of diarrhoea were frequent. This was observed at Meerut, Kussowlie, Phillour, and more strikingly still at Meean Meer, especially in the 37th Regiment. In the head quarter party on moving into camp there were 70 applications for astringent medicine in one night out of a strength of 389 men, and this prevalence continued more or less marked during the whole time of the outbreak. At Peshawur also diarrhoea was common, in many cases attended with cramps and vomiting. At Lahore before cholera appeared it had been observed tli at cases of fever frequently were complicated with purging and vomiting. At Murree, on the other hand, although the outbreak was sharp, diarrhoea did not prevail to any extent. At Ferozepore, although there was only one case that presented the symptoms of cholera, it is remarkable that diarrhoea was epidemic in the 39th Regiment. During the first week of August immediately following this case, there were from 60 to 70 applications for astringent medicine daily. There can be little doubt that under such circumstances diarrhoea represents merely a mild form of cholera. 43. It has been supposed that the presence of cholera affords a protection cholera conferred no immunity from fevers, but the history of the epidemic is from fevers. altogether opposed to this conclusion. In many of the cantonments which were severely attacked fevers increased with the outbreak, and continued very prevalent during it. The statistics regarding Allahabad, Meerut, Meean Meer, Mooltan, and Peshawur may be cited in illustration of the truth of this remark. And it is to be observed that they but imperfectly represent the extreme prevalence of fevers, for when cholera appears, no trifling cases, as a rule, are admitted into hospital. At most of the places fevers continued severe after cholera ceased. At Mooltan, where there were only three cases of cholera, the men were so prostrated from fevers that it was considered advisable to move them into camp at the commencement of the cold weather — a change which was attended with excellent results. 44. There are many other questions which naturally fall within the scope Many questions must be deferred °f this section, such as the comparative prevalence Age of children attacked. of the disease amon g those living in upper and lower stories, among the married and unmarried, the temperate and intemperate, or how far the attacks seemed to be influenced by age or length of service, but in regard to some of these matters, the data are insufficient, in others they point to no definite conclusion. Others again, however interesting, may be deferred for after consideration. One remarkable fact, however, regarding the ages of the children who were attacked with cholera may be mentioned, as it has perhaps a practical bearing which is not now apparent. Of 118 children who died from the disease, only one was under four months of age. During the first two years of age, deaths from cholera were comparatively rare. The disease was most fatal among those of from two to three years. It would be interesting to know the distribution of attacks according to age, but the nominal rolls of cases are not complete. 45. Before leaving the subject of this section, it may be observed that Discrepancies in minor details. sli ?kt discrepancies in the account of the different outbreaks are, to a certain extent, unavoidable. The narrative, for example, given in the notes includes many cases of cholera among fetaff Sergeants and others who are not entered in the weekly returns of regiments and who do not therefore find a place in the statistical tables. Again, the dates of cases are not unfrequently given differently in different records. A man comes into hospital with diarrhoea which developes into cholera. It then becomes a question whether his case should be entered as one of cholera from the date on which he was first admitted, or from that on which his symptoms 12 [ Section I NINTH ANNUAL REPORT OF THE became more severe. The dates of attack again yield daily statistics altogether different from those founded on the dates of admission into hospital. For these reasons, slight discrepancies may be found in the following pages, but they are only trivial and in no way affect the great questions at issue. If the nominal register of all cases of cholera, devised by the Army Sanitary Commission, were regularly kept, even these trivial differences would be obviated. 46. The sections in the notes which are numbered 111 contain the cvi- Sections 111. Facts regarding dCQCe regarding importation and Communicationimportation and communication. a c i ass o f £ ac^ s which are of great importance, and which it will be necessary to examine somewhat in detail. Was the disease imported by human agency into the several communities attacked, and once imported, did it spread by contagion ? The 108 different communities which are entered and numbered in the notes may be divided into 25 cantonments, each taken as a whole, 52 regiments or portions of regiments taken separately, 20 jails, 5 civil communities, 2 cities, and 4 districts. The cantonments which are taken as a whole either contained only one regiment or body of men, as Dugshaie and Kussowlie, or were garrisoned by a small force, like the various forts, or suffered little from cholera, as was the case at Benares. Among them also is included Nowshera, which escaped altogether, for the history of this station is important in reference both to the events of 1872 and the experience of former years. The five civil communities consist of the East Indian Railway establishment at Allahabad, the civil residents at that station, St. Peter's College at Agra, the Lawrence Asylum at Sunawur, and the Simla Sanitarium. The two cities are Umritsur and Peshawur, and the four districts, Jubbulpore, Delhi, Goojranwalla, and Goojrat. As already explained, I shall deal only with the facts. Mere opinions have not been entered, nor will they be referred to. The only question is — what evidence has been adduced of either importation or communication, and what value is to be attached to this evidence as a whole ? 47. The 97 bodies of troops and prisoners comprised in the 25 canton_ ments taken as a whole, the 52 separate regiments or Importation could not be traced . . „ . , j j.i nrv • m i 1 in any one of the ioo communities portions ot regiments, and the 20 lails supnlv the under careful observation. *¦ , i i i i j i , i ° x ,* , . most valuable data, because they represent bodies of men under constant and careful medical observation, and to these may be added the East Indian Railway establishment at Allahabad, St. Peter's College at Agra, and the Lawrence Asylum at Sunawur, making a total of 100. In no one of these could the appearance of cholera be traced to importation. In not a few of the cantonments, as will be shown in a subsequent paragraph, the circumstances under which the first case occurred amongst the troops were such as to render it very improbable that the disease had been imported. The same remark applies to the jails. At Sehore the first person attacked in the first outbreak was a mendicant, just arrived from an infected locality, and in the next some sepoys returning from a quarter where cholera was prevailing, but there is no evidence to connect them with the cases which subsequently occurred. In the Benares Central Jail some facts came to light which led at one time to the suspicion that the disease may have been brought in from without, but they did not bear investigation. The circumstances connected with the only case in the 20th Hussars at Umballa, and its possible connection with the arrival of a man from Kussowlie 20 days previous, are quoted in the notes exactly as recorded by the medical officer, but they are not seriously advanced as evidence of importation. Within a few hours of this man of the 20th Hussars being attacked, an Artilleryman was seized — two out of the only four cases which occurred among the European troops at Umballa. At Goonah, a place which is not entered in the notes because only one case of cholera occurred among the troops there, the solitary seizure, which took place in May, is attributed to the fact that the man had been at an outpost near which an infected detachment of Scindiah's men had encamped, " but the sowar states that he did not visit any of the men of the detachment." Giving every weight to the circumstances narrated in each of these cases, it is still quite correct to state that in not one of the 100 bodies of troops, prisoners and other communities which were under careful medical observation, and particulars regarding which are recorded in the notes, could the appearance of cholera be traced to importation. Cholera I gANITARY COMMISSIONER WlTfl THE GOVERNMENT OP INDIA. 13 Epidemic. 48. The two special civil communities not already included in the total of 100 need hardly be considered. At Simla there was n^S^S&^Si^SS^St only one case in the settlement— an imported case. i£Them ble to ascertam the facts By some this would be quoted in support of the theory of importation by human intercourse, but it is no proof of an outbreak being due to importation, which is the point under consideration, for no one else was attacked. Of the districts and cities, Delhi and Umritsur may be omitted, as they have been entered merely to supply a link in the history of the epidemic. No importation could be traced in either, nor was it even suspected. The districts and towns have generally been omitted in the enumeration of outbreaks supplying any evidence in this investigation, because in such communities it is almost impossible to ascertain the facts. Had all these places in which no evidence of importation could be obtained been counted as so many instances of no importation having been traced, the number of apparent proofs in this direction would have been much increased. 49. As all the districts and towns are thus generally omitted, the narratives regarding Jubbulpore, Goo j ran walla, Gooirat, Examination of the facts regard- ij_i 'in-ni t j. i_i i_ «i. s -lxj ing supposed introduction into the and the city oi resnawur into which it is stated Jubbulpore district. , v , + , A - nnne% mnn i^^^^A ™,*™k+ !,„,,« I™™ l«Pf that the disease was imported might have been left out also, but as the only object in view is to ascertain the truth, the story of the supposed introduction of cholera into these places may be briefly examined. The disease is supposed to have been introduced into the district of Jubbulpore in the first instance by a pilgrim from the Ajoodhea fair in Oudh. On the 7th April the fair was broken up, because cholera had appeared in it. This old woman, by name " Dohka," is said to have been taken ill with vomiting and purging at Ajoodhea on or about the 9th April, but not seriously, for she was able to walk over 100 miles to Allahabad. Thence the party proceeded by rail to Sleemanabad, and from that station Dohka is said to have walked 12 miles to her home, where she arrived with the others on the 27th April. On the 29th another woman of the party who had been "in constant attendance on Dohka" was attacked, and died on the 2nd May. But there is no evidence that Dohka really had cholera before she reached her village ; indeed it is quite clear that she had not or she could not have walked 12 miles to her village, not to speak of the 100 miles from Ajoodhea to Allahabad. She died afterwards, on the 6th May, it is said, "with all the symptoms of cholera," and this is not at all improbable, as meantime several of the people of the village had been attacked, and of these it is stated that one at least " had had no communication with the returned pilgrims." Other instances from Jubbulpore are cited in the notes, but the mere narration of the facts, as related in the notes, is quite sufficient to show how very far short they fall of affording any proof of importation. 50. In the Goojranwalla district the evidence merely amounts to this, that the first known case was a traveller who was attacked on the day of his return home from an infected Into Goojranwalla. district, and that four other cases followed within a few days. With one exception, there is no reason to believe that any actual communication had taken place between the traveller and those who afterwards suffered. It is believed that the medium of contagion was the drinking water, but on this point I shall reserve any remarks for a subsequent paragraph, when the whole of the evidence on the water theory will be considered. 51. The story of the Mahomedan priest who is said to have brought „!, _1 • _j_ _ /~i • i • . P cholera into Goojrat is very open to question. He was taken ill immediately on his arrival from Lahore Into Goojrat. where cholera was prevailing, and died on the 6th August. The original account stated that "on the 7th no less than ten persons were attacked, most of whom were friends of the deceased, and had remained present with him during his illness." As the whole evidence hinged on whether any had been attacked who had held no communication with him, further inquiry was made at my suggestion, and it was then reported that all of them had been with him. The inquiry was made through native oflicials, and although they may be correct, there is reason to doubt whether the data collected after such a lapse of time can be depended on. I mention the matter, however, not in order to throw discredit on the statement, but to show the importance of investigating the 14 [ Section I NINTH ANNUAL REPORT OF THE facts most minutely at the time, and also how very difficult, if not impossible, it is to learn what actually occurred among the general population. It is to be noted, moreover, that the mortuary register shows one death from cholera in the Goojrat district in May and two in July. It is quite possible that these entries are incorrect. Other instances of supposed importation and communication in the Goojrat district are cited, particulars of which are given in the notes, but it would occupy too much space to discuss them in detail. 52. The case of supposed importation into the city of Peshawur will hardly bear investigation. The native police officer to whose arrival it is attributed came into the city sur- Into Peshawur . reptitiously on the night of the 4th October from the quarantine camp between Peshawur and Kohat, but no connection can be established between him and the attacks which followed. Two persons in the city were seized within a few hours of his arrival, and so far as could he ascertained, they had had no communication with him. None of the people in his own house suffered. If the cases among the European troops in the fort on the Ist were cholera-cases attended with severe vomiting and purging, and one of which proved fatal in ten hours, or if they were due to the same cause or causes which produce cholera, then the whole story of the jemadar is of little importance. Or if these cases on the Ist were not cholera, what is to be said of the isolated attacks in the city and cantonment in May to which no suspicion of importation attaches ? 53. As the epidemic has been attributed in more than one report to the supposed spread by pilgrims from pilgrims returning from the Hurdwar fair, it will be Hurdwar. nroll ¦fn ovominn TT-nvir olir»T»flTr TxrVin'f ,• , -, disease was communicated trom veyed by one oi the numerous native servants who the sick to the healthy ? * nn "-~4-~A U,, ™1£ I^l- , ~4- 4- ~1 ••*. are prompted by self-interest to conceal its appear- ance among either themselves or their families. It may be communicated through the water or through the milk or through a thousand different ways which it is impossible to discover. To such an argument it might well be replied that if regiments and jails do not afford a suitable field for investigating this question of importation, where is such a field to be found ? But fully admitting that the history of importation, even if it has taken place, may elude all inquiry, what light is thrown on it by the facts regarding the spread of the disease once it has commenced ? Have the cases which came under observation proved centres from which the disease has infected others ? Do they afford any evidence that the persons attacked have multiplied a poison which produced in others the same deadly symptoms from which they themselves suffered ? 62. This point may be tested first by the experience of those who General immunity of the atten- came in direct contact with the sick. A Civil dants. practitioner died of cholera at Allahabad, but as he was not in the service of the Government the particulars of his case are not recorded. Of all the medical officers in public employ, not one was attacked, except an Assistant Surgeon attached to the 2-19 th regiment at Allahabad, who was suffering from dengue, and had not attended a single case of cholera. In the notes, particulars are given of the seizures among attendants, and it will be observed that the number is very small ; very often they escaped altogether. Of this there are many striking instances. Eor example, of 40 native attendants at Eyzabad none were attacked ; not one of the large number employed with the different regiments at Lucknow ; not one out of 70 native servants at Dugshaie ; not one at Jullundur. Eurther examples will be found at Meean Meer, Peshawur, and other places. Indeed, excepting at Allahabad and Kohat, the cases among attendants were confined to one or two isolated attacks. 63. The particulars regarding the attendants at Allahabad show that the The apparent exceptions at Aiia- seizures were to be attributed rather to the locality fhtcontTgion^theory? not support in which the men lived than to the fact that they were brought in contact with cases of cholera Of 30 Europeans so employed in the 2- 19 th, five were attacked, but they all [ Section I 18 NINTH ANNUAL REPORT OF THE lived in the same barrack by themselves, and this was not vacated on the occurrence of the first case, because it was assumed that it was due to contagion. The five seizures took place in five days, just when the outbreak was at its height in the regiment generally. These men had been employed in Hospital for periods varying from three to six days. The 25 who escaped had been engaged in the same duty for from 26 to 38 days. The occurrences at Kohat are also to be explained by the locality which the men occupied, for after attendance they were allowed to return to the lines which the regiment had vacated, because of the outbreak of cholera. It was only in the 3rd Punjab Infantry in which this arrangement was followed that the attendants suffered to any extent. 61. In the course of the account of different outbreaks, cases are cited Remarks 9n 9 n cases of supposed by the medical officers as evidence of communicacommunication. -finn nnrl airavxr nnoa nf ¦flric nnfiu'o ixrliir»li nm-no fr» tion, and every case of this nature which came to notice has been recorded. It would take up too much space to discuss them in detail, and I shall therefore confine myself to a few very general remarks regarding them. In the first place, it is to be observed that if the disease spread by contagion, the evidence of its having done so is very meagre. The cases of supposed communication which are advanced are strikingly few. In many of the outbreaks not a single instance can be adduced. And in regard to the instances which are adduced, many of them are altogether opposed to the idea of contagion. A mother and child, for example, or other two members of a family, are admitted from the same quarter within a few hours of one another, and it is concluded that the one contracted the disease from the other. But the facts rather point to their having both contracted it together in the same locality. Where different members of one family are attacked it must be remembered that they are often subject to like conditions, not only as regards their dwelling, but the other circumstances under which they live. Moreover, grief at the loss of a relative, the fatigue, want of sleep, irregular meals, and other privations incidental to nursing the sick are all depressing, and render the person exposed to them more liable to attack. All these must be weighed and considered before evidence of communication of cholera from one to another can be accepted. 65. The character of the evidence required to establish the contagious Nature of the evidence required nature of cholera is not sufficiently appreciated. to prove contagion, "Rvprv "nprsnn nttnrVlrprl nftpr lm.vino 1 nnmp. in nrm+nnf Every person attacked after having come in contact with a case of cholera is often quoted as an undoubted instance of the contagious nature of the disease. But if this procedure were adopted with regard to any disease, to malarious fever for example, evidence could easily be accumulated to prove that it spread from man to man. The proof of the contagious nature of cholera or of any other disease is only to be made out by showing that persons who have come in contact with those suffering from this disease have suffered in a greater proportion than those who have not. The fact of a medical officer or a hospital attendant being attacked with cholera is no proof whatever of its contagious nature. Attendance on a cholera case cannot confer immunity from the epidemic. Cases must be expected among the hospital establishment as among others. Again, although every instance in which a person is attacked after being in contact with a case of cholera is cited by some as positive evidence of contagion, all those instances of persons under similar circumstances who escape are set aside as affording only negative evidence of no value. But as a matter of fact, the one set of facts is just as important as the other. It is only by taking both together, — by comparing the proportion of attacks among those who have been brought in contact with cholera cases on the one hand, with that among those who have not been brought in contact with such cases on the other, that any proper conclusion can be drawn. Adopting this standard of comparison, there is certainly no evidence in the events of the epidemic of 1872 to support the opinion that cholera is a contagious disease. 66. It will no doubt be answered that cholera is not contagious in the M sense in which other diseases are contagious. Mere The doctrine of contagion acted . , , .., , O *"~ v on to an extreme extent during the contact IS attended Wltil UO danger ; tllC DOISOU, it IS epidemic. r, n lA K^ ±1 ,1 • i i x l at 1 1 • n said, lies in the discharges, and takes effect chiefly through the water-supply. The facts bearing on this water theory I shall Cholera | SANITAIl y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic. J 19 examine under Section V, which relates to local conditions. But in the meantime I would observe that, although the contagious nature of cholera in the ordinary acceptation of the term is generally denied, in more than one station the persons attacked were treated as if they were suffering from the mcst contagious disease, according to the usual meaning of the phrase. Parents have been prevented from attending their children, husbands their wives; the nearest relatives have been separated, and where the disease proved fatal have never seen each other again. Not to speak of the inhumanity of such a procedure, there can be no question that it is productive of much mischief, that it is calculated to engender the greatest alarm, and to cause a depression of spirits which ought especially to be avoided. There is no evidence to show that there is any risk in attending on the sick, when removed from the locality in which they were attacked. 67. All the information afforded regarding the atmospheric conditions section iv.-Meteoroiogy. infor- which obtained during the time of the outbreaks mation scanty. n.f, tlifi KPVfirnl stn.tinns is o-i'vpn in tlift fnnrfli spr»f.inn« at the several stations is given in the fourth sections of the notes, but it is very scant. In many cases no meteorological observations were recorded. In several instances, a severe storm of wind and rain immediately preceded the outbreak. This was the case at Allahabad, Chuckrata, Jullundur, Sealkotc, Meean Meer, and Kohat. But this was by no means the rule. At Lucknow, there had been no rain for ten days when the Europeans began to suffer. The prevalence of easterly and south-easterly winds is noted at most of the stations, at Eyzabad, Lucknow, Cawnpore, Shajehanpore, Umballa, Mooltan, Meean Meer, and Peshawur, and the close oppressive feeling which so often attends a continuance of easterly winds was complained of. At Morar, there was "a blast from the east" four days before the outbreak in the 1-11 th. At Agra, on the other hand, a fierce hot wind blew from the south-west. A peculiar heavy mist or fog was observed at Eyzabad, Deyrah, Phillour, and Murree. Flights of locusts were seen in many places. In some, as at Roorkee, nothing abnormal was observed. Occasionally different accounts of the same place are somewhat conflicting. At Meerut, for example, in one report, it is stated that the prevailing wind was south-west, in another that when the west wind blew cholera decreased, and increased again with a change to the east. 68. The general meteorological characteristics of the year will be de- scribed at greater length in a subsequent section of x*s^^^\^&£&aB? m the annual report, when more complete information has been obtained. Meantime, it may be observed that in Bengal Proper the rains of 1872 were unusually light. At Calcutta, the fall was 15 inches below the average. In the North- Western Provinces no special peculiarity was observed. The rains set in at the usual time, and were abundant, though somewhat less than in 1871. In the Punjab, on the contrary, " the rains were much heavier than usual, the Delhi District recei vino* 10 inches, the Kurnal 12, Hissar 16, Umballa 18, and Loodianah 23 inches more than the average. Jullundur got 20, Hoshiarpore 12, and Dhurmsalla no less than 38 inches more than the average of the last five years, while, curious to remark, the two Sub-Himalayan stations, Goordaspore and Sealkote, show a deficiency of 9 and 17 inches, respectively."* 69. In the above paragraphs regarding meteorology, I have merely want of a normal standard of recorded facts which have been mentioned by comparison different observers. Before we can say what connection, if any, they had with the epidemic, it is essential to know what constitutes a normal year, and also in what respects and to what extent the phenomena of 1872 varied from this standard. But unfortunately our information is as yet far too imperfect to allow of any sufficient answer being given to either of these questions. An important contribution to the meteorology of this country has lately been made by Mr. Blanford in his paper on the °wind current of Northern India, and I trust that the scheme for obtaining more accurate observations, and bringing them annually into one general view for the whole country, which has been so long under consideration, may soon be put into operation. * Report on the Meteorology of the Punjab for 1872, page 7. 20 [ Section I NINTH ANNUAL REPORT OF THE 70. The localization of cholera in particular places, even in particular buildings, is one of the most remarkable charac- Section V. Local conditions. , • i- n n -i. n -, . 1 , 7 Their importance in relation to the tenstics ot the disease, of which there are many localization of cholera. ill., j. „.!_• • j.l, „l • j. <• n n l ' • noi^n illustrations in the history of the outbreaks in 1872. At Agra, for example, the artillery entirely escaped, although hemmed in between the 65th regiment on the one side and a bazaar on the other, in both of which cholera was prevailing. Still more remarkable is the case of St. Peter's College, in which the boys were attacked with the greatest severity, while the girls in the convent, immediately adjoining, were almost altogether free from the disease. The question of the local conditions under which the different communities existed is a matter of great importance, the conditions of soil, of water level, of drainage, of overcrowding, or other sanitary defect, and in particular of water supply. In regard to soil, the Inspector General of Military Works has, at my request, called for a section from each cantonment showing the various strata from the surface of the ground to the water level and the thickness of each. When these have been obtained, and when the data they afford are taken in conjunction with the rain-fall and the prevalence of cholera, some light may be thrown on the question of how far these soil conditions are connected with the propagation of the disease. 71. It will be seen from the notes that in many of the stations attacked the drainage was very defective, and, although it may be argued that the soil imbibes little moisture, there Drainage generally defective. can be no doubt that imperfect drainage creates a condition of damp which is specially favorable to the development of malarious disease. Good drainage and proper water-supply are the two sanitary improvements which are most urgently called for. With very few exceptions the troops were well housed ; they have had ample space, and the conservancy of the station has been well attended to. 72. The water-supply for the troops in Upper India is derived chiefly from Defects in water-supply, and the Wells, which are generally SUnk Close to the barwater theory, moles, find tlift watpr. rlvn.wn nn by t,hf> nvrlinnrv racks, and the water, drawn up by the ordinary native leathern vessels, is distributed in skins. Orders were issued some years ago to provide at least one of them on each of the lines occupied by a European regiment with a pump ; and last year metal pails were sanctioned for conveying the water from the pump to the barracks. It will be seen that in one or two places pumps were at work, but the pails had not any where come into use, and it may be said that when cholera broke out the old system practically remained as it was before. To this system the whole sickness and mortality among the troops has been attributed, not by the medical officers in charge of them, for almost invariably they express an opinion that no connection could be established between the water and the outbreak ; but the favorite theory of the day is that any person affected with cholera multiplies within himself the poison of cholera, that this poison is emitted in the discharges, and that wherever and whenever a community is violently attacked by cholera the outbreak has been caused in the main by water which has been contaminated by these discharges. Is this theory in accordance with the facts of 1872 ? 73. To commence with, it is to be observed that there is no evidence to shew that cholera evacuations in any instance found The water theory irreconcilable ? . , ? , , .», ¦?.,. '? with the geographical distribution their way into the water supply : but admitting that of the epidemic. ? . • , „ ,-. ., „ r f, *i . .° .. there is ample facility for this occurring, is the general history of the epidemic taken in connection with that of other epidemics, or are the details of individual outbreaks both in themselves and as compared with those of former outbreaks, explicable on such a supposition ? The geographical distribution of the disease does not favor this idea. The epidemic of 1872, like every previous epidemic, had a geographical distribution. There were certain well-marked and extensive tracts of country which escaped either entirely or in a very great measure. There were other well marked and extensive tracts which suffered severely. There is no material difference in the watersupply of these different tracts, either in the source from which it is obtained or in the means by which it is drawn. It can hardly be supposed that over the one the water was generally denied by cholera discharges, while over the other no such defilement took place. Cholera 1 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 21 74. The argument is even more forcible when applied to the same extent with the experience of the same of country in different years. In the Central Proprovinces in different years. vinces, for example, as has already been stated more than once, there were nearly 60,000 deaths from cholera in 1869 ; in 1870, there were 107; in 1871, there were only 19; in 3872, 1,592. Is this extraordinary difference to be explained by supposing that in the first of these years the water supply over this great area was generally poisoned by cholera evacuations which it escaped in other years ? Illustrations almost as striking could be drawn from the history of the other provinces, all of which seem to be equally inexplicable on the water theory. In many of them there was ample cholera material, if the water theory be correct, for spreading the disease, and yet we have in one a severe epidemic, in another the disease, though widely distributed, is much less prevalent, in a third it is confined to a few cases here and there. 75. The same difficulty presents itself in the history of individual stations. Last year, for example, after a long period of exemption, both Dugshaie and Kussowlie suffered And of individual stations. severely from cholera ; while the adjacent hill station of Subathoo, though at a much lower elevation than the other two, suffered only to a slight extent, — a result the more unexpected, because it has suffered several times when both Kussowlie and Dugshaie escaped, yet the water supply of the one is just as liable to contamination as that of the others. Similar facts can be adduced regarding stations in the plains. At Allahabad, Cawnpore, and Lucknow the wells are of just the same construction as those at Sealkote, Nowshera, or Mooltan, The first-named stations are subject to frequent and severe attacks, the others have in comparison rarely been attacked, and never with any severity. 76. Or let us examine individual outbreaks in relation to this question. The water theory was founded on the fact that With the facts of outbreaks. among masses of people living in London side by side, and apparently subject to the same influence, except in this one matter of water supply, those supplied from one source suffered far more than those drinking from another. Is there any evidence of this nature ? On the contrary, there is no instance in the whole course of last year's epidemic in which any special severity of the disease among any particular section of the community can be associated with the use of a particular water used by that section. In Lahore, for example, there are 1,400 wells, in Anarkullee they are also very numerous, but there is no suspicion that persons using any one of these wells suffered more than others, much less that the severity of the outbreak was confined to those drinking from particular wells. Both here and in the city of Peshawur, where also the wells may be numbered by hundreds, the disease was spread generally among the people. In these places, and in many other instances which might be cited, we find numbers of people drawing from many different sources, and yet all suffering to much the same extent, a result which is hardly reconcilable with the idea that the attacks were caused by any specific poison accidentally introduced into the water supply. 77. The experience of the various camps in which the troops took refuge or the experience of the camps. fro . m . cholera illustrates this point even more strikingly than what occurred in cantonments. In some places they continued to suffer even where the water was above all suspicion, for instance, at Bara near Peshawur, where the supply was drawn from a rapidly flowing river. In the history of the outbreaks at this station, and also at Meean Meer, we have different camps miles apart drawing from altogether independent sources, and yet suffering severely from cholera. It cannot be said that the disease continued because the influence which had been at work in cantonments still exerted its power, for its cessation in several of them was marked and almost immediate. There is no fact to connect the benefit derived from moving into camp with any change from the use of a water containing cholera discharges to one free from this impurity. The benefit of movement is to be associated with change of locality, not with change of water suddlv •7O T-_ ii 1 l „ , , ° . , . lie/* 78. In the whole course of the epidemic there is not a single instance in no evidence that the disuse of wn i° n tne cessation of the disease can be attributed »SSLnft SSifiJT 16 * t° the disus e of any particular water. At Cawnpore, it was said that the shutting up of wells was attended with benefit, but there are no facts to support this conclusion. At 22 [ Section I NINTH ANNUAL REPORT OF THE Goojranwalla, as already stated, it was supposed that an outbreak of five cases had been stopped by closing a well ; but in this very village, some time after, another outbreak of four cases occurred, no well was closed, and the disease ceased just as suddenly as it had done before, — an illustration of how dangerous it is to connect two events together as standing in the relation of cause and effect without large and very precise evidence. 79. The almost simultaneous distribution of the disease among the _ . 14 ++ . various bodies of men in the same place but drink- The almost simultaneous attack „ ?«, , - 1 ,_ •*««"""• of different sections of the commu- ing irom many amerent sources greatly enhances the difficulty of reconciling the facts with the water theory. Attention has already been drawn to the evidence of a general influence pervading more or less all classes of the population for the time the outbreak lasted. This evidence may be studied in the details regarding all the outbreaks, but more especially those at Pyzabad, Deyrah, Roorkee, Meerut, Dugshaie, Kussowlie, Umballa, Jullunder, Lahore, Meean Meer, Goojranwalla, Murree, Peshawur, and Kohat, in which the statistics for each section of the community are tabulated separately side by side. In some cases tjie results are more striking than in others ; where the epidemic was severe they are naturally more distinct than where it was but mild. Allowance must be made for this variation in the severity of the disease in different places, for the small numbers of which some of the communities are composed and for the distances which in some instances intervene between them. But looking at any of them, it is impossible to ignore the fact that at or about the same time, sometimes on the very same day, several different sections of the community begin to suffer. If all drew their water from the same source, the spread of the disease might be attributed with some plausibility to water contaminated with cholera discharges, but when the sources are many and various, this.attempt at explanation altogether fails. Even in a single outbreak it would be a strange coincidence that a number of independent sources of water supply should be accidentally polluted in this way at or about the same time. But when, in order to explain the facts, it is necessary to suppose that this remarkable coincidence should have taken place not only in one but in nearly every outbreak, the supposition involves a series of remarkable coincidences, amounting to an impossibility. 80. Meean Meer, Peshawur, and Kohat are no exceptions to this rule, Meean Meer, Peshawur, and Kohat for though the Supply for the trOOpS at these no exception to the difficulty. tVljipph is in OTPfli mpnsnrfl frnm n i-iiTmm« n4-*. places is in great measure from a running stream, there are other classes of the population who draw from altogether different sources. At Meean Meer, for example, while the European troops are supplied from the canal cutting, the Native regiments have wells in their respective lines, the bazaar people draw from wells, and the servants throughout cantonments are also supplied from numerous wells. At Peshawur, the Native troops drink from the stream, the Europeans from two wells, and the city people from several hundred wells. At Kohat, although the use of the stream is more general, the inhabitants of the city and neighbouring villages use wells to a large extent. In all these places the almost simultaneous appearance of the disease in different sections of the community was most marked. 81. But if the history of the disease in the different regiments and other The general rise and fail of the bodies of people in one station be examined, the outbreak m different sections. rJiffionl+Tr avrklai'm'nre flia 4V,«+o ,*~ < j__ difficulty of explaining the facts in accordance with the water theory is rendered greater still, for there is a singular similarity in the results, — a tendency to rise to a maximum in all about the same time, and then gradually to decline. Where very many sources of water supply are concerned, it is hardly possible that the specific poison should not only be first added about the same time, but that it should continue to be added in such a way and at such intervals as to produce a general uniformity in results. The difficulty is all the greater where running streams are concerned, as at Meean Meer, Peshawur, and Kohat, streams of considerable volume and running with some rapidity ; and the fact that disease aniono" those drinking from the running stream follows much the same general course as among those drinking from wells, renders it all the more difficult to account for the results on the supposition that it was propagated by cholera evacuations received into the water. Cholera I SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 23 82. The almost simultaneous disappearance of the disease in the dif- ferent regiments and other communities in the themanX p ut a the c c s e am f e°ttoe among same place is also very hard to explain on the water theory. In order to account for the facts shewn in the outbreaks, it is necessary to imagine, not only that the different sources became contaminated on or about the same time, that they continued to be contaminated for a similar period, but also that on or about the same time the contamination ceased, and the many sources of supply became comparatively pure or at least incapable of propagating cholera. Or if it be said that the contamination may have lurked in the water skins, or the sand of the filters, or the barrels or any other vessels in which the water was drawn or by means of which it was distributed, it is equally improbable that these various centres of contamination should have been exhausted about the same time. 83. The similarity in the general history of cholera outbreaks is quite inconsistent with the idea that the spread of the islfwap^upposed^o^cc^^fhe disease was due merely to a series of accidents; but time wten it xs least likely. leaving this point as one which can be easily tested by the details in each case, I would observe that there is no relation between the quantity of the so-called cholera material which is available and the results which it is supposed to produce. It will be conceded that the more abundant the material, the greater number of people, in fact, who are suffering from cholera, multiplying and eliminating from their systems this supposed poison, the greater must be the risk of contaminating the water supply. But the outbreak never follows any such law. In Lahore city, for example, taking the number of deaths shewn in the Registration Returns to represent half the number of attacks, 10 cases in June produce 86 in July, while 476 in August produce only 10 in September, and such is the history of the disease not in a few places only, but all over the country. In order to account for the results according to the water theory, the accidental pollution of the many sources of water supply is supposed to occur at the commencement, just at the very time when it is of all others least likely to occur. 84. Again, the varying severity of different epidemics is not to be ex—.,„„. *? plained by the water theory. There can be no The water theory opposed to vary- x ? j_ijji tpo i * • ing intensity of the epidemic in dif- question that they diner much, not only in the ferent years. x , c it i i . . , • . extent of area covered, but also in intensity at individual places. At Peshawur, for example, in 1869, out of a strength of 1,723 European soldiers, 323 were attacked; of 3,380 Native soldiers, 179 were attacked. In 1872, out of much the same strengths, there were only 82 cases among the one and 45 among the other, and this result was due to the fact that the disease was less in all sections of the community, as may be seen from the following comparison of cases of cholera among the Royal Artillery, the two European Infantry Regiments, the two Native Cavalry Regiments, the four Native Infantry Regiments, and the Sappers and Miners, which make up the garrison. None of those which had been there in 1869, it may be observed, remained till 1872. The same marked difference, however, is seen in the jail and city, which have also been added to the statement : — „ , 4 Mi 1869. 1872. Royal Artillery ... ... ... ... 56* g-x- European Infantry Regiment ... ... ... 202* 27* Ditto ... ... ... ... no* 45* Native Cavalry Regiment ... ... ... 3\ g Ditto ... ... ... ?'. 22 6 Native Infantry Regiment ... ... ... 3^ 13 Ditto ... ... ... .. 43 5 Ditto ... . ... ... ... 24 14 Ditto ?, ... ... ... 20 5 Sappers and Miners ... ... ... ... y 4 •Jj" l •• ••• ... ... 31 1 ut y ¦•• ••• ••• ... ... 2,642 352 The conditions of water supply in the one year were much the same as in the other. A similar comparison might be made in regard to the troops at * Including men, women, and children. 24 [ Section I NINTH ANNUAL REPORT OF THE Kohat in these two epidemics. Other instances again might he given in which the reverse was the case, and the different classes suffered in 1872 more than in 1869. For example, at Fyzabad, there were — In 1869. In 1872. In Royal Artillery Battery... . ... '6 cases 10 cases. In European Infantry Regiment ... 22 „ 50 „ In Jail ... ... ... ... 3 „ 67 „ Many other examples might be quoted to the same effect. It can hardly be argued that in one year all the sources of supply in one place are poisoned by a larger quantity of cholera evacuations, and that in another year they all receive a smaller supply. Nor is there any ground for assuming that these discharges are more virulent in one epidemic than in another. 85. It has been argued in former epidemics that, although the European troops at Peshawur are supposed to drink from Difficulty of explaining the facts j.i_ n xi i_ • J i at Peshawur anS Kohat by the the wells, they vet may have received more or less water theory. „., . i $ j.u j. i•i, * 4- of their supply from the stream, which is notorious- ly liable to pollution. But if this be admitted, the difficulty of adapting the water theory so as to explain the facts is by no means removed. If the European and Native troops drank from the same water, how was it that the Native troops suffered so very slightly in comparison to the Europeans ? It may be said that the native is much more careful and cleanly in his habits, but if the stream is polluted, no amount of care can make auy difference. Natives, moreover, drink largely of water, for they drink little else. The attempt to explain the difference by the filtering beds and reservoirs in the European lines, which rather aggravate than diminish the evil, also fails, for the arrangements in use by the Native troops are just as objectionable. The history of the outbreak in the different lines at Peshawur, moreover, does not accord with the idea that the Europeans suffered because they drank cholerapolluted water, for the Royal Artillery at the end of the stream, where the pollution would naturally be greatest, escaped almost entirely. The facts at Kohat also, so far as they are known, are equally adverse, for Chickurkote, the village in which the disease was first seen, is down stream. Jungul-peer-kheyl, at the head of the stream, did not suffer for ten days afterwards. 86. At Kussowlie we have a remarkable instance of a body of persons who had been attacked with cholera moving out lo^itf^urionti^f^^o^e^hl of the station to a neighbouring hill, continuing dis^LeT ater supply> shook off the to draw their water from the same source as before, and yet remaining free from the date of their taking up their new position. The outbreak at Kussowlie was severe. The circumstances of water supply are such as to render the explanation offered by the water theory very plausible, but the instance in point shews that any such conclusion would be hasty. In another point of view the history of this camp is interesting. Communication between it and Kussowlie was constantly kept up. All other supplies besides water were received from Kussowlie. A number of cases of cholera accompanied the detachment when it first went out, and were encamped close to it. Other cases in the depot, as they occurred, were sent out to this place, but not one of the detachment suffered. The experience of another party at Kussowlie, which moved in a different direction, teaches the same lesson. This party was unfortunate. After a severe storm, in one night out of 90 men 7 cases occurred. The explosion was attributed to the water, but no other supply could be obtained. The camp was moved half a mile further along the ridge on which the party had first pitched ; the same water was used, and no more seizures took place. 87. These instances strikingly support the idea of the localization of The severe outbreak at st. cholera in Particular localities, dependent not on Peter's college, Agra, not explicable water but on some other as yet unknown conditions. on the water theory. . . , v , . ' The history of the very violent outbreak in St. Peter's College at Agra, the most severe known in the whole course of the epidemic, is just one of those cases that should be explicable on the water theory, if the water theory is correct. But it admits of no such explanation. The water used by the boys was drawn from a well common to the college, and a Cholera I sINITA ry COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic. J 25 considerable native community among whom so far as is known no cases occurred. It may be argued that though nominally drawn from this source, in reality it was very likely taken from the College well employed in former years — a well in most dangerous proximity to the old latrine, which is practically a well of filth close beside it. But this explanation accords with the facts no better than the other, for the day boarders, 27 in number, who drank of the same water as the boarders and orphans, and drank largely too, — as I was assured, and as might naturally be expected, in tbat very hot weather, — all escaped, with the exception of one. Anxious to ascertain the circumstances under which this boy was attacked, I found on enquiry that he was the only one of the day scholars who lived close by — a fact which points strongly 88. So far the argument has been pursued as if it were a fact established no case in mdia ever recorded beyond all dispute that man multiplies within himin which there is good reason to oplf flip nnissrvn of plinlpra nnrl fhnf flio rlio/^linvrpQci believe that cholera discharges ht3ii l * lb P^aUli UL CUUIOId, ctUU Uldl tlie CllSCnaigeS have caused cholera. nnntoin thn.f, r»m«nn Rnf fpw will arlrnif fV»nf fli^ea contain that poison. But few will admit that these statements have really been established as facts. At the best they are but assumptions in support of which there is very little proof. The history of the epidemic of 1872 certainly lends no countenance to them. Notwithstanding the wide-spread belief in this water-theory, it is a very remarkable fact that in India, where cholera is so prevalent, even in Lower Bengal, where it is always present, no case has ever been adduced in which there is good reason to believe that water contaminated with cholera evacuations really has produced cholera. It would be a mere waste of time to discuss any supposed instance of this nature in which the facts are not most fully and circumstantially related. We must know the exact date and place of the supposed occurrence, the previous history of cholera in the locality, the minutest particulars regarding the persons affected, and a hundred other details which at once suggest themselves as indispensable for the purposes of such an enquiry, and without which it can be of no value whatever. When all these have been furnished and submitted to the closest scrutiny, it will be possible to understand exactly what occurred, and to draw such conclusions as the facts warrant. In such a matter, where the points to be determined are so intricate, and the sources of fallacy so numerous, no va^ue statement can be admitted as evidence at all ; much less can it be accepted as proof. It is almost incredible that, in a scientific question of so great importance, and in which, from the imperfection of the means at our disposal it is so difficult to ascertain the truth, bare assertions altogether unsubstantiated by details — bare assertions such as would not be received by any judicial court, even in the pettiest case that could be brought before it — should not only have been advanced but accepted as conclusive. 89. The facts recorded under this section of the notes are not to „ t> e ignored or slurred over. If the water theory The importance of good water not . . ° . i i i -i. • **hia/j. vu.vui\ to be confounded with the "water- is to oe upheld, it is not sufficient to refer tneory, j _ j_i . _ __j_ <•• Tn i -r -i to the experience of East London or the Broad Street Pump. If it is true, its truth must be generally applicable. But in speaking of water and its connection with cholera, it cannot be too clearly stated that all that has been said refers solely to what has been called the water theory — the views advanced by Dr. Snow to the effect that the discharges contain the specific poison, and that any violent outbreaks of the disease are generally, if not always, to be explained by the fact that this poison has in some way contaminated the water-supply. That the water in many of the places concerned is liable to pollution no one will deny, or that the means of delivering it might be greatly improved. But because the water is liable to contamination it by no means follows that the violence of the outbreaks was caused by a specific poison contained in such contamination, more especially when facts are so strongly opposed to any such conclusion. Of the vast importance of good water as a means for the prevention of cholera, of the necessity of having it drawn from a pure source, and of having it distributed in such a way that it shall be preserved pure from first to last, I shall speak in a subsequent portion of this report, The water theory finds no support in the history of the epidemic of 1872, and it would be a gross exaggeration, as it is a pure assumption to affirm, that the troops and other com mum ties [ Section I 26 NINTH ANNUAL REPORT OF THE who were attacked suffered because they drank water which had been contaminated by cholera discharges. 90. The next series of facts which deserve attention are those relating to the measures adopted for the prevention of the Section Vl.— Preventive measures. ? m , i. j- 'i i • i a 1a 1 a 1 a disease. They may be divided into those taken to prevent its introduction, such as may be considered under the head of quarantine, and those taken to prevent its spread once it had appeared, isolation, disinfection, and movement from the affected locality. Quarantine was attempted in certain cantonments, districts, and towns ; but as the facts regarding the cantonments can be ascertained with more accuracy than those in other places, it will be better to consider what occurred in them first. All do not require attention, for in several, either no details are given or the measure was adopted too late, or it was intended not to protect the place attacked but to prevent the spread of the disease to other places, as at Subathoo, Dugshaie, and Kussowlie, or it was abandoned before cholera appeared, as at Phillour. 91. Meean Meer and Murree also may be left out of account, for in spite of quarantine the troops in both suffered severely. Strictly speaking, wherever cholera found entrance Quarantine in cantonments. in spite of quarantine, this fact alone is sufficient evidence that the quarantine failed, and in this view of the case every cantonment except Nowshera might be left out of the question, for with this exception cholera appeared in every one of them in which quarantine was established. But a certain measure of success has been claimed for the quarantine arrangements, not only at Nowshera, but also at Hoorkee, Umballa, Jullundur, Mooltan, Sealkote, Bawul Pindee, and Attock. On what evidence does this opinion rest ? If it is founded merely on the fact that all of them were in quarantine, and that all suffered comparatively little from the epidemic, this amounts to no evidence whatever. A mere coincidence of this nature is of little value. But if it can be shown that in previous epidemic years, when there was no quarantine, these places enjoyed the same comparative immunity, the very trifling value of even the mere coincidence is destroyed, and it still remains to be shown that good was really effected in any one of them. 92. But let us take the places seriatim, and examine all the evidence that The facts examined at Roorkee, can be advanced in favor of quarantine. At Eoor- Umballa, and Jullundur. Voo owanf rains wp.vp fnirAfi in vpnrlpv flip onvdnn kee great pains were taken to render the cordon effective to the no small inconvenience of the inhabitants, and yet in no year since it has been a station did Roorkee suffer so severely from cholera as it did in 1872. It will be seen on reference to the table in the Roorkee notes that in the course of the 17 years during which it has been occupied cases have been very rare. Among the Europeans, although the strength was somewhat larger, they never exceeded two in any former year. In 1872, there were seven and several suspicious attacks besides which some medical officers would have returned as cholera. At Umballa, the only evidence to favor the idea that the quarantine had any beneficial effect is that there were only four cases among the troops, but the statistics of Umballa in many of those years in which quarantine was never dreamed of are just as favorable, as may be seen on reference to its previous history shown in the notes. In 1854, for example, there were but three cases among the Europeans. In 1862, out of a larger strength, there were only four. But more to the point still is the fact that in the great epidemic of 1856 there were only six cases among the Europeans and one among the Native soldiers. The same argument applies with even greater force to Jullundur, for the outbreak here in 1872 was severe compared with the general experience of the station in days when quarantine was unknown. 93. At Mooltan, since 1856, the European troops have suffered from At Mooitan, Seaikote, Bawui cholera in five out of the 17 years, and in only one Pindee, Attock, and NowsJiera. Q f jg^ j ms the nutn b er o f attacks exceeded three, the number seized in 1872. In 1856, the number was eight out of a small strength. Sealkote again tells the same general history of comparative immunity much more marked in several years when there was no quarantine than it was with quarantine in 1872. In the great epidemic of 1861, for Cholera 1 SANITAR y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 27 example, there was but one case. The largest number of attacks among European troops at this station was 14 out of a strength of 1,438 in 1862. Rawul Pindee has nearly always enjoyed as much freedom from cholera as it did last year. The same may be said of Attock. Nowshera altogether escaped in 1872, but cholera has rarely visited this station. In the 1862 epidemic, out of a strength of 722 men, only two were attacked. 94. When I was at Peshawur, I heard an opinion expressed that if the quarantine at Attock had not been raised for a few days from the Ist October, the valley might At Peshawur. have continued to escape. But there is no evidence to warrant any such conclusion. When cholera did appear, the believers in importation thought they could trace it to Kohat, an altogether different quarter, but even here, as already shown, the case entirely breaks down. To prove importation it is not sufficient to trace the outbreak in October, even if this could be done ; it is necessary to go back to and account for the solitary cases in the cantonment, in the city of Peshawur, in the Fort of Shubkudder, and at Murdan in May. And the very suspicious cases which occurred among the Europeans in the Fort of Peshawur on the Ist October also must not be left out of account — cases which, if they were not really cholera, show that the severe fever of the Peshawur valley may assume a character almost, if not altogether, identical with cholera. 95. In considering if any good result can, in a single instance, be Escape of Umritsur without qua- attributed to quarantine, the extraordinary berantine. linvirmi* nf +lir» rliconcn nc ¦pr»o > nvrlc nm i t.ir>nlnv lr»r»nlf_ haviour of the disease as regards particular locali- ties in different years must be remembered, and the impossibility of predicting what special localities will suffer. In 1869, the town of Umritsur was the scene of a very severe outbreak, and much apprehension was felt for this place in 1872. Quarantine, as regards the local trains, was thought of, but was given up as too expensive. There was no restriction on traffic or on communication, which was constant, especially with Lahore. And yet Umritsur practically escaped; seven deaths from cholera were reported out of a population of 136,609 inhabitants. Had quarantine been instituted, the escape would have been attributed to it. In the same way, Meean Meer escaped in 1869 — a result which could hardly have been due to a quarantine in which nearly 1,100 passes were issued. 96. Even in a cantonment any thing approaching to a strict quarantine impossibility of enforcing strict is simply impossible. Hundreds of grass-cutters quarantine even in cantonments. and other servants mUS t g 0 Out and in daily. Supplies must come from without. In many of them the difficulty is increased by the fact that they lie, like Umballa or Nowshera, right on the great high road of communication. The mails must pass, all travellers cannot be stopped, nor can ordinary traffic be arrested without interfering with the whole trade of the country. And in addition to the number of people who must not be stopped, there are the many who cannot be stopped. To place an effective cordon round a large area, such as that contained in our cantonments, is no easy matter, and natives who desire to go in and out can find little difficulty in doing so. Where the police are concerned, a small bribe is generally considered quite sufficient to ensure the breaking of the quarantine. In every cantonment in which quarantine was attempted, there was a general admission that it was not strict, and that it was impossible to make it strict. 97. And yet the evils inseparable from any attempt at quarantine are Great evils attendant on it. *«? « r€at TllG tlo0 PSP S »>™ exposed at the Very time that exposure, and especially exposure to the night air, is calculated to prove most mischievous.* A general sense of alarm is created, especially amongst the natives, who are naturally prompted to t m At , A J, mm Mco , r > for example, when cholera threatened, there were 11 sentries posted round the station, and the strength ot the guards mounted daily for this cordon, exclusive of the Non-Commissioned Officers and men of the Artillery and 87th Regiment, was 132 Native Troopers, Sepoys and Police. How utterly useless the cordon was, was shown m the sequel At Umballa for nearly five months 47 sentries surrounded the cantonment, necessitating a daily detail of one Native Officer, seven Non-Commissioned Officers, 42 Troopers, and 45 Sepoys, besides four Police Serjeants and 42 Constables, let with a this tha P ,,f.,.,,m. 0 *t ?i „ ..„*. ..i L J jv-«uu» ml 42 Constables. Yet with all this the entrance of cholera\va"s not prevented. [ Section I 28 NINTH ANNUAL REPORT OF THE conceal the disease if it should occur. Trade is interfered with, and, as a natural consequence, prices rise. The exceptional opportunities thrown into the hands of the police inevitably produce oppression. The people huddled together in the quarantine camps, naturally depressed in spirits on account of the measures which, though taken with the best intentions, are most irksome and practically convert them for the time into prisoners, exposed to the weather, and otherwise in great discomfort are placed in the very situation best calculated to favor cholera amongst them. And yet, with all this, the quarantine is a mere name, for the different day's arrivals in the quarantine camp cannot possibly be kept separate from one another. In the notes, especially those regarding Umballa, many of these points are illustrated. 98. Before a system which entails so many and grievous evils can be stm greater when it is applied to tolerated, it must be shown that unquestionable the population generally. vnnA ia rWiirprl fvnm ii Tf. vpsts with flip nrlvnn.n.t.pe good is derived from it. It rests with the advocates of quarantine to adduce positive proof on this point ; but not only is there no such proof, but there is strong evidence to lead to the belief that the quarantine proved an unmixed evil, that it neither stayed the march of the epidemic nor moderated its intensity in the smallest degree. The evils which attend it in regard to cantonments are naturally very much greater when it is applied to towns or rural districts, inasmuch as the people are more ignorant, and the facilities for oppression are often increased by the distance from European supervision. The practice, moreover, which was followed of attempting to isolate villages in which cases of cholera occurred, draAving a cordon round them, and preventing the inhabitants from going out even to cultivate their fields, lest they should spread the disease, is open to grave objections. The whole principle of the rules for the prevention of cholera among the troops is that the disease is apt to stick to localities, and, therefore, that the locality in which it appears should be abandoned as soon as possible, but the procedure above noted forcibly confines the people to the very locality which they ought to avoid. 99. There can be no question that the restrictive measures, the quarantine both on the highways and in villages, which were Now prohibited in the Punjab. , -? ° , „*, ? , . . «*?-, -p, . , adopted in several of the districts of the Punjab, pro- duced no small discontent. In one district the Commissioner reported that " the people preferred the cholera to the quarantine." Except as regards organized bands of pilgrims, the Punjab Government has recently ordered that no quarantine shall be established without special orders ; but it is well that the facts should be recorded, and that the matter should receive prominent notice here, for there are not a few district officers and medical officers also who chiefly, I believe, because they have looked at the evidence from a very limited point of view, both as regards the history of this last epidemic and the experience of particular places in previous epidemics, have come to the conclusion that the quarantine arrangements were most beneficial. The orders of the Government cannot be too widely proclaimed that, except as regards pilgrims, there will in future be no restrictions. 100. And for the benefit of other countries it is indispensably necessary no evidence that in any instance that there be no mistake regarding the experience quarantine did good. «f T n .i; fl :„ +1,2- mo j.i 01l T^ o nn^f,'^ ork ;_ii of India in this matter. In a question so inti- mately connected with the happiness of the human race, it cannot be too widely known that quarantine was tried in the hope of. protecting a number of the cantonments in Upper India, that in many of them it signally failed, and that in no single instance is there the smallest reason to believe that it was productive of any good. The direct evils of quarantine are great enough in themselves, but many indirect evils also arise from it, and among these by no means the least is this, that so long as men believe that they can escape from cholera by such means, they will never be fully alive to the importance of the greatest safe-guard — sanitary improvements. 101. This question of quarantine is purely practical, and, as such, it must practical nature of the question not be mixed up with any merely theoretical con- to be determined. siderations. The point to be determined is not whether cholera is spread by human intercourse or not, but whether quarantine Cholera "I SANITAEY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 29 can protect a cantonment or any other community from cholera : Whether, even assuming that the disease is spread by man and by man alone, it is possible in practice to keep up such a state of isolation as will prevent its entrance. The believers in contagion not unfrequently argue: Cholera is propagated by human intercourse, therefore quarantine should be established and all intercourse with infected localities prohibited, But the last proposition is by no means a logical inference from the first. It may be so in theory, but the question arises, is it possible in practice to maintain such an isolation ? The answer must be — it is not possible. And hence it is that most of those who have had experience of the system, including not a few even of those who believe that quarantine if it could be perfect would be a complete protection, are strongly opposed to it, for they are satisfied that any such perfect quarantine is an impossibility, that any attempt of the kind can do no good and must be productive of the greatest evils. 102. These remarks are not intended to apply to the isolation of new arrivals in Jails which has been carried out for some years in the Upper Provinces under the name Jails. i?»«_x* Ti.* i. i.' it of quarantine. It is not quarantine nor would quarantine, in the striot sense of the term, be practicable even in Jails ; the segregation of new prisoners is a measure of value chiefly because it attracts special attention to the new-comers, and in practice it has been found useful. 103. Nor do the arguments against a general quarantine apply to . the discouragement of fairs and the diversion of streams Nor to the special case of pilgrims. n «i • i n ;• i -t ¦> ,i , oi pilgrims at those times when cholera threatens,, provided these measures are taken discreetly. The conditions under which pilgrims travel and congregate are essentially insanitary conditions, which favor the appearance and spread of disease, and in so far as these conditions are obviated good will accrue both to the pilgrims themselves and to the community in general. The proper conservancy of fairs is a matter of great importance. Warning the people of the serious danger incurred in making pilgrimages especially in epidemic years is also calculated to do good by reducing the number of persons exposing themselves to this danger, and there will be the greater likelihood of attaining this object if it be made known at the same time that, in the event of epidemic sickness appearing among them, all pilgrims may be subjected to detention. Under such circumstances, special arrangements for segregating them, for preventing their streaming through cantonments and cities, for providing proper food, and affording medical aid to the sick are all very desirable. They can be carried out with little or no hardship, and as the time during which they are required is generally limited to a very few days at each place, there is some hope of making them efficient. But this is a very different thing from the quarantine spread over weeks and months, which was attempted in many places in 1872. 104. In addition to the quarantine the enforced removal of any member, Enforced isolation of cases of and especially of any female member of a family cholera very hard on the people. attacked with cholera to a cholera hospital, which was adopted in some few places, was also most repugnant to the feelings of the people, and regarded as a very grave hardship. It is much to be doubted whether any good was effected by this measure, and much evil was done in this way, that there was the strongest inducement to conceal the disease, and there is no doubt that it was concealed to a great extent. In the many places in which the sick were treated at their own houses, no instance has been recorded in which any evil results followed ; there is not the smallest reason to suspect that the disease was spread either within or from these houses. I should like much to see the forcible removal of cholera-sick from their houses also prohibited. At such a time the separation must greatly increase the family distress ; the very act of removal is trying to the sick, and takes up the very time when alone medicine can do any good. Harsh measures of this nature, moreover, set the people against everything that is done under the plea C Section I 30 NINTH ANNUAL EEPORT OF THE of the public health, and render them averse to all those schemes of improvement which are the only real protectives against cholera. They come in fact to look on the sanitary reformer in the very opposite light from what they ought to do, — as the greatest destroyer of their domestic comfort and happiness. 105. Leaving isolation of the sick and disinfection among the troops as Movement from the infeqted lo- questions in regard to which it is very difficult to canty generally advtsabie. obtain definite data sufficient to decide how far they had any effect in preventing the spread of the disease, the next point to be discussed is movement from the infected locality. The rules regarding the abandonment of buildings or portions of buildings in which cases of cholera have appeared have worked well in many places. Not unfrequently after the change of locality the disease has immediately and altogether ceased. The particulars are fully narrated in the history of each outbreak, and the generally favorable opinion which has been expressed with regard to the action of the rules in this particular will be found to be borne out to a great extent by the evidence. The reports, as regards the effect of the movement even when the men were thereby exposed in camp at a season of great heat, are generally to the effect that no disease seemed to be produced by the change. 106. But in certain stations the movements to ground in the vicinity was attended with little benefit. In illustration of this Little benefit followed short -. v -i iii i?AiiT_ii-mr moves at several of the stations remark may be cited the cases ox Allahabad, Meerut, worst attacked. -... -.«. ___-, t, ¦. . , aili.-1.-j • Meean Meer, and Peshawur. At Allahabad, in the camps near the station, cases continued to occur, but the movements to places 30 and 40 miles down the Jubbulpore line of railway were completely successful. At Meerut, the moves, which were all confined to the neighbourhood of the station, were followed by a number of fresh seizures. At Meean Meer and Lahore, the change to the temporary barracks at Bheekawal and Nyaz beg, within ten miles of the cantonment and fort, were attended with excellent results, but as a rule the short moves did little or no good. In places near at hand the troops continued to suffer severely. Instances of this will be found in the history of H. Battery, Bth Brigade, R. A. ; of A. A. R. H. A. ; of the head quarters of 37th Regiment at Hullokee, Khana, and even at Okara, 80 miles down the line to Mooltan ; and of the families at Shalimar. At Peshawur, the movements, all of which were made within the valley, cannot be said to have been successful. 107. But these results were very much what had been anticipated. "Writing on the 20th June 1872, I recommended More decided moves for the ? , .°. ° ? , * ? , , . troops at these stations reoom- that, m the event oi these cantonments being attacked, more decided moves should be made, that the troops at Meerut should be sent to Roorkee, those at Meean Meer to Mooltan, and those at Peshawur to Nowshera, or still better to the east of the Indus at Campbellpore. In making these proposals, I referred to the experience of the epidemic of 1869, and to similar recommendations made in my letter of June of that year, written under very similar circumstances to those which presented themselves in June 1872. In 1869, I observed, "the benefits of moving into camp have, I believe, been sufficiently established, but the principle it involves might be carried still further by endeavouring to move away from the infected area altogether. Our knowledge of the laws which govern cholera is i^ot yet so exact as to enable us to say with anything approaching to certainty what the exempted area in any given case may be, but judging from the facts which are available, and setting all theories aside, there is good reason to hope that by moving troops into the neighbourhood of those places which have hitherto preserved such a remarkable immunity from the disease good results would follow. And I would therefore propose for the serious consideration of the Government that in the event of European troops being attacked at the stations in which an epidemic is anticipated, they should be moved to one or other of the localities indicated, in which experience has shewn that tfrey are more likely to escape." Cholera I SANITAE y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 31 108. It is only right to consider what would have been the probable probable effects of such move- results of such movements if they had been meats, if they had been made. carried out in 1872, so far as they can be judged by what actually occurred. At Roorkee, as has been already stated, cholera was more severe than it has been known in any previous year, but still the cases among the troops at that station were comparatively few. Out of a strength of 521 there were 7 cases ; while out of 1,953 at Meerut, there were 83 cases. In the party of Artillery which moved from Meean Meer to Hurruppa, 116 miles down the line of railway, there were two cases almost immediately on arrival ; only one was attacked afterwards. Gogaira, 87 miles off, was not occupied till late in the outbreak, and no opinion can therefore be expressed as to the results, which were very successful. At Mooltan, just as has happened on many former occasions, the epidemic was represented by two or three cases among the troops. But what is perhaps of more importance in forming any conclusion in the matter we have the remarkable fact that while 629 deaths from cholera were registered among the people in the Lahore district there were only 5 in the Montgomery, or Gogaira district, as it was formerly called, and only 2in the Mooltan district. As regards the proposed movements at Peshawur, we know that while the valley suffered severely, both Nowshera and Campbellpore were entirely free. There is every ground, therefore, for believing that if the movements recommended in June 1872 long before the epidemic reached Meean Meer and Peshawur had been carried out, many lives might have been saved. 109. But that benefit' was derived from even slight change of locality Good followed even the partial is amply testified by the number of attacks movement at Meean Meer. nrnrma> tJirvoA xxrhn movo loff in fV«o ofo+i^n nf among those who were left in the station of Meean Meer. In the 7-13 th Royal Artillery, of 8 men who remained, 5 were attacked. Of 7 men belonging" to the head- quarters, 2 were attacked. In regard to the 37th regiment, there is some discrepancy in the figures, but whichever account is correct the fact remains that those in the cantonment of Meean Meer suffered much more severely than those who left it. 110. The experience of another epidemic confirms the opinion that much Principle on which movement is advantage may be derived from movement, and at founded. the same time illustrates the principle on which such a procedure is recommended. When cholera appears in a barrack, the inmates are removed to another locality; they are taken from a place in which the disease is known to be present to one in which it is hoped that it may not be found to exist. Sometimes a slight change is sufficient to secure this object, but where the epidemic is severe* . the chances are against any such slight change being successful, and then it becomes advisable to make a more decided move in the direction in which the experience of former years and the history of current events show to be less under the prevailing influence. The whole procedure is founded on the peculiar localized character of the disease. It rests on no doctrines of contagion, nor can the benefit derived from it be explained on any such doctrine. 111. The doctrines of contagion and importation, however, interfered with ¦Theoretical objections interfered the more decisive moves recommended. At Pesha- with movement. wur, for example, it was feared that removing the ITT • 1 J i,i-i. , C 5 troops to the other side of the Indus might spread the disease down the Trunk Hbad, and on this account not only was the move not made, but a party of time-expired men also were detained on this ground. But the general direction of cholera is upwards to the north-Avest. There is not a single epidemic cm record in which the disease commencing above pursued its course downwards to the south-east. And until specific instances have been adduced in which troops flying from a cholera- stricken cantonment have been the means of spreading the disease, merely theoretical objections should not stand in the way of a measure which has so often been attended with excellent results, and which, if carried out more fully, might be productive of even more signal good. [ Section I 32 NINTH ANNUAL REPORT OF THE 112. Before leaving the question of preventive measures, it will be well Knies generally approved. Sug- to enquire whether any modification is desirable in gestions for trivial modifications. c « YU \ es regarding the measures to be. adopted on the outbreak of cholera among European troops." The general and indeed almost universal testimony of medical officers is to the effect that they are good and that they have worked well. Difficulty has sometimes been experienced in acting up to them in the matter of complete separation of those attacked owing to the want of sufficient hospital establishment. It has also been suggested that a distinct ruling should be issued as to whether the relations and friends of those attacked may be allowed to attend them, Eor my own part I believe that the rules in the matter of isolation and disinfection are more strict than need be, but as they can do no harm, and involve no hardship if reasonably carried out, it will be better to leave them as they are, so as to meet the views of those who think otherwise. The idea that cholera, at all events as we see it in India, is a contagious disease, that it is spread by contact with the sick, should be discouraged as much as possible, both because it is opposed to all experience, and also because it causes needless alarm. In regard to movement by rail, Rule 41 says "it will be better to select the day than the night." At Meean Meer, the reverse was found to be the case, as the men in the day suffered much from the heat. Without altering the rules in such minor details, it may be understood that on this matter the local authorities guided by circumstances should act on their own judgment. 113. The statistics of the previous history of the different cantonments have been added, first, because they are necessary Section Vll —Previous history. « ¦. . . -¦ .. * „ ? . . f for a comprehensive consideration of the epidemic of 1 872 ; and secondly ', because they contain important information which cannot fail to prove of interest to medical officers and help to a right understanding of the outbreaks which may come under their observation. The figures for the earlier years are taken from Dr. Bryden's Report on cholera, a mine of facts which will well repay careful study ; those of the later years are from his Tables, which have appeared in the Annual Sanitary Reports. They have been merely re-arranged by stations for more convenient reference. 114. So far I have endeavoured to record the facts accurately and to Any remarks apply only to cho- summarize the evidence impartially. Any remarks lerain India. wliir»li limrp Tippti mnrlp if mnef Via lin^nwfAnd -^^ll 1 ,^ which have been made, it must be understood, refer only to the history of cholera in India, and more particularly to the history of the past epidemic. My object has not been to write an essay, much less a controversial essay, on cholera, but merely to endeavour to narrate what has occurred in this country, and to consider how far this accords with the theories of the day. The field is wide enough for observation. But wide as it is, there can be no question that the history of epidemics, after they leave India, is just as important as their history while they are within its borders. It is only, as I have before remarked, by collecting every fact that can be gathered regarding an epidemic from its commencement to its close that we can be in a position even to attempt to understand the phenomena which it presents. The collection of facts from all countries attacked, facts observed and narrated apart from and unbiassed by any theory, is of the greatest importance. If we only knew all the facts, the framing of correct conclusions would be easy. 115. In India, although much progress has been made in ascertaining the improvement of mortuary statis- history of cholera, and the account of an epidemic tics required. -nnixr i'q vptat mnnli mni'fl rrmTnlnftk fl-m-n if nAnLI now is very much more complete than it could possibly have been even but a few years ago, much remains to be done. The mortuary statistics of the general population, although they have furnished most valuable data regarding the distribution and relative intensity of the disease, are still imperfect. Their improvement must, no doubt, be a matter of time, but earnest effort on the part of all concerned is indispensable for the attainment of this great object. The prohibition of those restrictive measures directed against cholera, which have been referred to in a previous paragraph, and which have induced the people to conceal the disease if generally promulgated would remove one obstacle out of the way. Cholera I SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 33 Epidemic 116. The accurate record of the facts of every outbreak, so far as they Accurate and unprejudiced record can be ascertained by patient and careful enquiry, of facts. must form the foundation of all advance m our knowledge of cholera as of all other diseases. Its sudden and fatal character has made it appear as if cholera were more mysterious than any other disease, but it is just as difficult to account for the epidemic spread of other diseases, of epidemic malarial fever for example, or of small-pox, as it is of cholera. In approaching the difficult questions connected with any one of them, the first essential is to record the facts unswayed by prejudice and uninfluenced even by the opinion of the highest authority. This worship of authority, which is so common, is not altogether unproductive of mischief. One medical officer, for example, whom we may call A, meets no fact in support of contagion or the water theory, but he believes in the authorities who support these views, and he concludes that, although he has failed to find any such evidence, B, C, D, and every other medical officer have been more fortunate. B does the same ; so do C and D, and so on. The consequence is that events are often viewed through an ideal, and therefore distorted, medium, and much valuable evidence is lost. 117. Another obstacle to progress is the mode of reasoning by analogy, which is not uncommon. Cholera, for example, is Danger of reasoning from analogy. i ¦ i i i_ n i i.l • supposed to be analogous to small-pox, and on this a superstructure is based which has no real foundation. Small- pox, it is argued, is a contagious disease, and spreads only by contagion. Cholera belongs to the same class of contagious diseases, therefore it also spreads by contagion, and by contagion only. But do we know that small-pox spreads only by contagion ? Its annual rise and fall in this country recurring steadily year after year, its comparative dormancy for a term of years, and then a year of epidemic violence, are facts altogether inexplicable on the doctrine of contagion, and prove incontestably that the law of contagion is not the law which governs the spread of small-pox. The obscure problems connected with the epidemic prevalence of disease are to be solved not by fancied analogies, but, like every other truly scientific enquiry, on the evidence. Meantime, there may be sufficient data only to show our ignorance, but to sweep away error is a great step to / 118. It will, no doubt, be said, as it has been said before, if it should be proved that cholera is not spread by human inter- Necessity for careful induction. X .„ , ll- 1 i.l • D 1 course, it man does not multiply the poison of cholera, if the evacuations do not contain that poison, and do not spread it through the water supply, then we virtually go back to the same state of ignorance as we were in a hundred years ago. To this I would reply that if we are on the wrong road, the sooner we go back the better, but the question is not what will be the consequence to any opinions. That is a very small matter. In writing the history of the cholera of 1867, I was much impressed with the apparent proof in favor of the distribution of cholera by the pilgrims; but increased experience would lead me to hesitate before I accepted much that was then recorded as evidence. Even then I pointed out that human intercourse failed to explain all the facts. The only point of importance is — what is the truth ? Facts cannot be too carefully scrutinized before they are accepted nor conclusions too carefully drawn from them. 119. But a still more specious argument which has been used is this, if sanitary improvements the only non-contagion doctrines are accepted — If we are to protection egamst cholera. believe that cholera is borne by the air or carried in some other mysterious unknown way, we are utterly helpless, we can do nothing, all progress is stopped. No argument could be more fallacious. It is the doctrine of contagion which has prevented progress. So long as men believe that all that is required to escape attack is to shun the sick, what interest can there be in sanitary reforms ? The great lesson which the history of this epidemic and of all other epidemics teaches is this, that all we can do to diminish cholera is to carry out those reforms, and that these reforms will do much. On this great point I have frequently insisted, and have again and < [ Section I 34 NINTH ANNUAL REPORT OF THE again pointed out the necessity for them, more specially in the matters of drainage and water supply. In the report on the cholera of 1869, I remarked* "it is only by a thorough system of sanitary improvements that any decided results can be obtained, improvements which shall not be confined to military cantonments only, but which shall embrace native cities and the country generally. As regards cantonments, I have already indicated what are the chief wants. The importance of thorough drainage has been repeatedly brought to notice, as well as the necessity of improved means for the supply, and still more perhaps for the distribution of water * * * Taking the general history of this epidemic into account, there is little reason to conclude that it was spread over the vast area which it covered by means of water which had been poisoned by cholera evacuations, but the very great value of a pure water supply, as a preventive of the disease, can hardly be over-estimated, nor the great importance of deriving it from some source removed from human habitations, and beyond the smallest suspicion of contamination." I can hardly write in stronger language now, but the experience of another year of cholera in Upper India adds additional weight to what I wrote then. 120. But it may be argued — " Where is the evidence that sanitary improve- ments have really prevented cholera? Is there any fact in the whole history of the past epidemic Illustrated by experience. to prove that clean places escaped, and that dirty places suffered ? On the contrary, is it not true that our European troops who are housed in stately piles, on whom every care is bestowed, suffer far more than the poor inmates of native hovels, who live too often in circumstances of filth and of over-crowding, and every other sanitary defect ?" In considering this question, there are several matters which must not be left out of sight. In the first place, the influence of race and habit cannot be ignored. The native child is reared ia circumstances under which the European child would almost inevitably perish. The native exposes himself bare-headed to a fierce sun, which the European with his head well covered finds it difficult to withstand ; and will walk many miles a day on a diet which would be regarded by the white man as most wretched fare, with which his frame under such hard exercise would never be satisfied. And if in these matters there is such a marked difference between the two races, is it surprising that there should also be a marked difference between, them in regard to matters of health, and that, however much his susceptibility may be aggravated by his own act, it still remains a fact that the European is specially prone to severe tropical disease, that he needs more care than the native to preserve health, that he could hardly, indeed, exist under such conditions as those in which they often live and prosper. And again, it must be remembered that the distribution of cholera, as may be proved beyond all doubt, is not regulated by conditions of filth or cleanliness. Large tracts of country often escape in which the people are no cleaner than those in others, and even within the epidemic area villages escape, while others, to all appearance very much the same, suffer severely. But we know by experience that much may be done by sanitary improvements to affect the incidence of cholera in particular localities, and to diminish its violence. Of this there could be no more striking example than the history of the jails in Upper India. In 1860, to go no further back, 223 prisoners died of cholera in the North- Western Provinces out of an average strength of 14,468. In 1861, out of 15,662, there were 524 deaths from this cause. In 1863, out of much the same strength (15,526), there were 156. In the epidemic of 1867, out of 15,107, there were only 31 deaths; in that of 1869, out of 18,587, 88 deaths; and in that of 1872, out of 16,788, only 43. A very striking example to the same effect is given by the Sanitary Commissioner of Madras regarding the jails in that Presidency.! Compare the annual mortality from cholera in the years from 1861 — 1866 with that in the years from 1867 — 1871. * Paras. 195 and 196. t Annual Report of the Sanitary Commissioner fov Madias for 1871, page 106. Cholera ~| SANITARr COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 35 Ratio of annual mortality in the jails of Madras Presidency per 1,000 of average strength. Ybakk. Cholera. Years. Cholera. __ _. I 1881.62 ... ... ... 26-3 1867 ... ... ... 0-8 ]862-63 ... ... ... 23-0 1868 ... ... ... 0-2 1863-64 ... ... ... 15-6 j 1869 ... ... ... 43 1864-65 ... ... ... 21-3 || 1870 ... ... I*6 The occurrence of such marked diminution in the deaths from cholera, and it is to be seen also in regard to other diseases, in conjunction with great sanitary improvements, is no mere coincidence. Whatever opinions may be held on theoretical questions, the great work to be done is, to perfect and extend such improvements, not only in jails and cantonments, but among the people generally. 121. Such are the practical deductions which I would draw from the history of cholera in India. The directions in. Direction of further enquiries. \ • i ntn ±t • j.-h • i iii • j« which further scientific enquiry should be instituted are being carefully considered, and points as they arise are being taken up as far as possible by Drs. Lewis and Cunningham, in the course of their special work. A more thorough examination of the local conditions under which outbreaks occur, into the conditions especially of soil and atmosphere, is much required, and a much more complete investigation into the general meteorological phenomena which accompany epidemics than has yet been possible. A favorite argument against the air-borne theory of cholera is that, if the cause of the disease were borne in the air, few, if any, would escape. Ido not write in support of the air-borne theory, but would remark that conditions of atmosphere may vary greatly in different localities within the same area., and such variations, coupled with differences in the soil conditions, may account for the results. Dr. Douglas Cunningham's investigations show that even the microscopic objects found in the air of neighbouring places present remarkable differences. His valuable paper on atmospheric organisms I hope to annex as an Appendix to this Annual Keport. 122. Among these local conditions, which demand much closer investi^apettenkofer 3 views deserve spe- tion than they have received hitherto, special mencial attention. firm must. V»o tyi^yla rvP fVinef» fn w)iir»li ar\ •*v.^,-.V, tion must be made of those to which so mucl importance has been attached by Professor Pettenkofer. Observations, in order to test this theory, have now been taken for some time in many parts of India* but, for reasons which have been detailed in previous reports, the data procured have not been so accurate as to warrant any decided conclusions being drawn from them ; and hence it is that although the question was not lost sight of in the investigation of the facts regarding the outbreaks at different places in 1872, no precise information can be given in regard to it. Further and more exact observations are required, and the best means of attaining this end are now under discussion. Meantime, the state of the question seems to be this — that while there is not sufficient evidence to warrant the statement that Pettenkofer's views are correct, there is still less evidence to show that they are incorrect. In Pettenkofer's admirable papers on cholera, some of which have been translated and made known to the profession in India through the pages of the " Indian Annals," it is clearly shown that the matter well deserves further attention. 36 [ Section I NINTH ANNUAL REPORT OF THE 123. There are many questions of great interest which have been left out of consideration, because they are more of a Many questions unconsidered. .-, ? <• .] j • i liia* i theoretical tnan practical nature, ouch, lor example, as whether man unaffected by the disease may yet bear with him from an affected locality the cause of cholera, which, for want of a better name, we call the germ, and if so, whether this germ is capable of multiplying itself either in the soil of the place to which it is brought, or whether, although incapable of multiplication, the quantity imported may yet produce limited results. These and other matters must be left for future observation. There are no precise facts in the late epidemic which bear specially on this subject. 124. In conclusion, I desire to express my acknowledgments to the many Acknowledgments to medical and officers whose assistance has been so valuable in other officers the course of this inquiry, especially to the medical officers, both executive and administrative, whose willing aid has enabled me to prepare a more complete account of the epidemic of 1872 than has ever been prepared of any previous epidemic of cholera in Northern India. ». 37 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Cholera Epidemic NOTES ON INDIVIDUAL OUTBREAKS. The communities to which these Notes refer have been arranged in the following Explanatory remarks. order— the same as that adopted in the Annual Tables :— No- Community. Page. No. Community. Pagk. 1 Dinapore ... •¦• 38 55 Umballa Jail ... ?. 91 2 Benares Cantonment ... ... 40 56 Phillour ... ... »* S „ Central Prison ... ... 40 57 Jullundur Jail ... ... 94 4 , Blind Asylum ... ... 41 58 „ 54th Regiment ... ... 94 5 „ Lunatic Asylum ... ... 41 59 „ Detachment, 12th Bengal Cavy. 05 6 „ District Jail ... «• 41 60 Ferozepore ... ... 97 7 Fyzabad, 26th Regiment ... ... 44 61 Mooltan Cantonment ... ... 99 8 „ Royal Artillery ... ... 45 62 „ Jail ... ... 99 y M Jail ... ... 46 63 Sealkote, sth Lancers ... ... l<>o 10 Lucknow Fort ... ... 48 64 „ 58th Regiment ... ... 100 11 „ Military Prison ... ... 48 65 Umritsur ... ... 101 12 „ Royal Artillery ... ... 48 66 Lahore Lunatic Asylum ... ... 108 13 „ 21st Hussars ... ... 49 67 „ Female Jail ... ... 104 U „ 62nd Foot ... ... 49 68 „ Central Prison ... ... 104 15 „ l-17th Regiment ... 50 69 „ Fort ... ¦•• 105 16 District Jail ... ... 50 70 Mean Meer, H-Bth Royal Artillery 17 Cawnpore, Bth Regiment ... ... 51 71 » A-A, Royal Horse Artillery 107 18 „ Royal Artillery ... - 52 72 „ 7-13 th Royal Artillery ... 108 19 „ 35th Native Infantry ... 52 73 „ 37th Regiment ... 109 20 ? Jail ... ... 52 74 „ 18th Bengal Cavalry 21 Allahabad, Royal Artillery... ... 55 75 » 24th Native Infantry 22 „ 2-19 th Regiment ... 55 76 „ 17th Native Infantry ... 112 23 „ 33rd Native Infantry ... 56 77 Goojranwalla ... ... 116 24 East Indian Railway ... 56 I 78 Goojrat ... ... 118 25 „ Civil Residents ... ... 56 79 Jhelum ... ••• 118 26 „ Central Prison ... ... 56 80 Rawul Pindee, 36th and 70th Regiments L2O 27 District Jail ... ... 56 81 „ 25th Punjab Infantry ... 120 28 Shajehanpore ... ~. 59 I 82 Murree ... ... 121 2y I Chuckrata ... - 60 83 Attock ... ... 122 30 Deyrah ... «• 61 84 Nowshera ... ... 123 31 Roorkee, 109 th Regiment ... ... 63 85 Hoti Murdan ... ... 124 32 „ Sappers and Miners ... 63 86 Peshawur City ... ... 124 33 Meerut, Royal Artillery ... ... 65 87 » Jail ••• ••• 125 34 „ 4th Hussars ... ... 65 88 .. Royal Artillery .. ... 12(> 35 „ 105 th Light Infantry ... 65 89 „ 1 -6 th Regiment ... 127 36 „ Bth Bengal Cavalry ... 65 90 „ 55th Regiment ... 128 37 „ 3rd Native Infantry ... 65 91 „ 15th Bengal Cavalry .. 130 38 „ Central Prison ... ... 69 92 „ 16th Bengal Cavalry ... 130 39 Delhi ... ... 71 93 „ Sappers and Miners ... 130 40 Agra, 65th Regiment «. ... 71 94 „ loth Native Infantry ... 130 41 „ District Jail ... ... 73 95 „ 21st Native Infantry ... 131 42 „ St. Peter's College ... ... 73 96 „ 26th Native Infantry ... 131 43 Morar ... ... 77 97 „ 36th Native Infantry ... 132 44 j Nowgong ... ... 78 98 „ Fort ... ... 132 45 Jubbulpore ... ... 79 99 Shubkudder ... ... 135 46 Sehore ... ... 80 100 Abuzai ... ... 135 47 Simla ... ... 81 i 101 Cherat ... ... 135 48 Subathoo ... ... 81 102 Kohat, Hazara Mountain Battery ... 135 49 Dugshaie ... ... 82 103 „ Garrison Company Artillery ... 135 50 Sunawur ... ... 84 104 „ Ist Punjab Cavalry... ... 135 51 Kuesowlie ... ... 85 105 » 2nd Seikh Infantry ... ... 135 52 Umballa, Royal Artillery ... ... 88 106 „ 4th Seikh Infantry ... ... 135 53 „ 20th Hussars ... ... 88 107 „ 3rd Punjab Infantry ... 186 54 „ 12th Bengal Cavalry ... 88 108 ? Jail "... ... 139 As a rule, only those communities have been numbered regarding* which exact particulars can be ascertained, such as regiments, jails, &c. With a few exceptions referred to specially in the report, towns and districts are not numbered. Any reference to an outbreak made in the body of the report, may easily be found by looking in the above list for the community concerned. "With a view to facilitate reference, the history of the outbreak in each community is divided, as far as possible, into seven separate sections, an arrangement which has also been followed in the report. It may be observed that where the outbreak has been but trivial, the whole cantonment is frequently dealt with as one community, but where it has been severe, the different regiments are taken separately. Section I contains some information regarding the situation of the cantonment or other place concerned, the strength of the garrison, the number of other inhabitants, the area of the 38 [ Section I NTNTH ANNUAL REPORT OF THE district, &c, &c., a few details such as are calculated to assist the reader, and especially the reader who has no personal acquaintance with India, in tracing- Notes on outbreaks. Explanatory ? an lA am ; n ™ £u~ — ~~A ~1~~ :« . H J«hi.^ n the epidemic on the map, and also in understanding the remarks. circumstances under which the occurrences detailed in the subsequent sections took place. Section II contains the details of the outbreak, as well as particulars regarding the prevalence of diarrhoea and fever. Section 111 details any facts bearing on the questions of importation as accounting for the commencement of the outbreak, and of communication as accounting for its spread. Section IV is devoted to any meteorological phenomena which have been observed and reported by the Medical Officers. Section V contains information regarding the local conditions, especially as concerns drainage, water-supply, and barrack accommodation. Section VI deals with the preventive measures adopted more especially with quarantine, where this was attempted, and with movement from the affected locality. Section VII contains the statistics of previous years so far as they can be supplied. The figures are all taken from Dr. Bry den's tables ; those for the earlier years from his work on Cholera, and those of later years from the tables appended to the Annual Sanitary Reports. With reference to these, it is to be observed that up to 1868 the figures for European troops refer to the men only. Since 1869 the women and children also are included. As the strength, however, given for each year embrace only those among whom the cholera cases have been entered, the comparison is very little affected by this change. Where years are left out altogether in these statements of previous history, it will be understood that they were free from cholera. The same rule applies to the omission of European troops, Native troops, or prisoners in any particular year. It only remains to observe, by way of explanation, that, where any section is left out, no information bearing on the points to which it refers has been obtained. Dinapore. — In the valley of the Ganges ; seven miles to the west of the town of Patna. The garrison consisted of a battery of artillery, the 96th Foot, No. 1, Dinapore. and two regiments of natives. The bazaar population is returned as 16,120. 11. Details of the outbreak.-— Among the European troops only two cases of cholera occurred, one in July and one in December. Among the Native troops there were also two, one in May and the other in September. Surgeon John Tuson, F. R. C. S., says that, " from the beginning of December to about the 15th, cases of cholera were continually occurring in the bazaar, and occasionally in cantonments, and on the 18th it culminated by 14 or 15 cases in one day." Among the bazaar people there have been recorded three deaths from cholera in the last week of June, sixteen in July, one in August, one in September, and five in December.- 777. Importation and communication. — Dr. Tuson says, "it was apparent that the disease had been imported from Patna," but beyond the fact that cholera seems at the time to have been prevalent in Patna, no evidence is adduced in support of this statement. VI. Preventive measures. — " Wood-fires were burned at 50 yards apart throughout the bazaar, and powdered sulphur sprinkled on them. * * These fires were continuously burned during the nights of the 15th December and two days afterwards; " " contemporaneously with the fires being burned the cholera disappeared." VII. Previous history. — The statistics of Dinapore show cholera year by year from 1826 to 1872, but its prevalence of late has much diminished from what it was formerly. Statement of cholera at Dinapore, 1826 to 1872. NUMBEB OF CASES. v Average . . Total Total B - strength. >; S 3 S cases. deaths. srajl i i i I i o 9fi f European Troops - 940 32 5 3 3 ... 1 44 ] 3 iB-w I Native „ - 8.333* 1 4 2 10 14 21 9 6 ... 2 3 1 73 22 , -,„ C European Troops - 1,211 1 3 ... 1 6 8 4 6 11 31 5 16 ' J/ ( Native „ - 6,594* 1 1 214 5 2 3 19 26 ... 03 17 1?a ( European Troops - 1,605 j 3 34 51 14 17 7 4 2 132 29 xn^l Native „ - 6,478*. 2 ... 5 9 9 21 4 2 ... 12 9 64 20 u9Ou 90 ( European Troops - 1,804 j 71 172 34 30 4 4 2 6 223 35 lwy l Native „ -not given 1422 42 11 152 1 62 6 IOQn f European Troops- 1,737 1 ... 1 2 5 1 ... 2 I ... 1 ... 2 15 lb6i) l Native „ - 4,626* 3 ... 3 1 1 ... 1 1 1 1 ... 1 13 "2 .QQI. QQ1 ( European Troops - 914 ! 67 ... 2 ... 11 71 ] () 18J5i l Native „ - 4,160* 1 ... 9 5 8 3 6 I 4 ... 37 11 1 ! ' i 1 ? The strength in the Dinapore Circle. 39 Cholera -| SANITA UY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J Notes on out- Statement of Cholera at Blnapore, 1826 to 1872— continued. breaks, Dinapore. - — Number of cases. Total Total Average S S S cases, deaths. Yeabs. strength. E? , \ v \ « S § -a _s «i . I J 1 1 I iijHintni -{ssr^r; *«•;• : i | i » -• } ] : = I 1I 1 i I (.Prisoners - ••• " - "' "m "A ' ' 2 ... i 5 6 183 45 vr T T T S : 8,U6. i 1 8 "l 1-16 3 10 ... 5 ... 88 18 (. Prisoners - ••• - "' "• "• "" '" [ [q 4 1835 J1xr Tl 7 s : i»" --' ¦ * j} "2" 2 l - 23 ! JSF T - ss.:::: l } jl] ] } I 2I 2 ]1a »* «BrT: B.^: I 1I 1 !I J i 1 3 1 : . 1 I 1I 1 g S JSr T T: S IJiJ 3 j- 2^ ] ] : : » J (. Piusoners - •• • .• • ••• •" "* ' V "1 o 2 r European Troops- 748 ¦•• ... 1 ... ... j "' 1 | 1 1 •» 1839] Native „ - 4,560* 2 ... 2 > ... 9 / 3 2 1 ... - •> fl /• Euro°p n n e can e an Troops - "922 3 7 19 & "j 1 I 1 j "j ... «j J2 1841] Native „ ¦ 6,123* ... 43 2 6 45 017 26 2 3 1 6 1 111 C. Prisoners - ••• ... •• *" "A "00 Tv r European Troops - 938 ••• 1 ... 13 2 5 7 ••• 3 ... 5 2 i-1842] Native „ - 5,280* 1 1141614 21 5 3 3 ••• 2 1 j*l 4rf (. Prisoners - ¦•¦ ... "L "• '" "\o - q r European Troops - 895 3 .» 1 .- 7 3 ... 2 11 J» • 1843] Native „ - 5,898* - 2 2 ... 1 212 2 1 2 4 ••• Jb (. Prisoners - ••¦ •¦• •¦• '" •¦• "" *"8" 8 » r European Troops - 904 ...... S 1 2 1 1 J •» •" .2 ,2 1844] Native „ - 6,313* 5 ... 5 5 9 4 1 6 3 1 7 1 17 (. Prisoners - •» ... "•• ••• "\ n «t C European Troops - 1,107 18 12 ... 3 5 ... f ... »• J" %* 1845] Native » ¦ 2,362 12 10 724 712 8 2 4 1 M ™ (. Prisoners - ... ... •" — '" *"- , C European Troops - 712 1 ... 2 % ••• " O q lt 1846] Native „ - 6,277* 4 2 3 7 838 8 5 3 3 2 .» 83 14 t Prisoners - ... ... "' ••• •" ,","0 A \ r European Troops - 974 . 4 1 ... 5 105 ... 2 1 - ••; - •" %* 1847] Native „ - 5,596* ... ... ... 10 23 4 818 14 310 2 Jw 27 t Prisoners - ... ... — ••• '" "A ft r European Troops - 1,063 ... ... ... 1 13 9 1 1 ... } - •» *? 'f 1848] Native ? - 5,106* ... 1 325 61115 18 4 111 « 94 ** t Prisoners - ... "' "1 9 V 1O ,«( European Troops- 1,028 ... ... 1 21 3 1 - "• 5 ... « o 1849 1 Native „ - 5,319* 1 ... 2 44 19 2 30 8 4 4 5 1 120 31 1850 European Troops - ... 1 ... ¦ "' 0 ' ( European Troops - 3 2 ... 1 2 12 - '" - ( J 1851] Native „ - 5,656* ... 1 ... 7j 10 8 2 2 - &> * t Prisoners - ... I "" *" w .^ ( European Troops - ... j 2 * '" ' 1852] Native „ - 5,173* ... 2 3 5 11 * C. Prisoners - ... -._ ( European Troops - 993 10 8 7 • ~ 1853] Native „ - 2,134 5 5 16 3 16 - 4o t Prisoners - ... • .f IC _,( Native Troops- 9 10 |18 1 1 •• d X o 1854 1 Prisoners - 659 1 2 8 1 1 ! 9 ( European Troops - ... j 6 j " ' 18555 Native „ - 6 50 8 f9f 9 ll (Prisoners - 595 ... 1 11 2 8 3 3 3 ... 1 2 ... 29 r European Troops - 918 6 J 18565 Native „ - ... 11 1 ... 4 ... ... 7 d ( Prisoners - 644 ... 1 8 16 1 1 1 1 2 ... 31 » io^C European Troops - 2 2 •" o 180/ I Prisoners - 692 1 ... 2 ... 2 25 19 49 2° 2 ° , QCC ( European Troops - 877 1 3 ... 2 ... 2 2 1868 { Prisoners - 750 '.''. ... lj 1 ... „. ... j 2 "' I • The strength in the Dinapore Circle. t In this and other instances the particulars of canes are not known. [ Section I 40 NINTH ANNUAL REPORT OF THE bSktfDkiapore. Statement of Cholera at Dinapore, 1826 to 1872— concluded. Number of cases. Avpraw • • Total Total Ybaes " steugth. . £ ¦ I • I I CaBGB - d6athS - Jl4d.j t 1 I I 1 1 11111111111 l C European Troops 1 518 1 1 2 1 2 9 3 7 3 1 30 8 1859] Native „ - 654 17 1 ••• ]% 8 I Prisoners - 723 1 - 1 18 25 2 47 25 C European Troops - 887 ... 1 2 8 7 3 2 23 8 IB6o] Native „ - 873 1 6 5 1 1 ... 1 1 16 7 ( Prisoners - 456 2 1 12 21 1 1 ... - 38 14 C European Troops - 783 2 1 3 1861 3 Native „ - 532 1 1 ... 1 J J (. Prisoners - 394 2 31 83 14 ( European Troops - 655 1 1 2 ... 4 1862] Native „ ¦ 418 1 1 2 2 3 ... 9 2 (. Prisoners - 398 10 *® ( European Troops - 925 1 1 ••• 1 1 4 3 18635 Native „ - 670 12 12 11 ... 1 9 J (. Prisoners - 436 ... ~ 22 31 18 71 19 (• European Troops - 968 1 5 1 ... 1 8 5 1864] Native „ - 587 1 4 o5 o 5 (. Prisoners - 467 2 24 1 1 28 8 .„.( European Troops - 1,062 X 2 J* .* 1885 1 Prisoner. - 433 1 32 33 14 r European Troops - 892 1 1866} Native „ - ... 1 1 1 (. Prisoners - 571 13 4 22 8 47 18 ( European Troops - 907 . ; 1 1 1867] Native „ - 639 2 4 12 9 6 ( Prisoners - 533 13 1 1 7 21 ... 43 25 (" European Troops - 854 1 1 1868] Native „ - 660 1 x * (. Prisoners • 399 1 4 1 1 4 ... 2 1 1 15 6 ( European Troops - 1065 11l 14 1 1869] Native „ - 532 ... 6 3 1 3 2 15 5 ( Prisoners - 438 2 14 18 4 20 .. 58 15 ]s . n f European Troops. 1,117 2 12 1 ... 3 9 7 1870 1 Prisoners - 454 1112 2 12 19 8 IQ^, ( European Troops- 1,181 6 2 8 6 1871 1 Prisoners - 455 11l 15 ... 18 4 ( European Troops - 1,114 1 12 2 1872) Native „ - 603 1 1 2 (. Prisoners - 411 1 •• 1 2 Benares. — The district covers an area of 995 square miles, and has a population of 793,433. The city, situated on the left bank of the Ganges, has nearly 200,000 inhabitants ; elevation above the sea 255 feet. Cholera is rarely absent from this part of the country. Cases occur nearly every month of each year. In the early part of 1872 the disease was chiefly prevalent in the part adjoining* Jounpore j afterwards it was widely spread, but was nowhere verysevere. As a whole, it may be said that the disease gradually attained its height in April and May, and then gradually declined. The cantonment and civil station lie about three miles from the city. The garrison consisted of D Battery, Bth Brigade, Royal Artillery ; Left Wing, Ist Battalion, 3rd Foot ; Detachment 4th Cavalry ; and the sth Native Infantry. 11. Details of the outbreak.— ln the cantonment the native troops altogether escaped. In the Artillery, (Assistant Surgeon W. F. Stevenson, M. B. } ) No. 2, Benares Cantonment. there were four twQ amongl the men and two among t he women, and three deaths. The first occurred on the Bth April, and the second on the 9th. The two others were on the 9th July. Diarrhoea was not prevalent. In the Buffs, (Assistant Surgeon J. Ferguson,) the only case was on the 11th April. Cases of diarrhoea were common. In the bazaars, embracing a population of 5,458, two deaths from cholera were reported in May and two in June. Among the Native troops (Surgeon Major R. H. Perkins and Surgeon A. Verchere) no cases occurred till December, when a sepoy was attacked. One of the camp followers, a woman, was attacked on the 26th March, and a child on the 6th June. In the Central Prison, (Surgeon W. R. Hooper,) containing 1,295 convicts with 169 men of a guard, the first case appeared in hospital on the 24th July. The No. 3, Benares Central Prison. man had been treatment f or some time. All the patients were at once removed to a barrack in one of the blocks and kept separate. Next day, the 25th, a second case followed among them, and on the 26th a third. The party was then removed to a temporary shed in the outskirts of the jail. On the 29th a fourth case Cholera 41 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic occurred, and on the 30th there were two more. Of the six attacked, five died. All the other prisoners escaped. On the 21st August, a European warder Notes on outbreaks, No. 4, Benares wag attacked in the subordinates' quarters, and on the 23rd, Blind Asylum. .... . *u-:i«i: ' AT — U«J a child in another room of the same building 1 . No prevalence of diarrhoea. In the Asylum for the blind and destitute there were 107 inmates, besides the staff of the institution. The first case occurred on the 19th July, the second on the 20th, and the last on the 3rd August. Altogether there were nine, but with these may be taken three, which occurred in the small dispensary which is within the enclosure. The eight buildings attacked were all at this end of the open space over which the cottages are scattered ; twentyfive of the cottages escaped. Diarrhoea prevalent. In the No. 5, Benares Lunatic Asylum, Lunatic j 8^ umj with 94 male and 32 female patients, there were fifteen cases, and seven deaths. The first occurred on the 28th July, four followed by the Ist August. By the 9th the disease had ceased. All the buildings afforded cases. Diarrhoea not prevalent among the men ; there were a few cases among No. 6, Benares District Jail. the women. In the District Jail there were 554 prisoners, three were attacked, and one died. The cases occurred on the sth, 16th, and 28th August. Two buildings were attacked. On the 31st two women, belonging to the family of the Darogah, and residing in his quarters at the jail gate, were attacked. ///. Importation and communication. — Neither Assistant Surgeon Stevenson of the Artillery, nor Assistant Surgeon Ferguson of the Buffs, could trace importation or find any evidence of contagion. None of the attendants on the sick were attacked. Dr. Perkins mentions that the female follower " lived entirely at home and did not visit the bazaar, or city, or neighbouring villages." As regards the civil institutions also, Surgeon Hooper had been unable to discover any importation in any one of those attacked. In the Destitute Asylum a hospital apprentice was seized, and also a member of the family of the hospital compounder. They lived in the affected quarter of the enclosure already referred to. In the Lunatic Asylum, of seven attendants on the sick, one was attacked. In the Jail the attendants altogether escaped. In the Central Prison, it is said that one of the police guard lost his wife from cholera on the 18th July, seven days before the first case among the prisoners. He came after this to the jail only once. A servant of his also came once. The police guard are quartered within a few yards of the hospital. None of the guard were seized. In connection with this, it may be mentioned that between the 4th and 7th June four deaths occurred in the Stone Bridge Bazaar. On the 6th, 7 th, and Bth there were three cases among Europeans residing in houses on the opposite bank of the river Burn a, within a length of half a mile from one another. In regard to the lady attacked on the Bth, it is known that the washerman of the family lost his father from cholera the day previous. When this lady had been ill for some twelve hours her children were removed to the Civil Surgeon's house, and one of them was attacked soon after. Neither the Civil Surgeon nor his family, numbering five, suffered. V. Local conditions. — The drainage is reported to be fairly good as a whole; but there is evidence that it is far from perfect in many parts of the station. There are no pumps in the cantonment; the water is drawn from wells. No connection could be traced between cases of cholera, and the water from any particular well. The hut in which the female follower was attacked was "overcrowded, badly situated and ventilated. The other case occurred in a hut of which the sanitary conditions were equally bad/ In the Blind Asylum all drank from one well, and no filters were used. In the District Jail several wells are in use. The three prisoners attacked drank from three different wells. In the Central Prison the whole of the left circle, including 657 prisoners, were using the same well as that which supplied the hospital. It was supposed at one time that possibly the hospital filters had been contaminated by the policeman or his servant, whose visits to the jail have been already mentioned, but of this there is no evidence whatever. The hospital is situated about 500 yards from the Burna, on the same bank, and about half a mile from the houses of the civil residents attacked. As soon as the first case of cholera appeared among the prisoners the filters were destroyed. When it occurred, three filters were in use, and they were employed indiscriminately to supply the sick. There was no overcrowding, except in the District Jail and in the Lunatic Asylum, but it was not great, and in the latter it did not exist to the same extent as usual. VI. Preventive measures. — In the cantonment, the barrack or room was vacated immediately a case occurred in it. No second case followed. The movement in the Central Prison and the subsequent history of the disease have been already described. In the case of the child attacked in the warders' barrack, the room was not vacated, and no other case followed among the occupants. In the Blind Asylum rooms, in which a case occurred, were at once vacated, and if a second case appeared in the same buildings the whole was abandoned. The inmates were distributed among the other buildings, and no further attacks took place among them. On the Bth August the lunatics were moved to Pandeypore vacant barracks. Only one case followed, and that was next day. In the District Jail the immediate vacation of a building on the occurrence of the first case was adopted, and no further seizures occurred among those removed. VII. Previous history. — Cholera has been a frequent visitor at Benares, but of late years the outbreaks among the troops and prisoners, in proportion to strength, have been less severe than they were formerly. 42 NINTH ANNUAL REPORT OF THE [ Section I b£ak e s?Ben°are"s. Statement of Cholera at Benares, 1826 to 1872. Number of casks. Ypars Average Total Total IE BS - strength. £ I • I S caBeB - deaths - I!liii i 1 I I 1 ! i on* ( European Troops - 92 1 ... 1 1826 [ Native „ - 8,518* 4 27 18 9 3 ... 1 ... 4 4 70 24 , uo - f European Troops - 87 1 ••• 1 2 1 1827 l Native „ - 7,434* 1 1 ... 2 1 2 118 ... 9 23 4 , OOQ ( European Troops - 80 11l 3 1828 l Native „ - 7,797* 2 4 6 19 9 31 7 - QOn ( European Troops - 130 2 ... 2 1 1829 [ Native „ - 12 2 14 1 11 5 1830 Native Troops - 5,176* ... 3 1 4 1 2 1 12 2 IQOI f European Troops - 126 ••• 1 1 1 ... 3 1 183 H Native „ - 4,965* 1 1 ... 5 4 5 1 1 ... 18 5 i oo.) f European Troops - 95 1 1 1832 I Native „ - 4,517* 1 5 2 1 9 1 ( European Troops - 140 ¦• 1 1 2 1833] Native „ - 4,004* ... 1 4 3 2 10 4 (. Prisoners - ... ¦•• 2 C European Troops - 101 1 ••• 1 2 ;.. 1834] Native „ - 4,546* 4 ... 1 5 2 (. Prisoners - ... 2 ( European Troops - 98 3 1 ... 1 ... 5 5 1835] Native „ - 4,978* 14 5 3 2 ... 4 3 31 16 (. Prisoners - ... 4 ( European Troops - 104 ••• 1 1 1836] Native „ - 3,930* 1 ... 1 1 ... 2 2 1 1 1 10 5 (. Prisoners - ... 17 r European Troops • 97 1 1 2 1837] Native „ - 3,574* .... 118 3 1 3 5 1 7 2 ... 41 21 v. Prisoners - ... 8 . ooc f Native Troops - 4,106* 2 ... 5 5 4 1 20 37 11 1838 1 Prisoners - ... 3 ( European Troops - 90 - 1 1 1839] Native „ - 5,160* ...... 4 2 3 2 4 1 3 5 1 1 26 15 (, Prisoners - ... * 6 r European Troops - 85 4 2 6 3 1840] Native „ - 7,563* 2 ... 5 5 6 3 1 1 2 1 1 ... 27 11 (. Prisoners - ... 4 ( European Troops - 95 1 1841] Native „ - 5,679* ... 2 ... 3 1 5 6 5 1 2 25 12 (. Prisoners - ... 5 , Q/IO C Native Troops - 7,346* ... 2 1 36 9 5 ... 2 3 58 31 1842 [Prisoners - 4 1843 Native Troops - 7 ; 512* 1 2 1 1 5 10 4 1844 C Native " " 630 6 ' 303 * 2 ••" 13 3 4 3 * "' 1 l 1 l 29 5 { Prisoners - ... 9 ( European Troops - 140 1 1845] Native „ - 1,695 ... 121 2 4 7 1 1 37 20 (. Prisoners - ... 4 ( European Troops - 130 1 1 1 1846] Native „ - 6,302* ... 2 .. 1 3 (. Prisoners - ... 7 C European Troops - 107 2 3 5 3 1847] Native „ - 4,804* ... ... 312 10 ... 2 2 1 ... 1 1 32 9 (. Prisoners - ... 6 ,, O ,J European Troops - 159 1 1 1 1848 l Native „ - 5,346* 4 3 5 1 1 ... 2 1 17 4 I _, * The strength in the Benares Circle. 43 Cholera Epidemic- SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Notesonout- Statement of Cholera at Benares, 1826 to 1872— continued. breaks, Benares. v NUMBBE OP CASKS. . . . Total Total Average g S g cases, deaths. Y*abB. strength. fr | g | | [ j H i i_l_LJ_J-J-i— I 2 ... 1 ••• 4 2 r European Troops - 161 ••• 13 12 ... 7 1849] Native „ - 5,405* •¦• " '" "' "' 5 C Prisoners 2,968 i"t" "i 8 "¦ '"* z ¦" [ " i : ::: "v" u 6+ 2 2+ 2 + . n ,~ f European Troops - ... ••• "' "A A"l q q 1 3 40 4 1852 1 Native „ - 10,503*- 1 227 d 3 L d 3 i X S European Troops • 78 ««• "* "' "' "' "' fi i 42 13 Native „ - 2,847 ••• - 2 * * ™ -' .. Z ... 19 Prisoners 1 1J ( European Troops - ... ••• '" •" *" /„ , 52 27 1854] Native » - ». l '" l g g"{ Z 9 2 (. Prisoners - 1,234 ••• 094 6 ® 1855(S a . tiveTr °° pS Tq lfi '" '.'.'. ... 1 6 23 'I 57 19 1 114 54 I Prisoners - l,dlo v 5 4i 21 11 ia _f Native Troops - 3,173 - - ••• Ll ° 'V * 19 7 1856 [Prisoners - 1,003 - - 4 4 10 1 t, Ai . ... 4 1 26 ... 4 3 2 ... 40t 18 . 7 f European Troops- Depot »• " ± ! 10 80 13 12 1 ... 120 58 (.Prisoners - 950 IOKO f European Troops- 511 1 ~ 7 ] 3 5 4 "* " ','.! 1 1858 [ Prisoners - 1,447 l 1 ft 11 Q 18 1 2 1 •« 46 26 IQ , Q C European Troops- 1,315 \ 2 \ . ... 8 3 1859 1 Prisoners - 1,104 5 ¦ 1 o oq « i i T 1 1 ... 47 33 (•European Troops- 1,447 - J f 8 ° ,i ,\ ' ... 47 24 1860 Native „ - 1,250 - 510 3lb Id -^ ... ••• « lfi (. Prisoners - 1,176 * S European Troops - 737 " '" "A "V "A -, 12 9 Native „ - 680 1 „. 8 1 0 1 Prisoners - 1,397 x •" x t oflo f European Troops - 1,142 - '" '" '" ""j 1862 [ Prisoners - 1,718 - 1 ~ (- European Troops - 1,210 1 ¦•• 1 12 ¦•• ~ 2 J 2 2 "J - 3g 3 g 1863^ Native „ ¦ 563 •• oi 00 1 71 44 (Prisoners ¦ 1,412 1 31 SS 1 /• European Troops - 1,081 •• J J 4 1 3 2 1864) Native „ - 551 » -^ - - »¦ - 49 26 (. Prisoners - 1,306 ... ••• a 1 11 9 ( European Troops - 998 4 ••• ' "1 V "j 4 2 1865] Native „ - 595 f 2 '" !!! 2 1 (. Prisoners - 1,193 q O 1 10 p 1866 (Na r tiv P P e anT T PB: - 645 "-- "3" 3 "4" 4 - - X "• - •'• '" 8 5 1867 Native Troops - 541 ... ••• 2 ••• X II 2 r European Troops - 663 •« •• 1868? Native „ - 563 \ " \ \ Prisoners - 1,400 1 L '" 12 3 2 ( European Troops - 906 ¦• •» •" — " a , 1869] Native „ - 569 l - ' « % 2 ( Prisoners - 1701 a " 1870 Native Troops - 562 ¦•¦ 1 , a( _. ( European Troops - 689 11l 3 l 1871 1 Native „ - 551 1 '" L A Q C European Troops - 655 ... 3 1 •• ' 1872] Native „ - 550 • x J 7. (. Prisoners - 1,797 6 3 "" ? The strength of the Benares Circle. t Not given. t Deaths only recorded. [ Section I 44 NINTH ANNUAL REPORT OF THE Fyzabad. — The town lies on the right bank of the Gogra, 78 miles east from Lucknovy, and has a population of 37,800. Three miles distant is Ajoodhia, the old city, which has 10,000 inhabitants and is a Fyzabad. favorite place of pilgrimage. The district contains 1,025,718 inhabitants, and covers an area of 2,332 square miles. The cantonment and civil station lie side by side a mile from the city, at an elevation of 408 feet. The garrison consisted of E Battery, 16th Brigade, Royal Artillery ; 26th Cameronians ; Detachment 7th Cavalry ; and 38th Regiment Native Infantry. 11. Details of the outbreak. — In the district cholera has for some years been almost constantly present. Very few deaths from it occurred in the first quarter of 1872. In April there were 197, and in May 397. The disease then gradually declined till November, when there was a slight increase ; in December it had almost disappeared. The total mortality, according to the register, was 849. Among the Europeans in cantonments, the 26^ Regi- Notes 911 outbreaks, No. 7, 26th nient {Surgeon F. M. Sides) wa« first attacked. They landed Cameronians. ;n; n Tiirii* in Jnlv 1 SfiS nnrl nrrivftd at Fvzahad in Jannarv in India in July 1868, and arrived at Fyzabad in January 1870. Their health was at the time generally good, but there were a number of anaemic men amongst them. These, however, did not suffer from cholera more than those who were strong and well. On the 18th August the first case occurred; the man had run a race the day previous, and had then taken a cold bath. Three more cases followed on the 23rd, and three more on the 24th. Dropping cases continued here and there till the 9th September, on which day there were five, and on the 10th there were twelve. The last case occurred on the 24th, after a clear interval of ten days. Altogether there were among — Strength. Admissions. Deaths. Officers ... ... ... 18 Men ... ... ... 835 27 15 Women ...... 74 7 5 Children ... ... ... 129 16 11 50 31 Diarrhoea and fevers were not prevalent. Of these 50 cases, 48 occurred in cantonment, and only two in camp. Of the 48, 39 were attacked in barracks, and nine in tents pitched either near the orderly-room or on the parade ground. Of the 35 buildings occupied by the regiment, 15 escaped. 111. Importation and communication. — Before the first case occurred among the men, so far as is known, there had been no cases in the bazaar, nor had any of the regimental servants been attacked. Within cantonments no native suffered throughout the whole season, except two, one on the 30th August and the other on the 31st. The first was the child of a sweeper belonging to the regimental hospital, — not the hospital where cholera cases were treated, — and the other a servant in the officers' lines. There was no evidence of importation. During the course of the disease in the regiment, there was no evidence of its being spread by contagion. A woman was attacked within 24 hours of attending her child, who was ill of cholera ; both came from the same quarters three days previously. An orderly, whose duty it was to see that the cots and bedding of men attacked with cholera were disinfected or destroyed, was himself seized ; his work brought him much about the infected barracks. The disease was widely scattered over the lines, and showed itself here and there at widely distant points. Of the 40 natives who attended the cholera cases, not one was attacked. V. Local conditions. — Drainage is tolerably good. Water for drinking is drawn from four wells ; one for all the single men is covered, and has a chain-pump. At the hospital there is another similarly fitted. The married people draw from two uncovered wells. From all of them the water is distributed in mussucks. No community drawing from any one of these wells suffered in any exceptional degree. There was no overcrowding . VI. Preventive measures ; quarantine. — In the early part of the season, when cholera was prevalent in the district, a cordon was drawn round the station, and this is believed to have protected it from the disease. Movement. — In the single men's barrack, as soon as a case occurred, the building was at once vacated. In the family barracks, the affected quarter was similarly dealt with. The inmates were placed in tents, except in two instances, in which they were transferred to a barrack where persons had been seized before, but which had since been vacant for ten days, and had, meantime, been whitewashed and disinfected. Movement into tents was adopted altogether in 26 different parties of single men or families. In 18 of them no further case occurred among the persons so removed. In eight of them, cases occurred after leaving the building, at periods varying from two to eleven days. In both instances in which buildings which had been fumigated were re-occupied by persons from an affected building, afresh case appeared, and they were immediately abandoned. On the 3rd September a detachment from the tents on the parade ground was sent three miles off', to camp at Mhow. No cases occurred after departure from cantonments. They returned on 2nd October. On the 10th September another detachment from infected buildings moved to camp Hurreepore, five miles distant on the Lucknow road; two cases occurred among them, one on the 13th and the other on the 19th; two other camps were formed, one at Durabgunge, three miles on the Lucknow road, and the other at Salaspore, six miles in the same direction. Both these were occupied by detachments from Cholera 1 gA NITAHY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 45 unaffected buildings, and they had no cases. A more general movement would have been •p vo-ha* made mucn earlier, had tents and carriage been procurable. N SU e ßo?ai Ar u tm r e c ry ' Fyza * ad ' The health of those in camp did not suffer in the least. The Battery, Royal Artillery (Assistant Surgeon F. Falwasser) had been quartered at Fyzabad for 18 months, and the health of the men had been very good. The first case did not appear till the 30th August, when two men were attacked, one in the guard room and one in No. 2 barrack. The third case did not occur till the 9th September. The last was ou the 24th. Altogether there were 10 seizures, all among the single men. Strength. Admissions. Deaths. Officers ... «. 4 Men ... ... 127 10 6 Women ... •• 9 ... ... Children ... ... 15 After the third case there was much diarrhoea, but it was easily checked. Two of the buildings were attacked ; four escaped. The daily number of cases among the troops was as follows :—: — I 111 i I R. A. 26th Ref?t. i Bazaar. R. A. 26th Regt. Bazaar. August 18th ... ' ... 1 ••• Brought forward ... 2 16 2 19th ... i ... 20th ... I ... •¦• ••• September 7th 4 21st ... ! » Bth 3 22nd ... ' ... ... ••• » 9th ... 1 5 23rd ...... 3 ... „ 10th ... 1 12 24th ... i - 3 ... „ 11th ... 2 3 25th ... ' ... 12th ... 1 26th ... , 13th ... 2 4 27th ... I ... .i 14th 28th ... I ... ? 15th 29th ... j ... 1 ... ? 16th 30th ... 2 2 1,, 17th 1 31st ... , ... 1 1 I „ 18th 1 September Ist ... ! ... 1 ... „ 19th 1 ¦¦ Jnd 1 ... |Oth 3rd ... ... 1 .« ii *^t 4th ? 22nd sth „ 23rd 6th 2 ... „ 24th ... 1 „, ; Carried over ... 2 16 2\ Total ... 10 50 2 In the artillery all but three cases occurred in the left sub-division of the battery. 777. Importation and communication. — No cases had occurred in the bazaar, nor among the other natives belonging to the battery. There was no reason to suspect importation, nor was there any evidence leading to the conclusion that the disease spread by contagion, beyond the fact that the child of a sweeper employed in the cholera hospital was attacked. This case lias been already mentioned, and in regard to it Surgeon Skues remarks :—": — " The mehter was not one of those employed near cholera patients, and no trace as to the origin of the disease could be discovered/ IV. Meteorology. — Dr. Falwasser mentions that he " noticed a peculiar atmospheric condition on two days when the disease in both the Royal Artillery and 26th Regiment was very virulent, viz., that the temperature was lower than usual, the air remarkably still; in fact, for the greater part of the day, not a breath of air, and a peculiar bluish mist which had the effect of rendering the day darker than usual, although there were few clouds about." V. Local conditions. Drainage. — Indifferent, and might easily be improved. Water drawn from two covered wells worked by means of an iron bucket and wineh — one belongs to the hospital. From the other all the men, married and single, and families were supplied. All used the same water. A Californian pump had been attached to hospital well, but it was taken away, as it was always getting out of order. There was no overcrowding. VI. Preventive measures ; movement. — On the occurrence of a case the building was at once vacated. In the case of the guard room no further seizures took place ; when the case occurred in No. 2 barrack on the 30th August, the building was vacated the same day, and the occupants of the left sub-division placed in tents 50 yards in front of it. For nine days all was well, but on the 9th September there was one case, and another on the 10th ; on that date the tents were shifted about 300 yards distance. Two seizures followed on the 11th; that evening they marched to Deeba Seemur, five miles distant. Here three cases occurred, one on the 12th and another on the 13th. The man attacked in the guard was a prisoner who bad come two days previous from No. 1, and this building was accordingly vacated on the 12th, and this right sub-division of the battery moved out to camp at Deeba Seemur, five miles off. On the 13th a case occurred, in consequence of which it moved to Mussooree, one mile further on. On the 24th there was another, they therefore changed ground to Purwa, another mile [Section I 46 NINTH ANNUAL REPORT OF THE distant. No more cases occurred. The men returned on the 4th, much improved in health _ . -^ ¦, -v, a f rom their stay in camp. Among 1 the women and children Notes on outbreaks, Fyzabad, J _* » . „ , . there were do cases, and they therefore never left their quarters. No. 9, Jail. Native Troops — No cases. Fyzabad Jail. — (Surgeon John Cameron, M. D.) When cholera appeared, it contained 1,213 prisoners, and had attached to it an establishment of 94 persons. 11. Details of the outbreak. — The first case occurred on the 19th October, nearly a month after the disease had ceased among the troops. The second was on the 22nd, others continued, but in no great numbers, till the 28th, on which day there were 18; 12 on the 29th, and 15 on the 30th. It then declined, and the outbreak may be said to have ceased on the 3rd November. Three isolated cases, however, followed on the 19th, 22nd and 24th of that month. In all there were 67 cases, and 20 deaths. The general health of the prisoners had been below par, and dysentery had been prevalent in September. Food was dear, and many came into jail sick and weakly. These, however, did not specially suffer from cholera. The cases were thus divided according to sex — Strength. Admissions. Deaths. Men ... ... ... 1,106 57 16 Women ... ... ... 107 10 4 Total 1,213 <;; 20 Diarrhoea was not prevalent, either before or during the outbreak. Of 15 buildings, 13 furnished cases, and only 2 escaped. Of the 67 cases, 20 occurred in camp and buildings to which the prisoners were ultimately removed. 111. Importation and communication. — On the 19th, the very day on which the first case appeared, a coolie at the railway station on the one side of the prison, and a woman in the bazaar on the other, were attacked. In this bazaar it is believed that cases had been occurring for some days previous, but the information is inexact. Some of the guard live in this bazaar, and are constantly going to and fro, but none of them suffered. Importation could not be traced, nor, in the course of the outbreak, could any extension of the disease be ascribed to contagion. Of eight attendants in constant waiting on the sick, two were attacked. V. Local conditions. — The drainage is good as a whole, but much needs improvement at the south-east corner. When cholera appeared among the prisoners, the rains had ceased for a month. The water for drinking is drawn from many wells, but there is no evidence to show that a body of prisoners, using any one well, suffered more than those drawing from another. There is some difficulty in ascertaining exactly whence the supply for each barrack was really taken. It is probable that the prisoners during their day's work in different parts of the jail drew water from more than one of them, but barracks Nos. 3 and 4 seem, without doubt, to have been supplied from a well divided between them. In the first there were five cases of cholera; in the second only one. Overcrowding. — The jail was much overcrowded, but not more so than most of the jails in Oudh. Each man had considerably under the prescribed 36 superficial feet, and three rows of prisoners in many of them slept between opposite doors. In the barrack where persons under trial are detained, and where there is room for only 34 persons, 74 were placed. No case of cholera occurred among them. They were in only for a few days, and did not suffer ; besides they had wheaten-bread, whereas the others had a very inferior diet. Food. — On the 10th October the wheaten flour, which had been in use for some months previous, was discontinued, and the prisoners were then fed on gram and rice, half-andhalf, ground and made into cakes, and this was varied occasionally with boiled rice of the Boojer variety — an inferior quality. The prisoners were of opinion that the disease was due to the rice. VI. Preventive measures j quarantine. — New prisoners are kept in a separate ward. There is no real quarantine. Movement. — On the 26th October the inmates of barracks Nos. 1, 3 and 10 were sent into camp at Deokah, three miles on the Tanda road. There had by that time been two cases in No. 1, four in No. 3, and three in No. 10. Among these prisoners, numbering 270, 14 cases followed on the 28th, 29th and 30th. On the 29th October the inmates of Nos. 7 and 9, and a portion of the inmates of Nos. 2, 4 and 8, in all 300, were sent to a native building, called the Goolabari, in the outskirts of the city. Four daye before the move to the Goolabari, the superintendent of the prison, when inspecting it with a view to use it as a place of refuge for the prisoners, found a man in it suffering from cholera, and he is said to have been attacked while living in the place. But for this, an earlier move would have been made from the jail. Before removal, there had been five cases in No. 2, one in No. 4, eight in No. 7, two in No. 8, and two in No. 9 ; four eases followed on the 30th, and there were no more afterwards. The male prisoners remaining in the jail after these parties went out, were spread over all the barracks, excepting Nos. 7 and 9, no matter whether there had been cases in them or not. Six cases followed in five of the barracks, all on the next day, the 30th October, and then the disease ceased till the three cases already mentioned occurred in the end of the month. On the 31st October the women were removed to the Begum's tomb, a building half a mile distant. There had been seven cases among them before they left the juil ; two followed, one on the same day, and the other on the 2nd November. After returning to the prison, they had a last case on the 22nd November. VII. Previous history. — The European troops and prisoners suffered more severely in 1872 than in any previous year. Cholera Epidemic. SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 47 Notes on outbreaks, Fyzabad. Statement of Cholera at Fi/zabad, 1859 to 1872. NCMBEK OF CASES. _ Average ! . . Total Total Years> strength . 6 8. fe cases, deaths. llflllj I ||f lit I 111 I ( European Troops - 1.342 ¦ 3 ... 1 4 3 1859] Native „ - 1,233 ... 1 ... 1 2 1 (. Prisoners - 142 ... | 1 ... 1 ( European Troops ¦ ],054 ... I ... 1 27 1 I ... 29 20 IB6o} Native „ - 527 ... I ... 2 9 11 3 ( Prisoners • 259 1 j ... ... 4 1 17 3 i Qa , ( European Troops - 1,114 3 • ... 2 5 1 18bl [ Native „ - 423 1 1 2 ... 1862 Prisoners - 766 1 1 1863 Prisoners ¦ 891 ... 2 4 19 25 9 ( European Troops- 964 1 1 1 18643 Native „ - 679 2 j 2 2 C Prisoners - 988 | 56 56 19 ( European Troops- 953 1 13 13 11 18653 Native „ - 705 2 5 7 6 ( Prisoners „ - 867 1 1 1 1867 European Troops - j 887 j ... 2 1 I 3 2 i oftn ( European Troops- ! 1,257 i 24 4 28 20 ( Prisoners - 1,180 3 ... j 3 1 ( European Troops - 1,022 17 4 1 I 22 17 18702 Native „ - 649 2 j 2 , 1 ( Prisoners - 735 j ... 1 ... 2 3 , 9 f European Troops - 1,193 13 49 62 39 iB/^l Prisoners ¦ 955 62 5 ... 67 19 - - - _ ! Lucknow. — Deputy Inspectors General of Hospitals, British Troops, J. Macbeth, M. D.; C. Archer, M. D., Indian Medical Department. — Altitude 400 feet above the sea, on the banks of the river Goomtee, to the north-east ofCawnpore. The district embraces 1,892 square miles, and contains 789,465 inhabitants. The native city has a population of 2,78,000 ; close to the city is the Muchee Bhawun Fort, garrisoned by a Battery of Royal Artillery and about 80 sepoys; three miles distant, on somewhat higher ground, is the cantonment. Here the force consisted of A Battery, F Brigade, Royal Horse Artillery ; Head Quarters, and C Battery, Bth Brigade, Royal Artillery; 21st Hussars; Ist Battalion 17th Foot; 62nd Foot ; and of Native Troops, the 13th Bengal Cavalry and 9th Native Infantry. The non-military native inhabitants of cantonments number over 18,000. In the civil lines there is a considerable European and Eurasian population. //. Details of the outbreak. — In the end of 1871, as noted in the Sanitary Report for that year, cholera had been prevalent in the city in November and December; 647 deaths had been caused by it, and amon»; the European Troops there had, about the same time, been 31 cases. By the end of the year the disease had disappeared, and was not again heard of till the 2nd April, when a death was reported from it in the north-east corner of the district. In that month it appeared in 13 different villages, chiefly in two police circles far distant from one another, and 49 deaths were registered. The further progress of the disease, so far as the rural population is concerned, is shown in the following statement : — Number of villages s^°^?!° Number of death * Month. suffering from tfe in eth -ported W choleia - month. cholera - April ... ... ... ... 18 13 . 49 May ... ... ... ... 61 50 222 June ... ... ... ... 160 80 421 July ... ... ... ... 78 39 196 August ... ... ... ... 62 23 136 September ... ... ... ... 11 1 21 October ... ... ... ... 12 8 60 November to 2nd ... ... ... 1 0 4 Total ... ... ... 1,102 In the city of Lucknow — Surgeon Major H. M. Cannon, M. 8., Civil Surgeon; Surgeon E. Bonavia, M. D., Health Officer— the first death was reported on the 15th May. From that date up to the 2nd November, 118 deaths from cholera were registered. The disease was widely spread, as shown by the fact that the deaths during these five months occurred in [ Section I 48 NINTH ANNUAL REPORT OF THE 67 different wards. In many of these there was but one altogether. In the chowk part of the city, which has a population within itself of 63,350, only Notes on outbreaks, Luckno-v. 29 of the deaths occurred; 16 of the 19 mohullas affected contributed only one each. In only nine instances did more than one death occur in the same house. The disease was thus widely dotted over the city. In the Fort the first case occurred in an overseer of the "Public "Works Department on the 10th May, before any case was known in the city. In the Royal Artillery (Staff Assistant Surgeon J. E. Fannin) No. 10, Port. Battery, which consisted of officers 4, men 88, women 9, and children 24, a child was attacked on the 12th May, and two men were seized in the same room on the nights of the 15th and 16th of the same month. Slight diarrhcea prevailed. Among the sepoys, one was seized on the 15th, and another on the 19th May. After many weeks a third was attacked on the 3rd August. None of the camp-followers or servants within the fort suffered. The cases among the Europeans occurred in three buildings widely apart. The sepoy guard has usually been relieved every Monday, but when cholera appeared, it was not changed for some time. ///. Importation and communication. — There was no ground to attribute the first case in the fort to importation, nor in the course of the outbreak was there any evidence that it spread from the sick to the healthy. V. Local conditions. — The fort stands high, and the drainage is excellent. On the city side, however, there is a main drain which runs below and carries sewage. The water is drawn from a well outside. "When in any room a case occurred it was immediately vacated, and none of the inmates were subsequently attacked. In the Military Prison, — Staff Assistant Surgeon H. Scott — which lies between the fort and the cantonment, there were 42 European prisoners, 5 warders, and a guard of 20 men. No. 11, Military Prison. 11. Details of the outbreak. — On the 21st August a man in one of the cells was attacked. He had been five weeks in prison. On the 2nd October another prisoner in another cell, in a different part of the prison, was seized. He had come from Cawnpore 16 days previous, and at that time there was no cholera in the Cawnpore cantonment. These were the only two cases ; one of them recovered, the other died rapidly. 111. Importation and communication. — There was nothing to indicate that the disease had been introduced from outside, or that it spread by contagion. None of the attendants were attacked. Diarrhoea was prevalent among the prisoners for some weeks, about the time cholera appeared. It was attributed to the pease meal, which was discontinued. None of the o*uard were attacked. V. Local conditions. — The water is drawn from a well outside in the usual manner. In the prison-yard is a well fitted with a pump, but the water is slightly brackish, and has not been nsed by the prisoners for years. The Cantonment. Details of the outbreak. — In the Artillery lines — Surgeon A. Guthrie T» IT T-k ilOi I*! ... } M. D. — the first case occurred in the regimental bazaar on No. 12, Koyal Artillery. ? -, o , u T , • ?,, ~ ? o , , ' V 6'"' tu^ vn the 19th July, in a child. On the 21st, a man of A Battery, P Brigade, was attacked in No. 4 barrack, a second on the 22nd, and a third on the 30th all in the same barrack. On the 2nd this barrack was vacated, and the inmates encamped one mile to the north-east, near the Beebeeapore house. In No. 6 barrack 2 cases occurred, one on the 30th July, and one on the 4th August. On the sth the inmates went out and joined the camp. On the 7th the inmates of No. 5 barrack also went out. During the eight days the camp remained near Beebeeapore, there were five seizures, one on the 7th, from the men of barrack No. 5 ; *one on the Bth ; one on the 9th, from the men of Nos. 4 and 2 ; and 2on the 9th, from the men of No. 6. On the evening of the 9th they moved to Sheikpoora, and after that two more cases occurred, one on the 12th, and another on the 14th, both from amono- the men who had occupied No. 6 barrack. On the 26th August they returned to cantonments, and had no further attacks. Diarrhcea was prevalent before moving out, and also in the first camp. In addition to the above, a few other cases occurred in cantonments, one of which was in hospital. The last case of all happened on the 16th August; five different buildings suffered in all. The total admissions and deaths in the battery were as follows :— Strength. Admissions. Deaths. 5 Officers Men 143 12 r, Women Children 17 ?,7 •2 2 I 1 16 8 Five cases occurred among the followers while the Europeans were suffering. * The very day they left the barrack. Cholera 1 SANITAR y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 49 In C Battery and the Head Quarters of the Bth Brigade Notes on outbreaks, Lucknow. there wefe altogether fiye cageg and three deaths. C, Bth K. A. Strength. Admissions. Deaths. Officers ... ... ... 4 Men ... ... ... 115 2 Women ... ... ... 16 2 2 Children ... ... ... 42 4 2 In the Head Quarters, Bth Brigade — •*= =» Strength. Admissions. Deaths. Officers ... ... ... 7 Men ... ... ... 7 Women ... ... .. 5 1 1 Children ... ... ... 6 1 1 The first occurred in hospital on the 6th August, and the last on the 12th. They occurred in four different buildings. Before the outbreak there was no prevalence of diarrhoea or fever. Diarrhoea became prevalent when cholera appeared. 111. Importation and communication. — There had been cases in other parts of the cantonment long previously, and some grass-cutters of the Artillery were seized shortly before any of the men, but there was no evidence either of importation or of contagion ; none of the attendants on the sick were attacked. IV. Meteorology. — The observations afford no very definite data. There were several heavy falls of rain, but from the 9th to the 28th July there was no rain. The temperature for this time, however, was rather lower than that of the previous year during the same period. Winds variable, but frequently from the east. V. Local conditions. — Drainage of the lines is very good ; water drawn from three wells is naturally of excellent quality, but fault was found with the filtering arrangements which rendered it impure. No overcrowding. VI. Preventive measures. — Movement was not always promptly made when a case occurred. In No. 4 barrack there had been three cases before it was vacated, and eleven days intervened, from the 21st July to the 2nd August. In No. 6 there had been two cases, and six days intervened before evacuation, from the 30th July to the 4th August. In No. 3 family quarters three cases occurred, one on the 11th, one on the 12th, and one on the 16th. On the 18th they went to Beebeeapore and had no more cases. No diseases appeared to be caused by camp. No. 13, 2ist Hussars. 21st Hussars.— Surgeon Major G. A. Turnbull. //. — Details of the outbreak. Strength. Admissions. Deaths. Officers ... ... ... 17 Men ... ... ... 421 1 1 Women ... ... ... 29 Children ... ... ... 54 1 1 2 2 First case, a Troop Sergeant Major, attacked on the 28th August. The second and only other case was a child on the 2nd September; both died. Two buildings were attacked, all the rest escaped. There was no prevalence of diarrhoea. 111. Importation and communication. — There were seven cases among the syces between the 19th August and 4th September, but no communication could be traced None of the attendants were attacked. V. Local conditions. — The drainage of the lines is reported to be good. The water was drawn from several wells. The men had abundant space. VI. Preventive measures. — As soon as a case occurred the room was at once vacated and closed. The men of the troops of which the Sergeant Major was attacked in addition left the building on the following morning. No. 14, 62nd Foot. 6;Jnd Foot.— Assistant Surgeon It. J. Scott, M. B. 11. Details of the outbreak.— The first case occurred on the 22ud May. The man recovered. There was no further case till the. 17th August, a third occurred on the 31st August, and a fourth on the Bth September. Dropping cases continued to the 27th September, and there was a last attack on the 18th October. Altogether there were among — Strength. Admissions. Deaths. Officers ... ... ... 17 Men ... ... ... 800 4 3 Women ... ... ... 97 q 4 Children ... ... ... 179 4 2 - 14 9 Eight different buildings were attacked scattered over the lines. The family barracks suffered most, but in only one of them did more than a single seizure take place in the same quarters. In this instance, a mother and child were attacked within 24 hours of each other. Diarrhoea and fever were not prevalent. [ Section I 50 NINTH ANNUAL REPORT OF THE 111. Importation and communication. — Before the man was seized on the 31st August, _ . so far as is known, none of the bazaar people or servants Notes on outbreaks, Lucknow. eyideuce of import . ation or contagion. Of 12 native attendants on the sick, all escaped. V. Local conditions. — Drainage very good. Water drawn from several wells, and no prevalence attached itself to the use of any particular one. No overcrowding . VI. Preventive measures. — In all cases but one, the affected room was at once vacated, and no further cases occurred among the inmates. In this instance, although not vacated, no further case occurred. The inmates of affected barracks were, as a rule, moved to tents on the side of the lines, and there they remained, each set for ten days, and then returned to quarters. A small party moved to camp at Beebeeapore ; no cases followed. There was one case iv tents. No. 15, l-17th Begiment. IST1 ST BATTALION, 17TII REGIMENT. — Surgeon W. J. Illgham. //. Details of the outbreak. — The first seizure occurred on the 29th June. Dropping cases continued till the 17th October; a further case occurred on the 26th November, followed by another on the 28th, and a third on the 29th — Strength. Admissions. Deaths. Officers ... ... 17 Men ... ... 870 12 10 Women ... ... 98 Children ... ... 153 1 J3 _10 Of these, three were attacked in hospital ; ten different buildings afforded cases. The case of the 26th November was in the musketry camp. ///. Importation and communication. — There had been no cases in the lines before the 20th May. No importation or contagion could be traced. No attendant was attacked. V. Local conditions. — Drainage is not very good in these lines. Water — two wells are used for drinkiug. Those using the one suffered as much as those using the other. The men had ample room. VI. Preventive measures. Movement. — Whenever a case occurred, the room was at once vacated, and the inmates moved into spare quarters. In hospital one case occurred on the 2nd July, and that part of the long ward was at once vacated. On the sth a second case occurred in another part of the same ward. The inmates were moved to the other wing of the building, and there a third case occurred among them on the 6th. With this exception, the abandonment of an infected room was followed by complete cessation of the cholera among its occupants. There was abundant spare room, so it was not necessary to use tents. If a case occurred in any building, the occupants of the room were moved to a room in another building, which was altogether vacated by transferring its inmates to a spare barrack. For example, if a room in A was affected, B, which was occujiied by healthy people, was vacatsd by their transfer to C. B then became a quarter to which persons from other affected barracks could be sent without alarming the occupants by the idea of contagion. Among the staff and non-military European residents of cantonment, the only attack took place on the 22nd August. In the bazaars the first case was on the 20th May; total 26 cases and 8 deaths scattered over the bazaars here and there to the 16th September. Two of the cases were attendants from the cholera hospital. Natives attacked were brought to the hospital from their houses whether they liked it or not, and it is believed that cases were not concealed. As I have already mentioned, one man of the 1-1 7 th was attacked with cholera in the musketry camp on the 26th November. The same day, after a long interval, there were four cases from different parts of the city, and next day a European in the civil lines was seized. On the night of the 24th, a horse in A Battery, F Brigade died rapidly of purging. On the 25th, 15 more were seized with similar symptoms. Of these, I saw several, and one or two of them presented a most miserable appearance ; thin, weak, with staring coats and tucked up abdomens, it was hard to believe that they had been fine, strong, well-conditioned animals only two days previously. Native Troops. — No report has been received either from the 13th Bengal Cavalry or 9th Native Infantry. Very few cases occurred in them. A return obtained from Dr. Archer, Deputy Inspector General of Hospitals, gives only the deaths; one on the 16th May, one on 3rd July, one on 16th July, one on -ith August, one on 17th August, and one on Ist September. Fevers were very prevalent among the Native Troops. As nominal rolls of cases from several of the European Corps also are wanting, the daily cases of cholera occurring among them cannot be tabulated and compared. Lncknoiv Lunatic Asylum. — Near the civil lines; 130 lunatics. No case of cholera. Lucknow Central Prison. — Near the cantonment; 1,700 prisoners, with establishment and guards ; was overcrowded. No case of cholera. Lucknow District Jail — Surgeon J. C. Whishaw con- No. 16, District Jail. prisoners _ 11. Details of the outbreak. — A mohurrir or native accountant, who lived in the precincts, was attacked on the Ist August and died. On the 11th August two prisoners in barrack No. 8 were seized, and a third, in the barrack for new prisoners, on the 26th. Cholera 1 SANTTAUY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 51 ///. Importation and communication. — No importation could be traced, nor does Notes on outbreaks, Lucknow. Dr. Whishaw believe there is any evidence of contagion. V. Local conditions. — The jail was much overcrowded. VI. Preventive measures. — In both cases the building was vacated within 24 hours, and no fresh cases occurred among the inmates. VII. Previous history. — Up to 1856 Lucknow was occupied only by Native Troops, and the station was several miles from the site now occupied. Since 1856 cholera has been an annual visitor. Statement of Cholera at Lucknow, 1856 to 1872. Number op casEvS. y B .,. v Average c c ¦ \ Total Total IIiABS - strength. £¦ J . J J cases. deaths. i \ \\\ i \ % \ \ \ \ \ h ** %\ < m A ?? a © fc p "I "~ I lw -«f European Troops - 905 35 31 66 46 iHob I Native „ - 10,413* 1 ... i6\ 10 20 i 5 ... II 1 ... 4 ... 48 14 1857 European „ - ... j ... | ... jl4 18 9 I 4 {45 , v , Q f Native „ - 1 ...... 2 ... j ... 3 iHob { Prisoners - 666 ... l ... j ... ! f2 ( European Troops - 3,320 18 ... 1 8 44 122 1 75 42 18595 Native „ - 1,355 ... ... 1 I 35 jlO 46 16 ( Prisoners - 469 ... ' ... 1 8 ! 1 10 7 ( European Troops - 2,216 1 7 1 ... 1 9 16 ... 35 22 18603 Native „ - 1,308 ... 2 25 6 11 ... 3 38 17 (Prisoners - 663 ... 9 ... i ... 1 10 4 ( European Troops - 2,215 \ 1 2 6 ; 9 8 1861$ Native „ - 633 | 1 j I 1 4 6 1 (Prisoners - 769 ... ! ... j j ; ... ... 8 ... 8 §6 ( European Troops - 2,093 . ! ... ! ... 1 ... ! 1 j 2 18023 Native „ - 1,316 ... ... i ... i 2 j ... i I 2 (Prisoners - 882 ... l 1 ... : 6{ 1 i ... | ! 8 ( European Troops - 2,420 ... ! ... \ ... i ... 23 15 | 1 7 ... 46 25 18635 Native „ - 1,717 ! .. ' ... i ...... 4 3 ' 1 1 9 2 ( Prisoners - 1,981 ... j ... ! ... j 219 1 j 3 34 45 3 305 153 r European Troops - 2,470 ! ... j | j 154 1 ... 55 39 1864] Native „ - 1,588 i ... j 2 ... S 1 3 1 ( Prisoners - 2,550 j 8 3 Is w,-f European Troops - 1,884 ... 1 2 14 6 23 20 iybo [ Native „ - 1,569 ... 2 1 8 2 ior a \ European Troops - 2,241 ... i 1 1 2 18bb i Native „ - j ... ... 1 1 1 ( European Troops - 2,535 | ... j 1 7 3 11 6 18675 Native „ - 1,590 ... ; ... ... 2! 3 ... 5 4 ( Prisoners - 2,482 5 5 2 ... 1 1 14 1 ,^ a ( European Troops - 2,215 ... ! 1 6 1 19 7 lHbH l Native „ - 1,917 | ... j 1 1 ... 2 2 ( European Troops - 3,107 j j 1 ! 1j 5 115 ''• 122 97 1869} Native „ - 1,767 [ .. I 1 i ... 2 j .. '" 3 3 ( Prisoners - 2,825 : I -j .. .... 2 2 , w -, n ( Native Troops - 1,728 3 \ ... ... 3 3 1870 1 Prisoners - 2,777 : ... | ... | 1 ... I 1 1 r European Troops - 3,152 ! ...... j ... 1 ... 1: . ... 31 ... 33 17 ]K713 Native „ - 1,645 ... ! ... I ... j ... j 13 3 6 2 ( Prisoners (Distt.) - 838 | ' { 3 3 q 3 r European Troops - 3,187 \ i 4 ... 12 21 Jl6 2 2 57 37 18725 Native „ - 969 ......... 1 2 ... 2 2 1 ... 8 6 ( Prisoners - 2,726 J i ... 3 "J '„'.' 3 = ! 1 ! i * The strength with Oude Field Force. t The months in which these two cases occurred cannot be traced. X Deaths only recorded. § Twenty deaths are entered in the Annual Table. Cawnpore.— lmmediately on the right bank of the Ganges, at an elevation of 413 feet Cawnpore a *T e the . sea> The station is partly civil and partly military, and contains an unusually large native population estimated at nearly 31,000. The city, which is close by, has about 85,000 inhabitants. The garrison consisted at time of the outbreak of Ist Battalion, Bth, the Kind's Regiment; A Battery, 19th Brigade, Royal Artillery; Ist Regiment Bengal Cavalry, and 35th Regiment Native Infantry. The district covers an area of 2,366 square miles, and contains 1,152,628 inhabitants. //. Details of the outbreak.— -In April six deaths from cholera occurred in the district. No. 17, Bth Kegiment. n 6 ay some deaths were reported from the city and . ? ? ¦, c . . . bazaar, and the men of the Bth were in consequence prohibited from visiting these places. Among the Europeans, the first case occurred in the B*4 [ Section I 52 NINTH ANNUAL REPORT OF THE Regiment, (Assistant Surgeon William George Ross), on the morning of the Bth May. Another case on the 11th, and from that time up to the 3rd Notes on outbreaks, Cawnpore. June few dayg pagged without g()me forfher geizurej but there was no great severity on any one date. Altogether they were as follows :—: — Strength. Cases. Deaths. Officers ... ... 24 Men ... ... 825 21 14 Women ... ... 63 4 1 Children ... ... 98 25 15 There were a few other cases of choleraic diarrhoea, which were not returned as cholera. The above statement, moreover, does not include a man of the regiment who was sent to the military prison at Lucknow and died there of cholera on the 2nd October. The cases appeared in ten different buildings. Eight buildings escaped. In the Artillery, (Staff Assistant Surgeon J. J. O'Grady) the first case was on the 13th May. Two more followed on the 15th, and the fourth and last No. 18, Boyal Artillery. jg^ The were battery .__ May. Two more followed on the 15th, and the fourth and last Strength. Cases. Deaths. Officers ... ... 5 Men ... ... ... 131 2 2 Women ... 12 1 1 Children ... ... 20 1 1 4 4 Of the two large single-storied barracks occupied by the battery, one had two cases, and the other entirely escaped. Another small building had one No. 19, 35th Native Infantry, case, and the fourth occurred in camp. In the Bengal Cavalry there was not a single case either in the regiment or among the camp-followers. In the 35th Native Infantry, (Assistant Surgeon A. Deane), one officer was attacked on the 13th May and recovered; the house in which he lived was occupied by several others. It was not vacated, and none of them were seized. In the regiment a recruit was attacked on the Ist June. This was the only case in the regimental lines or bazaar. There were four cases among the European non-military residents; all occurred between the 16th and 23rd May. Neither diarrhoea nor fever was prevalent. As regards the general population, it has been already stated that six deaths were reported in April. In May there were 413 deaths from cholera. Of these, 124 occurred in the city and suburbs including the cantonment bazars, in 52 different wards. The greatest mortality for this month in any one ward was 15. Twenty-six different villages widely scattered over the district were attacked in May. The largest number of deaths in any one village was 24. In 19 of them the mortality was less than five. In June there were 541 deaths from cholera throughout the district. Of these 90 occurred in city and suburbs, in 43 wards. Of these 24 were attacked in June, and the other 19 continued to suffer from the month previous. In two of the wards the deaths attained a maximum of seven duringthe month. In each of all the rest the number was under five. In this month 103 villages suffered. Of the 26 attacked in May six only continued to suffer in June. The greatest number of deaths in any one village in this month was 25. In 79 of them the total was under five. In very many of these there was only one death. In July the total deaths were 270. Of these 11 occurred in the city and suburbs, in 16 wards, of which three were now attacked for the first time. In one ward the deaths were 10. In all the others they were under 5. Eifty-nine villages suffered, of which 38 were attacked for the first time. The maximum deaths in any one was 21. In 49 of them the number was under five. In August there were 131 deaths, of which only four were in city and suburbs^ 23 villages suffered. The largest number of deaths in any one was 10. In 16 of them it was under five. In September 162 deaths, of which none were reported from the city or suburbs ; 25 villages suffered. In one there was a maximum of 13 deaths. In 14 o£ them the deaths were under five in each. In October, 81 deaths were reported in the district, none occurred in the city and suburbs, 12 villages suffered. In one, there were 14 deaths. In nine, less than five in each. In November there were two deaths, in December one. In the jail a prisoner, one of 338, was attacked on the No. 20, Cawnpore Jail. 9th May> N() other cage occurred> ///. Importation and communication. — In no section of the community was there any reason to suspect that the first case was due to importation. The matron of the female hospital of the Bth regiment was attacked while in attendance on cholera cases, but the many others who came in contact with the sick all escaped. In the Bth regiment the 11th case had attended the funeral of the 1 Oth, and was seized the following day. IV. Meteorology. — Dr. Ross observes — " The only peculiar atmospheric conditions were the absence of the regular hot winds and the consequent uncomfortable sultriness existing, with nasty muggy east wind and general electric state of the atmosphere." Dr. Deane observes " there was a steady east wind blowing." V. Local conditions. — The drainage is reported to be good. The water is drawn in the usual method from wells, in which it stands about 40 feet from the surface. In no part of Cholera -| SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 53 the community were persons drinking- water from any particular well specially attacked. On __ . ttm k.#u— n *o the contrary, of large numbers of persons deriving their supply Notes on outbreaks, Cawnpore. r ii, j. 1 a> j t ii from the same source, one or two only suffered. In the artillery both barracks were supplied from one well ; one had three cases and the other none. In the city when several cases occurred in a ward, the well was closed, and this is said to have had a good effect. I applied to the Magistrate for exact information as to what occurred, but too long a time had elapsed, and the precise data requested could not be obtained. There was no overcrowding. VI. Preventive measures. — Quarantine. — All that was attempted was to prohibit the men from visiting the city or suburbs once cholera had been reported. Movement. — In every case where the troops were concerned, any room in which a case occurred was immediately vacated, and the inmates removed either into tents or quarters. Of the 25 cases which occurred in the Bth Regiment, 17 were in barracks and 8 in tents, but with one exception all these eight seizures took place within a few hours of leaving an affected barrack. On the morning of the 14th May, A Company moved to tents at Ahirwan, about 2£ miles to the south of cantonment, one man was attacked on the march, and eight days afterwards a woman was seized. No more cases occurred. The company returned to barracks on the 24th, and kept free of the disease. On the 17th 18 families from affected quarters joined A Company, they had no fresh cases, and returned on the 22nd June. On the 18th May three other companies from two affected and one unaffected barracks marched to camp at Rameepore, 11 miles to the west. No more cases occurred. They returned on the 31st May and re-occupied their former quarters. On the next day, the Ist June, two cases were admitted from these companies. The men were immediately placed in tents on the parade ground, but three more cases occurred among them on the 2nd. They were then ordered to march back to Rameepore, but before they could leave, two more seizures had taken place. They started at 2 a.m. of the 3rd, re-encamped at Rameepore, and had no more cases. On the 26th and 28th June they returned to cantonment, and kept free of the disease. Two other companies which had not been attacked, but whose safety was believed to be endangered by the near proximity of infected building, were sent to Etawah on the 19th May, and remained in camp there till the 30th June. They had no cases. The remaining two companies, with the band and drums and a few married families, never left cantonments, but remained in barracks, spread over uninfected buildings as much as possible ; not a single case occurred among them. In the Royal Artillery the room in the large barrack in which the first case appeared on the 13th,. was at once vacated. When the second case appeared in this barrack and when on the same date another case occurred in another building, both were abandoned, and the inmates removed to camp at Gowkhera, 5 miles on the Allahabad road. On the 18th another seizure took place, but this was the only other case. On the 31st May the/ returned to quarters and kept free of the disease. Health in Camp. — The Artillery kept very well in camp, so did the Bth Regiment. In the latter several cases of sunstroke occurred, but from this those of them who had been left in quarters in the station suffered rather more. Between the 4th May and the 6th July the camps furnished nine cases and two deaths from this cause. In cantonment under the same heading 1 there were, during the same period, nine admissions and three deaths VII. Previous History. — The last ten years compare very favorably with the history of the station in former times. Statement of Cholera at Caionpore, 1826 to 1872. Number of Cases. Years Average . . Total j Total Strength. . £ J , J g Cases. ' Deaths. ll!iii% I I , ! I I i go« f European Troops . 1,763 1 1 1 2 18 14 1 3 3 1 45 22 X^ b I Native „ - 16,000* ... 1 5 8 5 13 5 3 2 2 1 1 46 14 , q9 h f European Troops - 1,988 2 12 8 6 2 4 3 2 4 1 44 6 iHdi { Native „ - 16,848* ... 3 ... 6 4 4 10 4 6 8 1 ... 46 15 , Q9Q f European Troops - 2,192 4 3 3 ... 1 12 39 30 11 1 1 2 107 33 18^( Native „ - 16,673* ... 13 3 6 5 12 18 4 .. 21 1 74 23 7 Q9Q f European Troops - 2,206 1 ... 18 11 6 5 5 4... 2 2 1 50 5 l^ y { Native „ - 2 ... 6 5 4 1 3 4 1 26 3 i qqa f European Troops - 2,031 ... 1 2 3 3 6 4 4 ... 3 .. 26 3 1X ' iU ( Native „ - 13,708* 1 2 1 4 1 ... 5 ' 1 15 1 leQl f European Troops - 2,039 4 2 11 11 1 1 1 31 2 lb6L { Native „ - 11,465* 2 ... 2 2 4 2 3 I 1 1 2 ... 20 * -i ft o 9 f European Troops - 1,945 1114 111 10 ia^ I Native „ - 10,768* 2 12 8 3 2 2 1 ... 21 5 IS oo[ European Troops- 1,842 1 2 3 18 91 179 1 1 ... 287 101 AOt)O i Native „ - 11,490 ... 2 2 8 3 4 2 48 27 11 1 ... 108 31 r European Troops - 1,885 1 ... 2 12 3 2 2 13 8 1834] Native „ . 10,675 3 4 5 5 9 2 2 3 ... 2 35 10 C Prisoners - ... m 7 * Strength of the Cawupore Circle. O [ Section I 54 NINTH ANNUAL REPORT OF THE Notes on out- Statement of Cholera at Cawnpore, 1826 to 1872— continued, creaks, Cawnpore. - J Numbbb of Cases. Average • • Total Tolal YBABB - strength £ I • 1 j CaSeB Deathß Deathßlialii i i i I i i ( European Troops - 1,905 1 ... 3 2 6 1835] Native „ - 14,099* 1 ... 2 510 3 4 2 3 6 2 ... 38 7 v. Prisoners - ... . 00 . ( European Troops - 2,059 2 ... 7 6 6 12 7 1 1 3 45 2 IS36 l Native „ - 14,157 ... 2 4 5 2 2 ... 3 1 2 ... 3 24 3 ( European Troops - 2,049 1 ... 2 4 10 79 1 3 2 ... 102 32 1837) Native „ - 14,175* ... 118 7102437 16 13 6 119 152 45 (. Prisoners - ... 8 ( European Troops - 1,890 1 ... 9 13 10 32 38 25 7 3 3 4 145 42 1838] Native „ 12,768* 1 522275546 12 12 5 6 2 1 194 95 (. Prisoners - ¦¦ ••• 6 i oon f European Troops - 1,277 1 ... 1 39 5 5 943 1... 41 8 18dy l Native „ - 13,684* 1 ... 3 5 6 6 5 8 8 1 5 1 49 18 IQ . A ( European Troops- 1,271 1 1 1 1 6 7 3 2 2 1 ... 2 27 ... lhW l Native „ - 16,147* 2 3 9 2 8 6 2 1 5 ... 2 ... 40 11 C European Troops - 1,336 1 ... . ... 1 17 49 11 2 1 82 15 1841 ) Native „ - 16,438* 1 ... ... 3 11333 12 1 6 9 2 81 27 ' Prisoners - ... , ... 3 ( European Troops - 1,583 . ... " ... 2 104 2 18 126 61 1842] Native „ - 19,886* 6 7 1132946 12 3 ... ••• 124 46 (. Prisoners - ... 1 ( European Troops - 1,966 2 ... 14 "3 10 H li ... 1 ...••• 46 19 1843] Native „ - 16,824* 2 7 2 710 ?19 17 5 5 ... 2 83 34 C. Prisoners - ... ... ... ... ••• 1 f European Troops - 2,297 4 1 1 ... 1 ••• 7 1844 t Native „ ¦ 16,539* ... 2 3 10 2 1 ... 1 5 ••• 24 r European Troops - 1,944 5 4 ... 100 15 8 22 1 1 ... 156 68 1845] Native „ - 5,451 ... 1 310 233 19 6 4 3 ... ... 81 30 (. Prisoners - ... _ ... ••• 2 r European Troops - 1,487 2 ... ' .!. - 2 1846] Native „ - 12,626* -. ... 3 "5 1 3 5 "2 1 1 1 ••• 23 (. Prisoners - ... ... ••• 2 ( European Troops - 1,102 ..""53 ... 8 1847 1 Native „ - 10,452* 3 *6 *5 4 3 2 2 3 6 1 35 7 ( European Troops ¦ 789 1 2 31 28 49 63 7 •¦• 1 81 67 1848] Native ? - 11,268* 2 ... 15 n19 3024 19 11 3 ." - 1 34 39 , C I'risoners - ... ... ... ... 4 r European Troops - 786 ... ... 80 "2 1 ••• 83 33 1849] Native „ - 13,974 9 ... 3 ~ 29 30 74 12 3 2 5 ••• 167 69 C Prisoners - ... ... ... ... 10 1850 European Troops - ... "[ *J 2 ... '..'. 8 * C European Troops - ... ... 5 2 ... ' 1801 1 Native „ - 2,711 ... 1 11 14 "4 4 6 18 1 2 ... 7 68 21 (European Troop- ... 1 T ... 2* IHSJ I Native „ - 9,662 2 3 4 2 2 2 1 .- 1 1 18 X r European Troops • 981 4 30 64 97 i 95 * 1853] Native „ - 2,626 13 15 6 335 2 ".!." ... ... 74 31 C Prisoners - ... ... ... ••• 4 1f1 ..( Native Troops - ... 2 ... 1 "3 "6" 6 4 "4 "... ... - 20 J l«o4<^ Prisoners - 876 1 1 41 26 ... - 69 iS f Native Troops - 2 ... 1 "*7 7 1 1 ••• 19 7 l8o& ( Prisoners - 674 ... 50 22 .. ... - ' 2 3 r European Troops - 479 ... 6 ••• 1856] Native „ - 4,560 ... ... 8 611 3 9 7 1 1 ... ~ 39 l7 n (. Prisoners - 546 ... 1 ... 2 ... — 3 f 1857 European Troops - ... M . 123f r European Troops - Included in the Return for Allahabad 1858] Native „ - 1 1 C Prisoners - 275 ... 1 ... ... 1 •• European Troops - 1,372 ... 12 1 2 44 4 8 1 ... ••• 65 54 1859] Native „ - 3,722 ... 13 42 ... 55 23 C Prisoners - 75 ... 1 ... 1 ( European Troops - 1,228 ... ... 5 12 1 ... 2 19 4 ... 43 24 IHW i Native „ - 1.024 ...... 4 7 4 2 2 3 ... 1 23 6 r European Troops ¦ 1,230 ... ... 1 ... 8 9 10 19 . 1 - 48 35 186 l) Native „ - 876 ... 18 9 ... 2 20 8 ( Prisoners - 203 ... 3 1.. ... 3 1862 Native Troops - 817 »• 1 1 1 ... 3 c European Troops - 1,162 ... 10 6 1 17 24 lHb6 [ Native „ - 594 ... 1 ... 1 ... 1 3 1 1864 European Troops - 1,131 ... 1 4 1 6 6 , ,„, f European Troops - 880 ... 1 ' 1 1 1865 [Native „ - 573 ... 10 10 4 * Fatal eases only entered. t Out of these 40 were among the Madras Fusiliers between 26th July and 3rd August ; 13 in the 64th Regiment, Bombay (7 in August and 6 iv September) ; 16 in the 78th Regiment, Bombay, in August, and 54 in the Bengal Army (11 in July, 37 in August and 3in September) in the camps. Cholera ~| SANITAEY COMMISSIONER WITH THE GOVERNMENT OP INDIA. Epidemic- J 55 Notes on out- Statement of Cholera at Cawnpore. 1826 to 1872 — concluded, breaks, Cawnpore. ¦' r ' Nvmbkii of Cases. Average . . Total Total Ybabs. Strength. c S S g* Cases. Deaths. In 1 1 * ! 11111 1 11 j , aM ( European Troops - 691 1 ... 2 3 2 im/ { Native „ - 796 1 1 1 , o n Q { European Troops - 722 3 3 18bb [ Native „ - 644 1 1 1 IQaQ ( European Troops- 1,310 2 12 13 27 17 imy { Native „ - 987 2 2 1 1871 European Troops - 1,042 1 ... 2 3 1 ( European Troops - 1,107 22 8 30 20 1872] Native „ ¦ 808 1 1 1 (. Prisoners • 365 1 ... 1 1 I Allahabad. — The station and city lie at the junction of the Ganges and Jumna at an elevation of 316 feet above sea level. The city is on the left bank of the Jumna, and contains a population of 74,671. The station, commencing close to the city, extends for several miles over the triangular area. In addition to the military force there is a large community belonging to the East India Railway Company, and many residents connected with the offices of the Government of the North- Western Provinces, of which Allahabad is the capital. The district which extends on both sides of the two great rivers has an area of 2,794 square miles, and a population of 1,382,826. The garrison consisted of E. Battery, 19th Brigade, Royal Artillery, No. 7 Battery, 23rd Brigade, Royal Artillery, both in the old barracks known as the Papamhow lines ; the 2nd Battalion, 19th Foot, occupying the new double-storied barracks, with the exception of 161 men at the fort, the 11th Bengal Cavalry and 33rd Native Infantry. The native non-military population of cantonments is returned as 6,450. 11. Details of the outbreak. — On the 12th of January the Magh Mela Fair, which is held on the dry bed of the rivers underneath the fort, just at the point where the two meet, commenced, and, as usual, attracted crowds of pilgrims from all quarters, but no cholera was reported either here or from any part of the district in this month. In February 17 deaths were reported, of which seven occurred in the city and suburbs, and the others on the east of the district bordering Oudh. In March there were 239 deaths, of which one only was in the city. The main force of the disease fell on the mortuary circles bordering Oudh, but there were a few on the right bank of the Ganges. In April the deaths from cholera were 1,894, of which only 10 were in the city and suburbs ; the disease in the district observed a general distribution very much the same as it had been in March. In May the number of deaths fell to 1,034, of which six occurred in the city and suburbs. The disease was not widely spread on the right bank of the Ganges, but in one or two places here it was severe. In June the deaths numbered 299, of which only three were in the city and suburbs. In July, 39, of which 12 were in city and suburbs, chiefly in the last days of the month. In August, 46, but it is to be observed that of these 44 were in the city and suburbs. In September, 26 deaths, of which six were in the city and suburbs. In October, 18, all of them in the rural circles, one followed in November and two in December. In the Artillery, (Assistant Surgeon J. B. Hamilton, M. B.) there were only two cases, one on the 19th, and the other on the 28th April, the latter was No. 21, Royal Artillery. a man who had been for a week in the fort. Of six blocks of buildings in the lines only one was attacked. Besides the two cases above noted there were 11 others of a suspicious character occurring at intervals between the 9th April and 2nd September. They occurred, two on the 9th April, two on 12th, one on 11th May, one on 30th July, one on the 3rd, one on the sth, one on the 17th, one on the 22nd August, and one on the 22nd September. Among the Lascars and in the Royal Artillery Bazaar three persons also were attacked, one on the Bth April, the second on the 13th, and the third on the 16th. In the 2-19 M Regiment, (Staff Surgeon W. Ashton, M. B.) the first ease occurred in the cantonment on the 25th March, and a second on the 3rd April. No. 22, 2-ietH Regiment. Qn the 28th Apri} & man wag in the Tfae 4th August... 1 13th August... 3 frd May and the 4th again furnished each one case sth „ ... 2 14th „ .3 from the cantonment. On the 6th there was a second and 7th „ 2 15th „ ... 3 last seizure in the fort and on the Nth two cases in the y*k " ¦• J^th " •• J cantonment. There was then an interval of over 10 weeks, loth " ... 11 19th " ... i when, on the 4th August, the disease re-appeared in the reginth „ ... 8 30th „ l ment. Including men, women, and children its course from I—l '1 ». >•• * fhio /in 4-£\ nroo oo c*r\r*nrr\ in 4-Yi Ck tyi orfPl n this date was as shown in the margin. 56 [ Section I NINTH ANNUAL REPORT OF THE Notes on outbreaks, Allahabad. The total numbers of cases and deaths throughout the year are shown in the following- statement : — Strength. Admissions. Deaths. Officers ... ? ..24 1 1 Men ... ... ... 643 43 24 Women ... ... ... 98 6 5 Children ... ... ... 190 8 7 58 37 The disease was widely distributed over the lines. The cases were admitted from 24 different buildings, only six escaped. Diarrhcea was not prevalent. With cholera fevers increased. In the week ending 2nd August there had been seven fresh cases. In the next week there were 19. The regiment had been nine years in India and had been in excellent health, but immediately before the outbreak a few cases of dengue appeared, and this disease was very prevalent in the latter half of August and beginning of September. In the lltk Bengal Cavalry, (Assistant Surgeon W. Finden) whose lines are at Papamhow, beyond the Artillery, there were no cases of cholera either among the men or the followers. In the 33rd Regiment, N. 1., Assistant Surgeon E. R. Johnson, with a strength of 582 w« oq «^ w o^r«n« + w - sepoys and 488 followers, the first case occurred on the Ist No. 23, 33 rd Regiment, a. x. ¦»/ t, , ? . ¦, . -, ? -?.,1 , i . „ . . May. .Between this date and the J4tn, there were in all eight cases, four among the sepoys and four among the followers. No further seizures took place till August, when, between the 12th and 17th, there were four, three among the sepoys, and one a follower. Then there was another lull till the Bth of October, when a follower was attacked, and on the 13th another, the last case. Among the Railway employes, (Surgeon John Jones), numbering some 800 Europeans and Eurasians and 3,000 Natives, the first case occurred on No 24, East Indian Railway. . i n „.-, T1 -? ? « , . ? m the 27th July, when two men were attacked in different rooms of the same building, within a few hours of each other. Altogether up to the 11th August, when the last seizure took place, there were 12 cases, of which 11 proved fatal. There were besides about 20 cases among the native servants, but no account of them has been kept. The disease was confined to no particular quarter, but appeared at distant points over the area occupied by the railway barracks. Of 131 separate buildings seven furnished cases. Among the general civil residents of the station, European and Eurasian, estimated at about 2,000, there were nine deaths from cholera, the first No. 25, general civil residents. . _ . , ' .. 10 ,, - , „, ? , . '? n , „. having been on the 12th August, and the last on the 21st September. Among these were several persons occupying a high position in society. Diarrhcea of a severe form was prevalent. In the Central Prison, (Assistant Surgeon R. Jameson, M. D.) with a strength of 1,592 prisoners and 142 men composing guards, no cases occurred except one among the police on the 16 th May. No. 26, Central Prison. In the District Jail, with 862 prisoners and 85 of a guard, there were seven cases and five deaths. The first three occurred in a gang employed in the Alfred Park, between 2 p.m. of the 27th and 1 p.m. of the No. 27, District Jail. 28th April. These three men slept side by side in one of the barracks in the park. On the 6th August a man was attacked while on out-gang at Government House. On the 28th, another was seized in hospital, and another in the cells. On the Bth September the last case occurred in the under-trial ward. ///. Importation and communication. — The first two cases which came under medical observation in the Allahabad district, occurred at the fair on the 31st January. Cholera had, for some time previous, been prevalent in Oudh, and a representation was made that it would be dangerous to allow the fair to be held. To this, however, the civil authorities would not assent, Dr. Jones, the Civil Surgeon, is of opinion that the disease spread subsequently by means of the pilgrims, but there are no detailed facts in support of this idea. In the Artillery, Dr. Hamilton was unable to find any fact leading to the suspicion that the disease had been imported, or that it had spread from one person to another. The first case was treated in a ward of the hospital without any bad result. In the 2- 19 th there was the same want of evidence. The men of the regiment are said to have been in the habit of frequenting the railway barracks, but on the 2nd August, shortly after the first case occurred in that part of the station, all further communication was prohibited. From the Civil Surgeon I learned that some soldiers of the 2-1 9 th had been drinking on the night of the 31st July with the railway man attacked next day, but they were not seen about these barracks after his seizure. It was necessary to employ soldiers of this regiment to attend on the sick, as the native servants supplied would not remain. Of 30 soldiers so employed, and they were all volunteers, five were attacked with cholera, and four died. They all lived in a barrack by themselves, close to the barrack which was used as a cholera hospital. Both these buildings belong to the new artillery lines, and were vacant when the outbreak commenced. The first of these orderlies was attacked on the 11th August, the room was not vacated as it was inferred that the disease was due to infection. Cholera 1 s^nitAßY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- -J 57 Other cases among them followed on the 12th, 13th, 15th, and 16th. On the 10th September the men re-joined their several companies in camp. Of the 30 Notes on outbreaks, Allahabad. men 25 were in attendance on cho i era cases for periods varying from 26 to 38 days, and all these escaped. The five who were seized were on this duty for from three to six days. One of the sweepers of the cholera hospital was attacked. The only officer attacked was one of the Assistant Surgeons, Dr. Dickson. He was suffering from dengue at the time, and was in a weak condition. He had not been in attendance on any cases of cholera. In the 33rd Native Infantry also Dr. Johnson could not trace the disease to importation. The first man attacked had been attending a comrade in hospital ill of diarrhoea. He had been employed on this duty for six days, he slept in hospital and spent the greater part of his time there. On the 30th April he returned to the lines, was seized with diarrhoea that evening and admitted next morning with cholera. On the same day, the Ist May, another patient in hospital was seized. In August an attendant on a cholera case was also attacked. Both the men came from one end of the same barrack. The cases among the followers occurred in different parts of the bazaar, and no connection could be traced between them. Some died in their huts, and the disease did not spread among their occupants. In the railway barracks it was at one time believed that the disease had been imported by one of the boys from St. Peters' College, Agra. The facts are these — On the night of the 6th July a boy named Elias arrived at one of these barracks, having left Agra that morning. He was accompanied by three others, Eastwood, Carberry, and Shea. Elias had been purged on the way. Diarrhoea continued during the night, and next morning he was evidently laboring under cholera. He died on the 9th. The family occupying the quarter into which Elias was received, consisted of a man and his wife and 10 children. As soon as it was known that Elias was suffering from cholera, the children were sent away. None of them were attacked. On the 7th Shea also suffered from severe diarrhoea and vomiting. The family consisted of the father, mother, and three children, none of them were attacked. Eighteen days after Elias' death the first case of cholera appeared among the railway people in a barrack some distance off, and with the inmates of which I was informed that there had been no communication whatever. During the outbreak no connection could be traced between different cases. Of 16 persons constantly employed to attend the sick in hospital, none suffered. Through a mistake the clothes and bedding of some of those who died of cholera, and which were much soiled with cholera discharges were sold by auction and distributed among the residents. No evil results followed. It may be noted, also, that three boys, sons of the apothecary, returned to their father from St. Peters' College, Agra, on the night of the 7th July. They went to a friend in Agra for the day previous. None of them showed any symptoms of illness. Regarding the ordinary civil residents of the station there was no reason to suspect importation. The boy Carberry who came from Agra on the 6th with Elias was attacked with vomiting and purging next morning. The family consisted of eight persons besides himself. No precautions were taken, the boy slept in the same room with four of the others, and none of the household were seized. The boy Eastwood who accompanied Elias and Shea from Agra was also seized on the following morning, the 7th, and died the same day. None of the other members of the family, which was large, suffered. In the case of the Central Prison an attempt was made to isolate the inmates, but no real isolation was possible as the guard were constantly at their houses in the neighbouring villages, in some of which cholera was for a time very prevalent. The wife of one of the warders, Costello, had gone to Agra to see after her two children on the morning of the sth July. When she went to St. Peters' College to visit them she found several of the boys ill with cholera. She immediately removed her own children and remained at a friend's house in Agra that day. At night one was attacked with cholera and the other severely purged. On the 6th she returned to Allahabad in the same train which brought Elias, Eastwood, Carberry and Shea. Both the children recovered. Neither in their family nor in the neighbourhood did any further cases follow their arrival. In the District Jail also isolation was practically impossible. Dr. Jameson could find n< evidence of importation nor could he trace any connection between the different cases. Nun* of the attendants on the sick were attacked. IV. Meteorology. — Dr. Ashton mentions that "6| inches of rain fell on the night of the 3rd and 4th." The first case of the outbreak occurred on the evening of the 4th August. V. Local conditions. — The drainage is all surface, and in some parts of the station, especially in the lines of the European Infantry Regiment, is not so good as it ought to be. Water. — In the Artillery the water for drinking is drawn from one well. The same system was adopted in the 2-19 th, and here it was passed through a large Atkins filter before use, and then distributed in earthen vessels to all the barracks. In the other communities the supply was drawn from several sources, but no connection could be traced between the cases and the use of any particular water. Those who were attacked and those who escaped drew from the same source. In the Native Infantry lines, 2 of those attacked drew their water from the Ganges, 3 from the hospital well, 3 from the well in the right wing, 3 from the quarter guard well, and 2 from a private well in a Subadar's compound. No pumps are in use. In no case was there any overcrowding . The ground in the vicinity of the artillery was reported to have been in a very filthy state. It is beyond cantonment limits. In no other instance was any complaint made of want of cleanliness. [ Section I 58 NINTH ANNUAL REPORT OF THE VI. Preventive measures. — Movement. — In the Artillery no movement was made beyond evacuating the quarter in which the woman was attacked. Notes on outbreaks, Allahabad. The detachment of the 2-1 9 th quartered in the fort was moved into camp on the parade ground within the walls when the two cases, one among them and the other in the Artillery, occurred on the 28th April. On the 6th May a seizure took place in these tents. It was the only one, and they returned to barracks on the 13th May. In August the movements of the 2-19 th at first were made into spare buildings. On the 10th August three companies went into camp at Begum Serai, 4 miles on the Cawnpore road, there had been ten cases in these companies before leaving cantonments. Five more followed at Begum Serai, one on the 13th, two on the 14th, and two on the 16th. On the 18th they moved by rail to Serajpore, 30 miles down the Jubbulpore line, one man was admitted on the 19th, but no other seizures took place. They remained in this camp till the 16th October, and then returned to barracks in excellent health. On the 14th, 15th, and 16th August three other companies moved by rail to Burgurh, 40 miles down the Jubbulpore line. There had been 29 cases among them before leaving cantonment. With the move the disease entirely disappeared. They remained in camp till the 19th October, and then returned to barracks much improved by the change. On the 17th and 18th August, a mixed camp of men, women, and children moved into tents on the rifle range about half a mile from the lines. Among them there had been 1 8 cases in barracks. Two followed in camp, one on the 18th August and the other on the Ist September. Of the 58 cases, 49 occurred in barracks and 9 in tents, viz., one in fort, five at Begum Serai, one at Serajpore, and two at the rifle range camp. In the 33?y/ Native Infantry the hospital was vacated as soon as cholera appeared, and the inmates sent on leave for a month. In the Railway lines the barrack in which the two first cases appeared was at once vacated, and a case afterwards occurred among the inmates after their removal to another quarter. No other building was vacated. In only one instance did another barrack furnish more than a single case, and here the attack of a mother and her three children was almost simultaneous. In the District Jail, the barrack occupied by the prisoners who were attacked in the Alfred Park was vacated, and no further cases occurred. In the other building's, both here and in the jail, a second case was awaited before removal, and as no second case occurred in any one barrack, no movement was made. VII. The previous history of Allahabad in respect to cholera has been most unfavorable, as shown in the following statement : — Statement of Cholera at Allahabad, 1826 to 1872. Number or Cases. Yeabs Average c . . Total Total Strength. >; jg . «5 g Cases. Deaths. I i •§ ¦= ? o , 1 1 1 I 1 . . . , c 9,. f European Troops - 85 ; 1 1 18J/ 1 Native „ - B,lol* ... 1 4 4 6 11] 18 11 1828 Native „ - 7,832* ... 1 1 ... 7 I 5 11 26 12 2 65 19 1829 Native „ - ... 1 2 ... 1 1 5 ... 11 ... 12 1 1830 Native „ - 6,656* 1 1 2 2 1831 Native „ - 4,969* 3 13 2 9 IQ o 9 f European „ - 169 ... 1 1 ia^[ Native „ - 4,615* 1 1 2 1 , „,„ f European „ - 94 ... 1 1 2 1066 { Native „ - 4.802* ...... 1 1 ... 2 ... 14 5 23 12 1834 Native „ - 4,665* 4 5 9 6 1835 Prisoners - ... ... ... 1 1837 Prisoners - ... „ ... 1 1838 Prisoners - ... „ "" ... M , 16 1839 Prisoners - ... 5 1840 Prisoners - ... ... ... M 9 1841 Prisoners - M< ... ", 14 1842 Prisoners - ... Mi ... m Mi ... " .. 16 1843 European Troops - 837 17 5 22 10 1841 f Euro PeailP eai1 » * 908 2 ... "2 21 36 ... ... ... 61 30 ( Prisoners - ... ... 3 ! European Troops - 248 2 "9 1 ".. ... ... ... 12 8 Native „ - 2,326 ... 114 4 1 1 12 4 Prisoners - ... 1 ... 67 ,o 4fi f European Troops- 490 ... 2 ... ... 1 ' ... ..'. 3 2 j.o±u^ p r i soners . j 1847 Prisoners - ,„ [\\ '" '' ' " "[ 2 1848 Prisoners - ... §ii m [" '[[ '[[ "[ '" '" 11 f European Troops - ... \" " , m "J mi 32 "2 '.'.'. ... 34 26 ia ± J { Prisoners - 3g 1851 Native Troops - 2.105 1 I " "i '4 1 J ,M, M '" ... 8 2 IMQ f Native „ ¦ 2,076 , ... 11 8 1 ••• ..." ... 20 7 lbo6 i Prisoners - j 14 ?A Native Troops - 1 2 3 ! I j ... 1 ... 7 3 130 *|_ Prisoners - 874 2 ... 8 ... 1 9 4 j 1 ? Strength of the Allahabad Circle. 59 Cholera SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- Notes on out- Statement of Cholera at Allahabad, 1827 to 1872— continued. breaks, Allahabad. ' Number of Cases. . ._„_,. Total Total Ybaes. *™$L , j i i Cases. Deaths. lfi .-C Native Troops 1 1 1 3 1 ... 1 •» 8 2 1855 [Prisoners - 1,384 26 38 64 33 lc . r f Native Troops - 2,025 12 4 3 2 U b 18o6 i Prisoners - 2,039 1 29 ... ... 30 19 1857 European Troops 2 3 — 1 1858 f Euro'petn Troops 4,788f 4 1 5 2 1 2 2 ...... 4 2 ... 23 11 ( European Troops " 2,504 1 Z. Z 38 111 18 18 52 1 "a ... 1 238 129 IB fe ": & ••:: ••• :~&s>"ja fi ~ .: » « C European Troops - 2,460 ... 2 20 19 2 ... 2 2 1 1 5 ... 54 27 18605 Native „ - 706 3 8 8 12 22 14 I Prisoners - 1,595 10 1 2 ... ... ... ••¦ 13 8 ,_, f European Troops- 1,277 4 2 20 4 ... 2 32 21 1861 [Prisoners - 1,730 56 3 6 1 66 26 IQPO f Native Troops - 488 1 1 * \ 1862 1 Prisoners - 1,979 ... 1 1 2 1 ( European Troops - 1,054 1 3 ... 26 24 54 44 18635 Native » - 643 * 3 l ••• -: 2 "i i o i (.Prisoners - 2,233 ... 1 ... 2 4 ... 1 1 9 5 C European Troops - 950 2 11 W 18645 Native „ ¦ 518 '. 2 ... ... 2 £ I Prisoners - 2,192 1 ... 101 ... 1 ... - 103 28 lc _f European Troops- 1,013 6 ... 5 3 - 14 10 1865 1 Prisoners - 2,346 - 8 8 2 1866 European Troops - 1,020 3 4 1 8 4 r European „ - 958 2 26 28 18 1867] Native „ - 627 7 7 4 C Prisoners - 1,985 24 3 27 14 r European Troops - 910 1 1 •• 18685 Native „ - 785 1 1 ... 1 ... 2 1 6 ( Prisoners - 1,848 2 - 2 2 r European Troops - 1,141 ... 1 32 14 20 26 11 41 148 106 18695 Native „ - 901 1 2 2 4 6 15 7 I Prisoners - 2,376 8 11 19 7 , O - A ( European Troops - 484 ... 1 1 187O l Native „ - 824 ... 1 1 1 , 0 ,.i ( European Troops- 993 3 3 2 1 9 8 1871 [ Native „ - 958 1 »• 1 1 f European Troops - 1,378 1 3 5 49 1 59 38 18725 Native „ - 904 4 3 4 ( Prisoners - 2,521 3 2 2 7 5 » Besides these there were 52 deaths from the disease among the Madras Fusiliers in June. f Including those at Cawnpore. Shajehanpoee is one of the districts of Tiohilcund, and lies to the south and east of Bareilly. It contains 2,328 square miles, and 945,705 inhabi- No. 28, Shajehanpore. tantg> The town has a population of 70,000. The cantonment was garrisoned by the 2nd Battalion of the Ist Foot and a Wing of 45th Native Infantry. //. Details of the outbreak. — In the district a few deaths have been entered in each of the first six months of the year. In July they rose from 1 2, the maximum in any one of the previous months, to 66. In August they were 1,318, in September 1,214, in October 1,449, and in November 306. They then again declined rapidly. The total mortality assigned to cholera throughout the year was 4,403. In the city which is included in the above the disease was severe s and long continued. In August alone there were 502 deaths here, and in September 19. In the garrison there were only 11 cases, six among the Europeans, and five among the natives. They occurred, two on 6th August, one on the 7th, two on the 10th, two on the 14th, one on the 15th, one on the 17th, one on the 21st, and one on the 6th September. The disease pursued an erratic course. Surgeon H. Kelsall mentions that from the Bth to the 14th August several men of the H. Company from No. 8 barrack suffered from diarrhoea, in one or two instances attended with vomiting. 111. Importation and communication. — The first case could not be traced to importation, nor was there any evidence to lead to the belief that the disease was spread by contagion. None of the attendants on the European cases were attacked. One of the sepoys was seized in hospital while attending a case of cholera, but the period of attendence and other particulars are not stated. 60 [ Section I NINTH ANNUAL REPORT OF THE IV. Meteorology. — Dr. Harris, the Civil Surgeon, and holding the medical charge of the Wing of the 45th Native Infantry, states that there was Notes on outbreaks, shajehanpore. nothing . pecu liar in the meteorology of the year. Dr. Kelsall mentions that the "prevailing winds were from the east." V. Local conditions. — The drainage of the station is reported to be good and its general sanitary condition excellent. Water is of good quality, drawn from wells. There was no overcrowding. VI. Preventive measures. — Quarantine. — It is stated that the civil authorities tried to stop travellers at fords or bridges on roads leading from infected parts of the district, but there does not appear to have been any attempt at a regular quarantine. Movement — On the 14th August the married families of the right half battalion of the Royal Scot, 90 in all, including men, women, and children, moved into camp about £ miles to the north of the station upon the outer circular road; only one case occurred there. On the 11th August the 45th Seiks moved into camp 5 miles east of cantonment. The general health of those under canvas seemed rather to improve by the change. VII. Previous History. — Has generally been very favorable. Statement of Cholera at Shajehanpore, 1845 to 1872. Number of Cases. Y _. nR Average . . Total Total IEAKb- Strength- . £ _g S g Cases. Deaths. iiiiiigiiiii , v , - f Native Troops - 1,048 .„ 1 1 imo { Prisoners - 1 1851 Prisoners - ... 2 lfi . q f Native Troops - 963 5 5 2 lbod ( Prisoners - 28 , Q ..f Native Troops ¦ 1,033 2 2 18ot) i Prisoners - 700 1 102 19 1 123 29 C European Troops - 688 1 1 1 18595 Native „ - 946 1 1 1 (. Prisoners - 304 1 ... 1 , CAn C European Troops - 510 1 3 4 3 l&W p risoners . 331 i i 1861 Prisoners - 524 1 2 3 1862 European Troops - 630 ... 1 1 1 3 3 1864 Native Troops - 309 1 1 r European Troops - 472 ~ 23 1 24 19 1867} Native „ ¦ 207 2 3 5 3 C Prisoners - 277 1 ... 3 18 22 6 C European Troops - 584 1 1 2 18693 Native „ - 337 1 1 ( Prisoners ¦ 295 1 1 1 1870 Native Troops - 359 1 1 ( European Troops - 476 5 1 6 4 1872 ) Native „ ¦ 242 5 5 3 ( Prisoners - 254 1 1 1 " Chuckrata. — (Surgeon J. B. Roe, M.8.), a hill station No. 20, Chuckrata. situate over the Western Doon. In 1872 it was occupied by the 92nd Highlanders. 11. Details of the otdbreak. — There were five cases in the Regiment, two on August 12th, one on 15th, one on sth, and the last on 7th September. " The progress of the disease was erratic in the extreme, it would not have been possible to separate the cases more widely from each other than by placing them where they actually did occur/ Of the five cases three recovered. There was no tendency to bowel complaints. Only two cases occurred in the bazaar and both recovered. In some of the surrounding villages there were also cases. Many of them were in persons who had recently returned from Deyrah. ///. Importation and communication. — " There was constant daily communication with Deyrah via Kalsi where the cholera prevailed," but there is no evidence to show that the first case was due to importation. "No connection could be traced between the earlier cases and the subsequent ones. None of the hospital attendants, either Europeans or Natives, suffered in any way. When each case occurred, four of the men occupying the same room accompanied the patient to the cholera ward and were kept isolated along with him." IV. Meteorology. — " The barometric pressure was rather below than above the average. There was a heavy fall of rain the day before the two first cases occurred, the day was foggy, but not excessively so. The direction of the wind was northerly." V. Local conditions. — There was no overcroioding. VI. Preventive measures. — Quarantine was established on the Jumna on the 6th August, but it was afterwards ascertained that cases had occurred on this side. When this became Cholera ] gANITART COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 01 known, an inner line of quarantine was placed closer to the station on the Bth. The inmates _ , of huts where a case occurred were immediately removed Notes on outbreaks, Chuckrata. and p l aced in tents . No further geizures took p l ace among them after removal. VII. Previous History. — Chuckrata has been a station only since 1869. No case of cholera has occurred in any year except one in the month of June 1870. Deybah. — Assistant Surgeon G. G. Maclaren, Civil Surgeon. — The district lies at the foot of the Himalaya, between the Jumna and Ganges as these rivers emerge from the hills. The area is 1,020 square miles, No. 30, Deyrah. and the population 116,981, The town of Deyrah has about 14,000 inhabitants. In the cantonment there was only one Regiment, the 2nd Goorkhas. 11. Details of the outbreak. — Daring the first six months of the year, only two deaths from cholera were registered in the whole district, one in February and one in June. In July the number rose to 54, and in August to 175. It then rapidly declined. Of the deaths in August 163 were in the city. In the 2nd Goorkhas (Surgeon-Major F. P. Allen) eight sepoys were attacked and all died. Among the followers ten cases and six deaths. Diarrhoea was very common before and during the outbreak. The disease was general in its distribution. The dates of the admissions from cholera and diarrhoea are given in the annexed statement in which the deaths from cholera in the town are also entered. Cholera at Dei/rah in 1872. 2nd GOORKHAS. Date. Choleba cases. Diabbhcea cases. Cholera deaths in the Town. Sepoys. Followers. Sepoys. Followers. i July 26th ... ... ... 1 27th 28th ... ... ... 2 29th 30th ... ... ... 1 „ 31st ... ... ... 1 August Ist ... ... ... ... ... 12 2nd ... 1 ... ... ... 11 3rd ... ... ... 1 ... 15 4th ... ... ... 8 sth ... ... ... ... ... 12 6th ... 2 1 ... ... 9 7th ... ... ... 7 Bth ... ... ... ... ... 6 9th ... ... .., 4 10th ... ... ... 6 11th ... 1 ... 2 ... 3 12th ... ... ... 1 ... 5 13th ... . ... ... ... 1 14th ... ... ... 1 ... 3 15th ... ... ... ... ... 4 16th ... ... ... ... ... 4 17th .. ... ... ... ... 4 18th ... ... 1 ... ... 6 19th ... 2 3 ... .. 6 20th ... ... 1 ... ... 2 21st ... 1 1 ... ... 9 22nd ... ... ... 1 1 3 23rd ... ... 1 ... 2 2 24th ... ... ... ... ... 6 25th ... ... .. ... ... 12 26th .» .- ... ... ... 1 27th ... 1 ... ... ... 2 28th ... ... 1 29th ... ... 1 30th 31st September Ist ///. Importation and communication. — The first case of undoubted cholera in the Doon was that of the boy O'Neill from St. Peters' College who was suffering- from the disease on the 6th July on his way to Mussoorie, but there is no evidence to connect any other seizures [ Section I 62 NINTH ANNUAL REPORT OF THE with him. The disease was general over the station and confined to no particular locality. No instance is adduced in which there was reason to believe Notes on outbreaks, Deyrah. Notes on outbreaks, Deyrah. that the cho]era spread from the sick> None of the attendants, so far as stated, were attacked. IV. Meteorology. — The rain-fall was less than in the preceding year, but the maximum range of the thermometer below that of 1871. "No steady down-pour of rain took place, whilst the valley was enveloped in a dense fog, such as I never before noticed in the Doon. The rains were not ushered in with the usual storms. Little rain took place comparatively in August till the 18th, when it rained continuously till the 20th. In the evening the clouds had a peculiar appearance exactly similar to a distant dust storm in the plains. What little wind there was came from the east. Heavy rain with high wind accompanied by thunder and lightning took place on the 21st August. After this only three admissions took place among sepoys and followers/ V. Local conditions. — The drainage is reported to be good. " The water-supply is from a canal which "in the rains is liable to receive the surface drainage from the ground above it, and impurities from cattle. It is generally very full in the rains and runs at a rapid rate." There are two canal streams at Deyrah, which issue from the hills at a distance of nearly 4 miles from one another and run in altogether independent courses, never approaching each other nearer than one mile's distance apart. The one supplies the cantonments and the other the city. Both of them run very rapidly. In the cantonment there are no wells and in the town only three, of which one has fallen into disuse, one supplies the prisoners only, and the third is little, if at all, drawn on. The men had ample space. VI. Preventive measures. — Movement. — Affected buildings were at once vacated, and the inmates placed in tents. No case occurred among them after removal. TIL Previous History. — In 1869 the troops and prisoners at Deyrah escaped, but in the great epidemics of 1845, 1856, and 1861, they suffered more than in 1872. Statement of Cholera at Bey rah, 1836-72. Number of Cases. V Average C y . Total Total IEAES> Strength. >> g . _g S3 Cases. Deaths. 11Iisi i 1 I | I I 1836 Prisoners I 1 1838 Ditto 10 1810 Ditto 1 ,<,.-(¦ Native Troops ... 1,049 .„ 1 1 14 5 ... 12 10 1845 [Prisoners 1 1850 Native Troops ... 1,320 12 1 4 1 IQKO f Ditto ... 564 41 16 I 1 I 58 33 18W [ Prisoners I 10 1855 Native Troops 1 ... 2 3 ia/;fi f Ditto ' ... 755 32 32 23 lBob [ Prisoners ... 39 1 ... 1 2 1 1858 Native Troops ... | 2 ... 1 3 1 IHPI f Ditto ... 750 2 1 18 6 1 28 7 LBt)i I Prisoners ... 66 | ... 13 1 1 15 6 1862 Native Troops ... 752 3 ... ! 3 3 1865 Ditto ... I 100 1 ... ! 1 1867 Prisoners ... 41 4 8 ... j 12 2 , Q * 9 < Native Troops ... | 415 I 1 8 1 ... 10 10 LB/Js i Prisoners ... 58 j 2 l| 2 5 4 HooitKEE lies nearly due north of Meerut. The garrison of the cantonment consisted of the head-quarters and wing of the 109 th Foot, the headquarters and six companies of Sappers and Miners and the 41st Company, Royal Engineers. The non-military portion of the population is returned as 1,128. The town of Roorkee, which is adjacent, has 7,000 inhabitants. The district of Seharunpore, in which Roorkee is situate, has an area of 2,227 square miles, and a population of 880,663. //. Details of the outbreak. — In the district deaths from cholera were reported in every month of the year. In August they reached a maximum of 694. In September they were '366. The total for the year was 1,351. At the annual fair at Hurdwar, which lies in this district, one or two suspicious cases were seen. Dr. Garden, the Civil Surgeon, states : " During the recent fair two natives of Jummoo were attacked with diarrhoea or mild cholera, and one died in 20 hours from collapse, though he had passed but two yellow stools and vomited only five or six times. I should have thought but little of these cases had not a body been se.nt in to this station by the police for examination. This was done in my absence by the Sub- Assistant Surgeon, and from his description the contents of the intestines were choleraic. He and his companion were both natives of Jummoo, and had been taken ill at the same time with similar symptoms. The second man is now nearly well. The rest of the party deserted Cholera 63 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic them on the 12th and made their way out of the district as fast as possible. Up to the present time I have had no grounds for supposing that Notes on outbreaks, Roorkee. cerfcainly nQ cageg haye occurred amongst the other pilgrims." In the vicinity of Roorkee the first cases reported were at Jelalpore Dada on the 25th June, when 29 cases and 20 deaths were said to have occurred in one day. On the sth August the disease was known to be at Nuseerpore Afzulpore, 9 miles off, but the surrounding neighbourhood seems to have kept clear until the loth August, when it broke out at Bailra very virulently. Up to the 26th eight villages had been attacked. On that day there were three in the town of Roorkee. In 60 places, nearly all within 12 miles of Roorkee, which suffered from cholera, and of which the population was 78,619, there were 777 cases and 323 deaths. Dr. Planck, the Sanitary Commissioner of the North- Western Provinces, who enquired into the circumstances at my request, states that " many more villages with a much larger total population equally near to Roorkee, never suffered at all/ In the 109^ Regiment (Surgeon Major R. Thornton, from whose report many of the above particulars are taken) there No, 31, 109 th Regiment, were seven cases, of which three were fatal. The first was on the 2nd September, a man in hospital was attacked. "On the previous day there had been a great accession of disease in the villages around the cantonment. From four cases on the 31st August to 18 on the Ist September, and on the 2nd there were ten cases exclusive of the European/-' On the 4th another man in hospital who had been in the same ward with the first case. On the Bth a third also in hospital, and had been under treatment since June. On the same day a Private in the barracks and a woman from the married quarters. On the 9th another woman was attacked, and on the 16th one of the men. Among the Sappers and Miners (Surgeon A. Eteson) there were four attacks between the 16th No. 32, Sappers and Miners. and 21st September, two of which were fatal. These cases are tabulated in the following statement, in which all those known to have occurred in the town are also entered. Side by side with them, it may be well to place the weekly admissions from fever and diarrhoea. Fevers were not prevalent. In the week ending the 26th July the medical officer of the 109 th remarks — "Several men have come to hospital this week, complaining of colic and diarrhoea, which is apparently attributable to the filters in the barrack room not being kept clean." In the week ending 30th August there were two fatal cases of diarrhoea. The return for the week ending 25th October shows two deaths from " remittent fever." They were in hospital with ague, n were both attacked at the same time, and after being relieved from the collapse stage, appeared much better and passed a tolerable night until 4 a.m., when they asked for a drink. On receiving it they lay down again ; Stedman died immediately, and Jones two minutes after." The admissions into hospital on account of fevers and diarrhoea among the troops at Roorkee are given in the following statement, in which the dates of the cases of cholera also are entered. Statement of Cholera at RoorJcee in 1872. ___ _____ — _ 4 ADMISSIONS INTO HOSPITAL FROM g" CO _______ o| 1 , 8 S Fevees. Diaeehcea. o « I W *1i 1 " ? 1 i 109 th Regiment. Sa P? ers aud . Sappers and I I I ! St ,.o UB tb 8 5oi t gJJUXm M * B **- t SK H O rH I CO I 26th July ... * _ 2 2 2nd Augt... * 3 6 2 9th „ ... * 2 9 2 16th „ ... * 1 5 2 23rd „ ... * 2 15 ... 1 26th „ ... 3 27th ? ... 4 28th „ ... 1 29th „ ... 1 30th „ 7 4 I 1 31st „ Ist Sept 2nd „ ... 1 ... 1 3rd „ 4th „ 1 sth „ 6th „ 4 4 2 7th „ ... 2 Bth „ ... 2 ... 3 9th „ ... 3 ... 1 * Week ending. f No deaths recorded J Including women and children. NINTH ANNUAL REPORT OF THE [Section l 64 bSks BRoorkee" 8 Roorkee" Statement of Cholera at Roorkee in 1872 — continued. £ ADMISSIONS INTO HOSPITAL FROM i & , g I J JS "a § Fevers. Diaerhcea. o ,2 -'¦¦¦'¦¦ — - — . -.. .¦ . i .. - . - - ...-. ¦ — — — 1 1 ?-...,-¦ *S « 2 109 th Regiment. Sa PP ers a " d . Sappers and a o £ ef « n em j. Miners. 109 th Regiment. Vf. | Strength 501f. Strength 728 . Miners. Sept, 10th... 2 „ 11th... 2 „ 12th... 3 „ 13th .'.' ... 3 12 3 „ Hth „ 15th „ 16th... 1 ... 1 1 „ 17th... 1 „ 18th... 3 ? 19th... 4 „ 20th ... ... 2 9 11 2 ? 215t... 5 .. .. 1 ? 22nd... 2 „ 23rd... 1 „ 24th... 2 „ 25th... 2 „ 26th... 2 .. „ 27th 12 9 1 * No deaths recorded. + Including women and children. ///. Importation and communication. — Dr. Thornton states — " The first case at Bailra was clearly traced to an inhabitant who had been at Deyrah where there was cholera. He returned on the morning of the 15th August and died the same day. The other cases occurred immediately afterwards." The first European attacked " had not been outside the cantonment for a considerable time and was in hospital at the time of attack." None of the attendants on the sick in 109 th are entered as having 1 been attacked. "The introduction of the disease among the Sappers/ writes Surgeon A. Eteson, " is supposed by Dr. Dickson, who was then in medical charge, to be due to the men having* visited the town where cases had already occurred/ None of the attendants suffered. In no instance was there reason to believe that a person sick of cholera spread the disease. IV. Meteorology. — Dr. Eteson observes — " Dr. Murray Thomson, Meteorological Reporter for the North-Western Provinces, has stated that the meteorological character of the year generally was normal. The rain-fall was not excessive, and the monsoon was neither delayed in its arrival nor curtailed in duration." V. Local conditions. — The drainage is reported to be very imperfect. In his remarks appended to the return for the week ending 9th August, the medical officer states — " The drainage around the barracks is most defective. Nothing has been done to clear existing watercourses or to make new. The men in passing from room to room to-day, at the time of medical inspection, had to wade through water, almost up to their knees/ The water is drawn from wells and is of excellent quality. VI. Preventive measures — Quarantine. — On the 17th August it was determined to establish a quarantine round Roorkee. This was carried out by ] 6 chowkedars being placed on the bridges and roads. The town was not included. But people on urgent business passed in and out, and the necessaries of life were supplied from outside. On the 18th, the people having forced the chowkedars and beaten some of them, while some of the chowkedars were convicted of taking bribes, the cordon was strengthened by a line of sentries of the Sappers and Miners. This rendered the quarantine more effective. This arrangement was continued till the 12th September, when, in consequence of orders from the general commanding, the military sentries were withdrawn, three days before they could be replaced by policemen. It could not be re-established till the 16th. " The consequence was/ writes Dr. Thornton "that some of the Sappers went beyond bounds, and the result was three cases among the Sappers and Miners/ Movement. — When a case occurred the affected quarter was immediately vacated, and the inmates placed in tents in cantonment. VII. Previous History. — From 1856 to 1871 the cases of cholera have been singularly few. In no year did they exceed two. The outbreak of Ib 7£ was much more severe than that of any previous one. Cholera 1 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 65 Notes on outbreaks, Boorkee. Statement of Cholera at Roorkee, 1856 to 1872. Number of. Cases. Average . C . Total I Total lEiBS> Strength. £¦ J . J J Cases. ¦ Deaths. 11l _J I|III I | I I I | 1856 Native Troops - ; 587 | ... I ... \ I 1 1 1857 European „ - ; I ... i 2 j | 2* 1858 Native „ - j»•l •« I ... 1 ... ' \ 1 1861 European „ - : 588 | 1 1 1 1864 Native „ ¦ j 895 2 ... 2 1867 „ „ - I 809 2 2 1 ,„,_„(, „,_„ ( European „ - 521 j j ... 7 ... 7 3 IH7Z [ Native „ -! 732 | ... , j ... 4 ... j 4 2 !II ' ' | * Deaths only recorded. Meerut. — The station of Meerut lies to the east and slightly to the north of Delhi. At the time cholera appeared among" the troops the garrison consisted of four batteries of artillery, 2 European and 2 Meerut. Native Regiments. The non-military population of the cantonment is returned as -35,194. In the city, which is about a mile distant, there are 51,000 inhabitants. The district contains an area of 2,361 square miles, and a population of 1,271,454. 11. Details of the outbreak. — On the 12th April one of the men of the Peshavvur Mountain Battery, returning from Looshai Expedition to Abbottabad, was attacked at Meerut with symptoms of cholera. The medical officer is not certain that the case was one of cholera, but it was very suspicious; the patient recovered. On the 17th May there was a death among the native non-military population of cantonment which is returned as having been due to cholera, with the remark that it was of a doubtful nature. The first undoubted case occurred in a native living in one of the cantonment bazaars on the 14th August. On that date there were two cases, but none others are known of till the 24th. In the meantime on the 21st August, the first European soldier was attacked. The number of cases and deaths among officers, men, women, and children of each corps was as follows : — Strength. ' Admissions. Deaths. Coeps - t | i i t 2 ' t t g S o s £ 5 o s j 5 ; o s scoc o Head Quarters, 19th Brigade, | Royal Artillery ... 6 5 j 4 7 j j D.D., Royal Horse Artillery 4 144! 14 26 ... 9 1 7 1 E-F., Royal Horse Artillery 4 lit |16 23 j 1 13 ... ... 1 7 , F-16th, Royal Artillery ... 2 188 115 35 j 1 ... 1 2 1 2 D-19th, Royal Artillery ... 3 125; 17 24 ... 7 ... 1 ... 5 ... 1 4th Queen's Hussars ... 12 423 j 58 89 .. 4 I 1 4 j 1 105 th Light Infantry ... 13 460 1 33 4 7 1 24 3 7 Bth Bengal Cavalry ... 3 256 ... ... ... 1 3rd Regiment, Native Infantry 6 575 j ... ... ... 1 I I __ ' The daily incidence of the disease in the different corpg of the garrison, in the cantonment No. 33, Royal Artillery. No. 34, 4th Hussars. No. 35, 105 th Light Infantry. No. 30, Bth Bengal Cavalry. No. 37, 3rd Native Infantry. bazaars and in the city is contrasted in the annexed statement. There is reason to believe that the cases among the non-military native population is much under-stated. On this point Major General Travers remarks — " The sickness and mortality amongst the natives was very great, and whilst the majority of the population were suffering from fever, and numbers died from that cause, it would appear that the police cannot have succeeded in ascertaining the real number of cases of cholera especially in the bazaars. The difficulties, however, with which they have to contend in this respect, more especially in such large and populous bazaars as those at Meerut are very great, owing to the aversion of the natives to reporting any disease which they know may possibly entail still more stringent sanitary measures." In the absence of a nominal roll of cases for the 105 th Light Infantry, the details of the dates have been taken so far as they are given in the report of the military authorities. In all the lines of the European force the disease is described as having been most erratic in its course, and spread over many buildings. F-lGth, the men of which escaped, occupied the Rocket Troop Lines, and Assistant NINTH ANNUAL REPORT OF THE [ Section I 66 Surgeon Berkeley states that the battery of which he had charge at Meerut in 1869 and which was quartered in these same lines escaped in a like Notes on outbreaks, Meerut. remarkable manner. Cholera at Meerut in 1872. Canton- Royal 4th Hus . 105 th Re- Bth Bengal 3rd Native ? a ?7 ™ al Central Dates. City. meiit Artil- . fc c Infantry . m Canton- p risou Bazaars. lery. 6 ments. August 14 ... ... 1 ... ... ... ... ... • 1 „ 15 „ 16 n 17 „ 18 „ 19 - „ 20 ... ... „ 21 1 ... 1 2 „ 22 ... ... „ 23 1. 2 ... - 2 „ 24 3 1 ... ••• 4 „ 25 ... 3 1 1 ... ... 2 „ 26 ... 3 3 ... 2 l ... ». 6 „ 27 ... 3 5 ... »• 5 „ 28 ... 4 1 ... 12 „ 29 ... 13 3 1 ... 2 ... - 6 » 30 ... ) 1Q < ... 1 1 „ 31 ... | 1U 1 ... 1 1 ... ... ... 2 Sept. 1 ... 16 2 2 ... 5 ... ••• 9 2 ... 8 ... 1 ... 4 ... ... 5 2 3 ... 24 13 ... 7 ... ••• 11 4 ... 9 2 2 . • ... 5 ... 12 3 1 ... ... 4 1 ' „ 6 ... 14 2 ... ... 2 ... ... 4 2 7 ... 15 2 6 ... 2 ... ... 10 8 ... 16 ... 5 ... ... 5 2 9 .. 15 1 2 1 ... 4 4 „ 10 ... 23 3 1 ... 1 ... ... 5 „ 11 ... . 12 ... 3 ... i ... 4 „ 12 ... 8 ... 2 ... • ... ... 2 „ 13 ... 10 1 1 ... ... 2 „ H ... 6 ... i ... ;„ ... i i , 15 ... 1 2 2 ... 1 ... ... 5 „ 16 ... 3 ... 1 ... ... ... J „ 17 ... 4 1 ... 2 .. ... ... 3 „ 18 ...2 13 ... 4 l „ 19 ... 3 l ... 2 ... 3 1 20 ... 4 3 ... ... 2 ... .« 5 1 „ 21 ... 3 1 ... ... ... 1 2 „ 22 ... 2 ... ... „ 23 ... 2 ii ;;; i ... ... 3 1 „ 24 ... 2 ... 1 „ 25 ... 2 ... 1 1 ? 26 -. 3 ... 1 1 ... ... 2 » 27 ... ... 1 ... .:. 1 1 „ 28 ... „ 29 .. 2 1 ... • •" 1 » 30 ... ;;; October 1 1 1 ... „ 2 ... ... ... ;:: ;;; - ... ;;; „ 3 ; „ 4 ; „ 5 ... ... 6 .. 7 ... „ 8 „ 9 „ 10 „ 11 Cholera 1 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 67 The prevalence of fever and diarrhoea, so far as this can be Notes on outbreaks, Meerut. of hy admissions iuto hospital, is shown ill the following' statements : — Admissions into Hospital from " Fevers/ £&1* I I 1 NH ffl ™ f4 j > en ssS w I .£ I d IP | ft H fa^O^ S £ J £ Week ending sth July ...... 2 8 5 ... 4 2 3 12th „ 1 1 i 2 ... 4 2 4 19th „ ... ... 1 ... 3 1 6 ... 3 26th „ ... 3 2 6 2 3 9 4 12 2nd August ... 1 2 5 2 2 8 5 23 9th „ ... 1 3 5 3 8 8 8 18 16th „ ... 2 10 5 4 8 14 5 20 „ 23rd „ ... 12 5 8 j 3 4 25 19 11 30th „ ... 13 15 16 13 12 22 18 40 6th September ... 6 8 9 5 5 7 18 25 13th „ ... 3 9 11 9 5 12 11 13 20th „ ... 3 2 4 6 14 163 27th „ ... 3 4 4 ... 11 8 12 35 „ 4th October ... 5 1 3 1 2 16 2 10 „ 11th ? ... 8 4 5 8 ... 36 5 32 18th „ ...594-84 27 47 25th „ ...2686.1 7 ... 17 „ Ist November 6 6 2 2 14 8 7 i I Admissions into Hospital from " Viarrhoza." W W ? 1 3 SI 1 . 1 * f 1 £S t es ? b' S s^ X =5 6 w * Week ending sth July ... ... ... ... ... ... 1 12th „ 1 19th „ ... 1 26th „ ... ... ? 3 2 „ 2nd August ... 1 ... 1 ... 1 9th „ ... 16th „ 1 1 ... 5 23rd „ ... 1 12 2 „ 30th „ ... 5 2 3 8 „ 6th September & 3 1 4 2 2 13th „ ... 6 3 1 2 ... 1 „ 20th „ ... 1 3 1 27th „ 1 ... 1 1 „ 4th October ... 1 11th „ ... 1 2 2 5 18th „ 2 ... 1 25th „ ... 3 1 ... 4 „ Ist November 2 1 * 3 * There were besides 21 admissions from " Dysentery" in these weeks in the 4th Hussars. Almost simultaneously with the cholera, dengue reached Meerut. "What with fever and dengue, hardly a man was fit for duty, and almost every officer was sick. In the district although a few deaths from cholera were registered in the early months of the year, no authentic case came to notice till the 23rd May. On that date eight cases and four deaths were reported in the north-west corner in the Barote mortuary circle, and there was a total of 26 deaths in that month. In the month of June there was slight prevalence in the west, chiefly near the Eastern Jumna Canal. The total deaths throughout the district in that month were 88. In July the disease almost entirely disappeared. Only thirteen deaths from it were reported from the whole district. Up to the 1 8th August only five deaths were reported in that month, when Sirdhana, with a population of 13,072, a town about 11 miles north of Meerut, was attacked. The total deaths from cholera for the district in August were 127. In September there were 222 deaths in the district spread over many different places widely distant [ Section I 68 NINTH ANNUAL REPORT OF THE from one another. The cases were few in any one place except in Sirdhana and Meerut. In the villages lying between these two places there were no deaths. The half of the district lying to the east of Meerut Notes on outbreaks, Meerut. city escaped entirely until the 20th September, when five deaths from cholera took place in the south-east corner. In October there were nineteen deaths in the district. These also were widely distributed. The total deaths from cholera in the Meerut district were 510. In the station Dr. "W. Moir, the Civil Surgeon, attended ten cases among the civil European residents, a considerable population. In several of them the use of sulphate of magnesia seemed to induce an attack. 111. Importation and communication. — There is no history of importation by pilgrims or of spread by communication. Along the course of the Trunk road and line of rail there is no history of cholera. In the artillery the man first attacked " had not been to the bazaar or out in the district, and the occurrence of the case could not be accounted for in any way," nor could importation be traced in any other sections of the community. One coolie and a water carrier in the artillery died after attending cholera patients, but the dates of these attacks are not given, nor is the time during which they came in contact with the sick specified. In the 4th Hussars (Surgeon C. M. Jessop) none of the attendants were attacked. " A man had been detained in hospital at 5-30 p.m. of the 17th September, being apparently much better, he was allowed to go home to attend on his wife who was sick. He returned at 8-30 with cramp and vomiting, and died nine hours later. His wife sick with similar symptoms was admitted ten hours after his death, and died within twelve hours. These two cases came from the married quarters and arose, it is imagined, from infection by a punkah coolie who, with vomiting and purging, left and died in the bazaar." In the 105 th Light Infantry (Surgeon W. Howard) none of the attendants suffered. "In many instances soldiers were allowed to attend to their wives and children, but in no instance was there a suspicion of disease being spread by contract." With regard to the disease Dr. Howard further observes : " The character of the disease was peculiar, inasmuch as it was apparently caused by malaria, and was so associated with fever, that in some cases it was difficult to say where one commenced and the other ended. In nearly all cases it more resembled an algid form of malarial fever than cholera. To take a typical case : a man is admitted with ague, he has had it every day at the same hour several days in succession, he is shivering, has pain in his whole body, thirst, and great prostration, skin shrivelled, finger nails livid, countenance anxious, pulse small, after admission to hospital in some cases, in others before, purging and vomiting occur, and he at once goes into collapse." IV. Meteorology. — Dr. Berkeley observes : " there was almost constant rain, but not heavy, the rainfall during August being 653 inches, and in September 6*35. There was, as a rule, a very stagnant atmosphere during the epidemic. There were no means of ascertaining the exact direction of the wind. South-west winds certainly prevailed. Fogs were prevalent, and there was a marked absence of electric phenomena." Dr. Howard remarks : v one fact on all occasions asserted itself, that on a fine day and with a west wind cholera decreased, and an east wind with heavy clouds and rain with or without thunder produced an increase, so much so that one could calculate almost the amount of disease that would result." The General Commanding the division in his report states that "up to September Ist the weather had not actually interfered with the movements into camp, but shortly before 5 a.m., on the Ist, heavy rain commenced to fall and continued for four hours." " During the morning of the 2nd heavy rain again fell. On the 3rd there was another heavy storm of rain and wind, and heavy rain again fell in the evening. On the morning of the 19th a heavy storm occurred, which apparently produced an increase amongst the troops as well as the natives." V. Local conditions. — Drainage is decidedly imperfect. The water is drawn from wells which are numerous. The attacks could in no instance be traced to the use of any particular water. There was no overcrowding. VI. Preventive measures. — Quarantine was not attempted. As cases occurred the rooms or buildings were vacated, and the inmates, as a rule, first accommodated in tents on the parade grounds. If more cases appeared they were transferred to camp outside. The more decided movements were not always made so promptly as could be desired, but the almost universal sickness among all classes, both fever and dengue, as well as the want of sufficient medical officers, were great difficulties. A small portion of the 105 th Light Infantry first left cantonments on the 24th August and encamped on the sand hills by the side of the Bijnore road, about, two miles from the barracks. Others joined on the 29th and 30th. On the Ist September there were five cases in this camp, and although partial movement was made in the vicinity, three more followed on the 2nd and five more on the 3rd. On the 4th the detachment divided, 100 moved on four miles further on the Bijnore road to Sainie, and the rest to a place five miles on the Gurmucktesur road. In the artillery no decided movement was made till the Bth of September when D-D moved into camp five miles on the Allyghur road. On the 12th E-F Koyal Horse Artillery encamped seven miles on this same road. In the artillery all the cases except four occurred in the cantonment. From the 21st August to the 31st the seventeen cases among the troops, all occurred either in buildings or tents within cantonments. Cholera SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 69 Epidemic- Meerut Central Prison — Surgeon W. Moir, m.b., Civil Surgeon — about one mile from ?. the cantonment. Strength 809 prisoners. After being very- Notes on outbreaks, Meerut. , , , , . . & r « J healthy this jail for some years back has been in a most unsatisfactory state, and the sickness and mortality have been very heavy. In 1871 the deathrate was 154 per 1,000. 77. Details of the outbreak. — The first case of cholera occurred on 2nd September among the families of the European and Eurasian Warders who occupy a block of buildings about 100 yards distant from the main gate. Two other of the inmates of this building were attacked at or about the same hour. On the sth September a prisoner in hospital was seized. On the 6th there were two cases in hospital. On the Bth one in hospital and one in a cook house. On the 9th four, of which three were patients in hospital and one a woman in the women's barracks. Dropping cases continued till the 27th. Out of about 30 buildings eight were attacked in different parts of the jail. In the hospital building there were seven, but of the others, all but five occurred among prisoners who were under treatment for some other ailment in another building which was set apart as a hospital when the proper hospital was first affected. Between the sth and 27th September there were altogether eighteen cases among the prisoners, of which nine proved fatal. Among the officials besides the cases already mentioned only one other occurred, a child of the compounder who was attached to the special cholera hospital. 111. Importation and communication. — Neither the cases among the warders' families nor the first case within the jail could be traced to importation. When the warders' quarters were attacked, all communication was stopped between them and the interior of the jail. During the course of the outbreak no cases could be ascribed to intercourse with the sick. The only instance at all favoring this idea was that of the compounded child already noted, who may have been brought in contact with the cholera patients either directly or indirectly, but of this there is no proof, and the father had strict orders not to leave the cholera hospital. IV. Meteorology . — The first cases on the 2nd September are said to have occurred coincident with a strong east wind. V. Local conditions. — As has been already stated, the prisoners have for some years been in a low state of health; the same remark applies to great part of the district in which the water level has risen very considerably wherever, as is the case near Meerut, the canal has extended. The drainage of the jail is reported to be most defective. The water drawn from wells is excellent. There was not the least overcrowding in any quarter, for the strength was little over one-half of the full complement. VI. Preventive measures. — Quarantine had been kept up as far as possible, and there had been no fresh admission into the jail for 15 days before the outbreak. Movement. — In consequence of the difficulty of providing a guard, the hospital was not abandoned till the 11th September — six days after the first case appeared, and when in all seven cases had occurred in that building. The inmates were on that day removed to tents on the ground in front, and not a single fresh case occurred among them. On the 27th September, when the hospital floor was being dug up by a gang of other prisoners, one of them was seized with cholera and died. The women's barracks were also vacated, and no other cases occurred. VII. Previous History. — In former years cholera was a more regular visitor at Meerut than it has been of late. In the great outbreaks of 1845 and 1867 the disease prevailed chiefly in August and September as it did in 1872. In those of 1856 and 1861 it prevailed in July and August. Cholera at Meerut, 1826 to 1872. Numbeu of Cases. Ypars Ac Average Total Total Years, ? i £ a ¦§* gj £ »? -< as o 55 o 10 ,-f Native Troops - 3,558 ... 1 ... 3 111 2,' 1 5 4 18 10 1845 [ Prisoners ... I j 46 1846 Prisoners - i i 4 1847 Ditto - i - i ! 1 1851 Native Troops - 3,043 I 2 2 j 1 ... 5 1852 Ditto - 1,931 1 ' 1 2 I 2 1 ... 1 j 1 9 1853 Ditto - 3,125 2 1 2 1 j 1 1 ... 8 2 1854 Ditto - ! ... 2 ... 2 , o , a ( Native Troops - 3,012 1 1 | ... 4 6 4 1856 1 Prisoners - 502 33 6 39 18 1857 European Troops (camp) - 49 133 54 119 19 374* , oeo f European Troops - 1,411 | 1 ... 11 12 1 1858 1 Prisoners - 646 | 17 ... | 17 12 1859 European Troops - 1,400 ... 1 1 1 [ 3 1860 Ditto - 1,071 1 1 ... i 2 1 r European Troops - 1,327 1 1 jBl 1 ... j 84 50 1861? Native „ - 1,028 1 3 ... 1 28 8 ... ! 41 9 t Prisoners - 423 1 ... 30 31 18 1862 Native Troops - 598 11l 3 1 1866 European Troops - 380 1 1 , o/3^ ( European Troops - 351 i 1 ! 1 1 1867 1 Native „ - 618 ! 1 1 1 1868 Native Troops - 694 j 2 2 i o«r> ( European Troops - 402 1 1 1 187O l Native „ - 664 j ... 1 1 ... _ i * Deaths only recorded. Agra. — A station on the right bank of the Jumna, having an elevation of 557 feet. The civil and military portions of it are spread over a large area Agra * and interspersed within this area are very many native bazaars. When cholera appeared the strength of the garrison was two batteries of B-oyal Artillery, 1 regiment of European Infantry, and 2 regiments of Native Infantry. Of these 1 battery and 313 men with their women and children were in the fort, which is about a mile from the military station. The cantonment contains a non-military population consisting of a few European residents and 20,341 natives. In the city and its suburbs which lie close by there are 130,000 inhabitants. //. Details of the outbreak. — The first case is said to have occurred on the 2nd April in the city ; on the 14th April a barber in the lines of the No. 40, 65th Regiment. Ist Regiment Native Infantry was attacked and died of undoubted cholera. Among the Europeans the first case occurred on the 6th May ; 3 children of Her Majesty's 65th Regiment (Surgeon H. Sherlock), belonging to 2 different families, were all at once attacked in the same barrack, 2at one end of the building, and 1 at the other. Next day, the 7th, another child was seized in the same barrack. Dropping cases, making a total of 28, continued up to the 12th July, and then there was an interval, so far as the 65th Regiment was concerned, to the 27th August. Between that date and the Bth September more dropping cases occurred, and then one solitary attack took place on the 21st. The cases were confined to no particular part of the lines ; 14 different buildings were attacked and 8 escaped. The course of the disease was " most erratic." Altogether the results in this regiment were as follow :—: — Strength. Admissions. Deaths. Officers ... ... 17 ... - Men ... ... 911 28 18 Women ... ..93 2 2 Children ... ... 115 4 3 Total ... 34 23 72 [ Section I NINTH ANNUAL REPORT OF THE In addition there were 2 cases which were not recorded. One of these was the father of one of the first children attacked. He was brought to hospital the day after his child was taken ill. In the Notes on outbreaks, Agra. Royal Artillery in cantonment (Assistant Surgeon C. Godwyn), there were no cases; none among 1 the Native Troops, and none in the fort ; nor was there any prevalence of diarrhoea. In the 65th, fever of a mild type was slightly prevalent. In the cantonment bazaars there were 29 cases, of which 8 were fatal. Of the total nearly all occurred in the regimental bazaar, within 3 or 4 days, commencing with the 14th June. In the city and suburbs, including St. Peter's College, the remarkable outbreak in which will be detailed hereafter, there were — 4 deaths from cholera in April. 4 „ in iMay. 28 „ in June. 84 ? in July. 70 „ in August. 7 „ in September. Of these the largest proportion occurred in the suburbs. In the district, with a population of 1,097,425 and an area of 1,873 square miles, the disease was most widely and irregularly distributed. Thirty villages were attacked, but altogether including the city the deaths throughout numbered only 452. In the village of Tuprah, 2 miles south-west from cantonments, 12 deaths from cholera occurred between the 22nd April and the Ist May. In none of the others was any death reported till the 15th May. Some of these were only a few miles from cantonments, others 40 miles off in the extreme corners of the district. In many of them there were only 1 or 2 deaths from cholera among a population of several thousand people. ///. Importation and communication. — There was not the smallest evidence of importation. Excepting the barber, on the 14th April, the first persons attacked in the cantonment were the 3 European children on the 6th May. None of the servants or camp-followers had then been seized, so far as can be elicited by careful enquiry. Nor in the course of the outbreak, which was spread over so long a period, could the disease be shown to spread from one to another. One man in hospital was attacked in a bed next to the part of the ward where men suffering from severe diarrhoea had been treated, and some of these proved afterwards to be cases of cholera and were then removed elsewhere. An hospital orderly was also attacked. He had for some time been subject to diarrhoea. Of 20 native servants connected with the cholera hospital 1 sweeper was seized. Two out of the 4 servants attached to the native cholera hospital were attacked, and 1 died. On the other hand, for want of proper accommodation at the commencement of the sudden outburst which occurred in the regimental bazaar, 22 out of the total of 29 cases were treated in their own huts. They were attended by their own friends, and in no single case did the disease spread to other members of the family. With regard to the immunity enjoyed by the Royal Artillery, Dr. Godwyn remarks — " In the Field Battery whose lines are jammed into a corner, as it were, and covered on one side by the infected Infantry Regiment and on another by the infected bazaar, from which it is separated only by a row of pensioners' bungalows, not a single case of diarrhoea occurred, neither did any cholera". IV. Meteorology. — " The temperature during the month of May/ writes Dr. Sherlock " was extremely hot and oppressive, the thermometer being as high as 104- in the shade. No rain fell, and a fierce hot wind blew from the south-west. In the beginning of June a few sharp showers of rain fell, the temperature becoming comparatively low. The wind, nearly all through the months of May, June and July, blew from the south-west with a slight variation from the east." V. Local conditions. — The drainage is reported good. The water drawn from wells, 70 feet from the surface. Three wells were used for drinking water in the 65th lines ; one of the wells has now been fitted with a Warner's pump which works well and supplies ample drinking water for the whole regiment. It is filtered at the well and then delivered through a tap ; metal buckets are about to be supplied for distributing it to the barracks. A scheme for bringing water in from the new Agra and Delhi canal has been talked of, but no project yet matured. The bazaar of the European Infantry and the Royal Artillery has been allowed to grow into the size of a large village, with a population of 1,300. The location of so many people in such proximity to the lines is extremely objectionable in every way, and the proposed removal of the whole or at least a portion of it is very desirable. Conservancy. — The general conservancy of the station is well cared for, but the pits in which the sewage and refuse are deposited are a very great nuisance. The stench which arises from them is abominable, and although not perceptible at any great distance, it must have a prejudicial effect. Trenches should be substituted and the trenched land afterwards cultivated. The pits, with the smell and the flock of vultures sitting by them, should be abolished. FI. Preventive measures — Quarantine. — No quarantine was attempted. At the fort the detachment of the 65th Regiment was not relieved as usual, so as to prevent communication as much as possible. The native guard however, numbering 31, was relieved daily throughout. Once the cholera hospital was established, all the cases among the bazaar people were taken to it. The persons attacked had no option nor had their friends. Movement. — As soon as a case occurred in any part of the European lines, the particular room affected was at once vacated and the inmates placed in tents on the parade ground or removed to other quarters. In these tents only two seizures took place, one 9 hours, and the other 36 hours after removal from an infected Cholera "1 SANITiEY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 73 room. On the 17th June 3 companies moved to camp Rambagh on the other side of the Jumna, followed by 2 more on the 18th. One case occurred among them 3 days after going out ; the company changed Notes on outbreaks, Agra. ground and no more cases followed. On the 26th June 2 other companies went to the Taj gardens. On the 2nd July they had 1 case and they moved to the Rambagh. On the 12th July they had 1 case and another on the 15th. Of these 4 cases in camp 2 recovered. Three companies returned on 6th July and the others on the 24th July. The next case occurred in one of these companies after return to cantonments. Of the total of 6 which followed their return, 1 occurred in a room which had furnished a case before and which had meantime been scraped, fumigated, and whitewashed. As these 6 cases occurred, the affected rooms were vacated and no seizures followed in tents. In this second part of the outbreak only 1 building was attacked which had escaped in the first part. District Jail. (Surgeon J. G. Pilcher, Superintendent), No. 41, District Jail. 300 prisoners. //. Details of the outbreak. — One prisoner was attacked on the 3rd September and recovered. Diarrhoea was not prevalent. Among the establishment no cases. ///. Importation and communication.- -The prisoner was attended by 3 others who were shut up within night and day in the same barrack; none of them suffered. The attack could not be traced to importation. In Central Prison, with 1,200 prisoners, no case among either the convicts or the establishment. None in the Lunatic Asylum, with 29 lunatics. In all these institutions there was free communication with the general population. St. Peter's College. (Surgeon Alex. Christison, m.d.), occupies a piece of ground imme- diately adjoining the Central Prison and divided from the convent only by a wall. The college consists of one long No. 42, St. Peter's College. building, the entire length of which, in the upper story, is devoted to a dormitory, 271 feet long by 22 broad. Below these are other sleeping rooms, class rooms, and refectories. There is besides a small separate bungalow in which a few very young children are housed. The main building of the college is not further than 300 yards from the convent buildings. When the cholera appeared, the strength consisted of 1 rector, 1 priest, 17 lay brothers, 46 boarders, and 130 orphans, or a total of 195. The orphans all slept in the upper story, all the other boys in the lower. In addition there were 27 day-scholars, who came about 8 a.m. and returned to their homes in the evening. They had luncheon sent to them from their own houses, but they drank the same water as that supplied to the other children, and the amount consumed, especially in the hot weather, is large. About 30 native servants are attached to the college, and there is a scattered village of some 200 Native Christians which closely abuts on it. //. Details of the outbreak.— The first case occurred on the early morning of the sth July. Three boys were attacked almost simultaneously. By 9 o'clock there had been 6 attacks. They rapidly increased and by midnight amounted to 21 with 6 deaths. On the 6th and 7th further cases were numerous. No record is kept of admissions into hospital, so that the number seized on each day cannot be stated with accuracy. By the Bth there had been 44 eases and 21 deaths. The disease then rapidly declined, and on the 10th the last case occurred. In these 6 days there were altogether 52 cases, of which 29 proved fatal. But in addition several more of the boys who were distributed over the country on the commencement of the epidemic were attacked. Including them, so far as can be ascertained, there were 63 seizures and 34 deaths. The orphans suffered much more severely than the boarders. Of 46 boarders 7 were attacked and 4 died, the ratios being 15*20 and B'9l. Among the 130 orphans there were 56 attacks and 30 deaths, or a proportion of 4307 of cases and 23*07 of deaths. Only lof the day-scholars was attacked — a boy, named P. Kelly, who ceased to be a boarder in April, but attended as a day-scholar and lived with his family close to where the matron and little boys lived. When the outbreak took place this family went to the barrack for European warders at the Central Prison. There, on the 7th July, Kelly became ill and was removed to the Thomason Hospital, where he suffered from cholera and recovered. With this exception, the disease was confined to the resident pupils. Diarrhoea was not prevalent. Shortly before there had been 49 cases of measles among the boys. Of the staff of the institution not one suffered. Among the native servants, so far as is known, no case appeared. In the Native Christian village there were 8 deaths from cholera ; the first case did not appear till after the disease broke out among the children. In the convent, with as trength of— 180 European sisters, 150 Native „ Some 50 Native servants ; there were only 3 cases, all among the children, and all apparently originating in hospital. One on the 13th July, a second on the 10th August, and a third on the 15th August. Two were attacked in hospital, and the third had left hospital only 4 days previously. [ Section I 74 NINTH ANNUAL REPORT OF THE 111, Importation and communication. — There is no evidence to lead to the belief that the first case was due to importation or to communication Notes on outbreaks, Agra. an infected quarter . nor during . the course of the outbreak could any connection be traced between different cases following' one another as the result of contagion. On the night of the 2nd of July and again on the 4th there had been a musical and theatrical entertainment, at which many persons from outside were present. On the first occasion there were no soldiers there except the band, and on the second occasion of 70 soldiers, nearly all were from the fort, where no cases of cholera occurred this year. At these entertainments the boys were kept up till a late hour in a heated and impure atmosphere. In considering this point of importation the history of the boys who left the college to join their friends is of importance. On the evening of the 4th, before the performance commenced, 1 boy started for Mussoorie ; his going had no connection with the outbreak which did not show itself till early on the following morning. On the road this boy was attacked with cholera on the afternoon of the sth, and died on arrival at Mussoorie on the Bth. Of those who were sent away on the morning of the 6th, a number were received by friends in Agra, and others were despatched to their homes in various and distant parts of the country. Father Symphorien, the resident head of the institution, has been kind enough to furnish me with a list of all the boys who were sent away from St. Peter's on the 6th July on account of the outbreak. Some of them cannot be traced, as their friends have changed their residence, but the following particulars have been ascertained regarding 53 out of the 65 who were sent away on the 6th :—: — x), . ? , Number of boys Number at- ¦» , ? , Place to which sent. sent * tacked Number died. Agra ... ... ... ... 24 3 2 Mussoorie ... ... ... ... 2 1 1 Lucknow ... ... ... ... 1 1 Allahabad ... ... ... 10 6 2 Cawnpore ... .. ... ... 3 1 Seetapore ... ... ... ... 1 Delhi ... ... ... ... 1 Buxar ... ... ... ... 1 Jhansie ... ... ... ... 1 Goorgaon ... ... ... ... 1 Toondla ... .. ... ... 5 Shajehanpore ... ... ... ... 2 ... Meerut ... ... ... ... 1 ... Total ... 53 12 5 I have been in communication regarding each of the boys included in this statement, and I Jind that in not a single instance did a boy import cholera to the place where he was sent, although often received among families where the space available was not over-abundant. In illustration of this the case of the boy Ross may be particularly mentioned. He was, says Dr. Christison, " a petty boarder who lived with the orphans. He died on or about the 10th July in a tent near the house of his father, a Serjeant in the Police Lines at Agra. The - y - t o O father and mother and 9 or 10 brothers and sisters lived in 2 very small rooms. The sick boy was among them for several days and his urgent symptoms had existed for some hours before he was removed to the tent. None of the family suffered." The 2 boys transferred to Mussoorie both left on the 4th before the outbreak showed itself in the college. One of them died of cholera at St. George's College, Mussoorie, on the Bth. He was treated in an isolated building, though at first cholera was not suspected. The other boy mixed with the rest of the school, numbering over 100. V. Local conditions. — The drainage is good so far as the running off of rainfall is concerned, but one drain in particular which runs under a portion of the Native Christian village is liable to contain many impurities. The water for the convent is said to be brought from the Hurree Purbit well which is a very favorite well in Agra, and is largely drawn from by all classes of the community of Agra, both European and Native. The water-supply for all the inmates of the college is drawn from a well, about one-third of a mile outside," which is much frequented by natives of adjoining villages. In these, so far as is known, no cholera occurred. From this well the supply was drawn for 6 weeks before the outbreak. The father and lay brothers drank from the same source as the boys. Previously it was taken from another well which is close to the main building and only about 20 yards from the latrine used by the boarders. This latrine at the time was on the same very objectionable system as that which was in former years generally followed in the place. Seats were placed over a hole some 70 feet deep close to, if not actually down to, the water-bearing stratum. Into this hole the night soil and urine dropped and there it remained altogether unheeded. This arrangement, which would be condemned under any circumstances, became all the more dangerous when the latrine hole was placed, as in this case, so near a well as has been already stated ; however the well had ceased to b e used for supplying the boys. Another latrine at the opposite end of the building had been used by the orphans, Cholera 75 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic but in 1870 it gave place to a system of closets. It was on the same plan, and when the tower surmounting it was knocked down some few weeks Notes on 'outbreaks, Agra. »>-«^« .„<-•>,. + i • *v, a^~ I,^l^ 4-V. n „,„ ago, preparatory to closing the deep hole, the stench was so overpowering that workmen could hardly be persuaded to approach it. In 1869 when the girls were rather severely attacked by cholera, the boys were drinking the water from the objectionable well and using the same latrine, but they had only one case and that was not fatal. The dormitories were much overcrowded. Each boy in the large sleeping room had only about 45 superficial feet of space. The girls who almost entirely escaped were packed quite as close. In their sleeping room, moreover, there were 7 rows of beds between opposite doors, whereas in the boys' room there were only 4 such rows. The rooms both in the college and convent are badly ventilated. The two entertainments of the 2nd and 4th July are believed to have overcited the boys and so predisposed them to the disease. None of the 10 small children living in the separate bungalow, as already explained, were at these entertainments, and yet 4of them were attacked and 2 died. The institutions are poor, and neither boys or girls have that full allowance of nourishing food which growing children require. VI. Preventive measures — Quarantine. — No quarantine was attempted. Both in respect to the college and convent communication went on as usual. Movement. — On the 6th, the day after the outbreak commenced, all the boarders that had friends in Agra and elsewhere were sent away to them. The rest of the boarders and the whole of the orphans were sent out to the Taj gardens, a distance of 3^ miles, on the morning of the 7th. There 3 fresh cases occurred. On the morning of the Bth, they removed to Secundra gardens, 4£ miles from St. Peter's in the opposite direction. There during the Bth, 9th, and 10th, 8 cases occurred, and then the disease altogether disappeared. When the boys moved out to the Taj they took their bedding and food from the college. Throughout the outbreak, both while they were at the Taj and afterwards at Secundra, persons from their old quarters were allowed to come among them ; there was no interdiction of communication from the college to them. All cases of cholera that occurred after leaving were sent to the college hospital for treatment. Between the I.lth and 15 th July the boys who recovered joined the main body in a convalescent state. On the 28th July all returned to the college buildings, and no more cases occurred. In the convent no building was vacated on account of cholera. The hospital, as has been already stated, apparently furnished all 3 cases. They were treated in a room of the main ward. It is said that the people in the village of Secundra and in the Secundra Orphanage suffered from cholera, because it was imported by the St. Peter's College children. In the village, first case occurred on the 20th July. In the orphanage, it broke out on the 21st July. From this date to the 7th August, there were 17 cases, all of which but 2 were eventually fatal. There is no evidence that this outbreak was due to importation beyond the fact that there had been no cholera in the vicinity till some days after the St. Peter's children came. There is no evidence that any communication had taken place. VII. Previous history. — On this Father Symphorien states — v I have no records on this subject beyond 1858. I hear from reliable sources that the cholera occurred for the first time in the institution in an epidemic form in 1855, when about 12 boys and 7 girls died. There were then about one-third less children than now in both institutions. The next appearance of cholera was in 1860, when 1 lay brother, 15 boys, the nurse of the infants and 8 girls died. It came again in 1861 when 2 boys died; and its fourth appearance was in 1862, when it carried away 4 boys and 4 or 5 persons in the convent, in whose number there were 3 nuns. There has been no cholera amongst the boys with the exception of 1 or 2 cases perhaps between 1862 and 1872. I must, however, mention as a remarkable instance that in 1863, on the 25th March, 3 Christian Brothers arrived at Agra from downcountry sick with cholera, the scourge being then raging at Allahabad. One of them died a few hours after arrival, the other recovered, but nearly lost his eyesight. We had an outbreak of cholera in the convent in 1869, when 7 or 8 girls died of it; there was then but one case in the college which did not prove fatal." The history of the Agra cantonment and of the jail as regards cholera is given in the annexure. Statement of cholera at Agra, 1826 — 1872. Numbee of Cases. Ybaes. Average c Total Total Strength. >» . .2 :§ S Cases. Deaths. Iliiil^llill 1826 Native Troops - 12,000* 3 2 5 10 , » M f European Troops - 1,092 1 3 2 1 12 !22 1 2 3 1 1 I ... 49 io IS4/ I Native „ - 12.938* ... 1 5 2 36 53 23 27 12 4 1 ... 164 30 1828 Native Troops - 10,134* 2 ... 2 10 9 2 5 3 3 36 4 . 9Q f European Troops - 1,032 1 ... 1 1 1 ... 4 18 - y [ Native „ -... 2 ... 1 2 1 2 1 2 I 1 ... 12 3 lflQn f European Troops ¦ 1,366 1 1 1 1 4 ifi6V l Native „ - 6,972* 12 4 ... 2 ... 1 1 2 ... 13 3 . I _^ __ ? Strength in the circle. 70 NINTH ANNUAL REPORT OF THE [Section I ™?etL?Ag™," Statement of cholera at Agra, 1826— 1872— continued. Number of Casks. v,.., Average .. . . Total Total BSI Strength. >A j> S S Cases, Deaths, -.nqi C European Troops - 1,298 16 3 1 11 6 I Native „ - 6,081* 1 1 1 4 4 ... 11 4 1 8^2 5 European Troops - 968 1 1 I Native „ - 6,059* 13 2 ... 1 ... 1 ... 1 9 2 ¦i ooq f European Troops - 938 1 1 (Native „ - 5,352* 1 ... 1 2 ... 4 .., C European Troops - 913 ... 1 4 4 ... 9 3 18343 Native „ - 4,966* ... ... 5 12 4 ... 2 ... 23 9 C Prisoners - ... ... 5 1835 f European Troops - 983 ... 1 ••• .. 1 I Native „ - 3,840* ... 3 ... 2 3 6 1 3 ... 1 19 ( European Troops - 989 1 1 1 ... 1 4 1836) Native „ - 4,424* 1 ... ... 3 4 1 ... 1 2 i ... 1 14 C Prisoners - ... ... ... ... »• ... ... 1 ( European Troops - 1,041 1 4 g 2 ... 16 10 1837) Native „ - 4,297* ... 1 ... 1 1 4 1 2 7 3 ... 20 2 (. Prisonei^s - ... ... ... ... ... ... 4 (¦ European Troops - 925 4 2 3 ... 2 ... ••• . »• ... 11 6 1838) Native „ - 4,471* 1 1 27 41 14 35 4 3 5 1 ... n 143 51 C Prisoners - ... ••• ... 71 1839 ( Native Troops - 3,677* 1 ... ... 2 ... 11l - ~ 3 1 10 1 C Prisoners - ... ••• ... ... 2 r European Troops - 981 1 ... 1 1 2 \ 1 3 10 1 1840) Native „ - 4,272* ... 1 2 4 3 1 ... 2 »• ... 13 4 t Prisoners - ... ... •» ... 1 1841 < European Troops - 1,138 ... 1 "i 1 ... ... 3 1 I Native „ - 3,821* ... ... 6 2 4 ••• . 12 2 1842 f Native Troops - 4,178* ... 3 1 ••• ... 4 2 i Prisoners - ... ... . 1 ( European Troops - 1,195 1 ... 142 11 154 55 1843) Native „ - 5,148* 1 39 1 1 42 19 v. Prisoners - ... tM 30 ( European Troops - 1,089 . . 2 '" 2 1844> Native „ - 6,856* "3 ... 2 4 2 „. 11 1 (. Prisoners - ... ... 5 r European Troops - 1,063 4 6 1 ... 1 4 ... 16 4 1845) Native „ - 4,805 "5 11 4 1 1 22 5 (. Prisoners - ... ... 5 1846 Native Troops - 3,582* "] 1 1 1 2 ... 1 ... ... ... 6 1 ( European Troops - 1,047 , ,M, M 4 1 10 6 1 1 ... 23 2 1847) Native „ - 3,471* 1 1 1 3 ' Prisoners - ... 1 c European Troops - 1,269 .„ „. ... 1 ... 12 "3 ... 1 8 4 1848) Native „ - 3,798* 1 1 ... 1 ... 2 5 (. Prisoners - I ... 3 1849 f European Troops - 498 2 2 ... 1 5 2 _ a l Native „ - 3,980* 2 ... 3 1 »• 6 1 1850 Native Troops . I 3,325 1 ... 1 ... 2 1 2 ... 7 1 ( European Troops - | • ••• 2 ••• 8f 1851) Native „ - j 3,118 M , ... 1 ... ... 1.1 (. Prisoners - 1 ... ... 67 1852 Native Troops - | 2,040 „. ... 1 „ 1 1 1854 { Native Troops ¦ ! 7^652 2 ... "3 7 12 1 I Prisoners -j 3,521 5 12 , 8 1 1855 Native Troops - | 7,788 2 2 ... 1 5 r European Troops ¦ 924 " . . 160 45 1 ... ... 206 98 185(5) Native „ - 2,897 ill 38 53 94 34 (. Prisoners - 3,632 ... 1 2 ... 3 442 132 2 ... 582 234 2857 ( European Troops - ... 2 12 ... •«• 5f i Prisoners - ... ... 1 1 1858 f European Troops - 883 ... ... ... 1 ... 2 5 8 3 (. Native „ . 1 #<< 1 1859 European Troops - 1,293 ... "l 1 ... ".. 3 5 j ... ( European Troops - 1238 77 36 1 •» H5 | 59 I860) Native .. . >29 Z Z Z Z. ... "l Z. 5 2 8 ! 5 (. Prisoners - 1,890 ... ... ]" Z. ... ... Z. 801 7 808 173 r European Troops - j 1,220 1 103 8 11 114 69 1861] Native „ - 619 ... ... '".. ... ". 410 7 21 3 C Prisoners - j 2,494 2 169 19 ... . 190 67 ( European Troops - i 1,153 ? ' 2 1 63 66 49 18625 Native „ - ' 682 Z ... 1 ... 1 1 3 (. Prisoners - 2,209 23 23 12 * Strength in the circle. t Only fatal cases entered. Cholera -| gANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 77 Notes on out- Statement of cholera at Agra, 1826 — 1872 — concluded. breaks, Agra. J v ' Number of Cases. Average . . Total Total Ybabb. Strength. . tA j» . S S Cases. Deaths. I_J_ 1 i i i i i i i i J ( European Troops ¦ 1,115 21 11 32 21 1863} Native „ - 704 2 2 1 ( Prisoners - 2,158 7 ... 49 54 110 42 i sac f Native Troops - 647 1 1 18t)D I Prisoners - 1,830 1 12 18 31 20 C European Troops - 1,002 1 ... 1 1 18665 Native „ - 3 ... 3 ( Prisoners - 1,787 1 1 1 i q«7 f Native Troops - 703 1 1 lbb ' [ Prisoners - 2,166 1 1 2 1 1868 European Troops - 908 2 1 „. 3 ( European Troops - 1,058 1 1 1 18695 Native „ - 950 6 3 5 14 7 C Prisoners - 2,336 5 10 2 17 9 ICM f European Troops - 1,399 10 15 5 3 3 ... 36 23 187^ I Prisoners - 1,661 1 1 ... The military station of Morar, 681 feet above sea level, is situated almost due west of Cawnpore, and is 78 miles south of Agra. About 3 miles distant is the large native city of Gwalior, close to which is the Gwalior Fort. In Morar the garrison consisted of 3 batteries of artillery with the head quarters of the 23rd Brigade, the Ist Battalion, 11th Foot, and three regiments of native soldiers. In the fortress there was a battery of artillery and a detachment of 250 men of the 106 th Light Infantry. 17. Details of the outbreak. — The city of Gwalior and all the surrounding country belong to Scindiah, and it is extremely difficult to obtain trustworthy information. It is known, however, that although individual cases of cholera occurred, there was no epidemic prevalence among the people. Surgeon, R. F. Hutchinson reports a fatal case in the city on the 10th July, one on the 11th and a third on the 18th. Two more were reported on the 12th August and one on the 25th. In the cantonments the only cases occurred in the 1-llth Foot. Surgeon J. Tulloch, M.D., states: — "On morning and early of afternoon of 18th June nine men from Nos. 5, 6, and 7, double-storied barracks went or were brought to the dispensary with vomiting and purging and were detained and treated in the temporary hospital. As their symptoms did not subside after a time, the circumstance was reported by the Assistant Surgeon. When visited at 3-30 p.m., the men were found suffering more or less from choleraic disease. One man worse than the others had passed several rice-water stools. All these eight men had severe vomiting and purging, with prostration, coldness of surface, and shrivelling of the skin of fingers. Most had cramps. All had that leaden hue and sunken expression which is almost peculiar to the cholera-stricken * "* *. Though the symptoms were of mild character, there could be no doubt as to the nature of the disease." The returns show no unusual prevalence of either fevers or diarrhoea. 11l Importation and communication. — " The most searching enquiry was instituted to ascertain if any known cause existed to account for this sickness in the 1-llth, but without success. There had been no communication with the infected nor for that matter with an infected district **¦**. In short nothing was elicited to account for the visitation of cholera, for cholera it was beyond all doubt." IV. Meteorology. — " The weather was hot, the thermometer ranging from 112 Q to 80° during the month in the shade. The rains had not set in. The wind had been westerly and north-westerly for many days." Dr. Hutchinson in his weekly return, dated the 14th June, notes that at 10-12 a.m. of that day there had been {c a blast from the east." V. Local conditions. — The 1-llth Foot occupied two sets of barracks. One, the old one-storied barracks at the north end of the station in what are known as the left European infantry lines, the other the new double-storied buildings in right European lines at south end of the station. Four companies were in each set of lines. The accommodation was ample. "The drainage, if not perfect, was not calculated to engender sickness." The water which is drawn from wells was found on analysis to be free from contamination. VI. Preventive measures. — Movement. — The barracks attacked were at once vacated and disinfected. VII. Previous history. — Since 1860 up to which the annexed statistics extend, cholera has been a frequent visitor at Morar, and on several occasions has fallen very heavily on the garrison. 78 [ Section I NINTH ANNUAL REPORT OF THE S-etks^MoSr. Statement of cholera at Morar, 1860-72. Numbek of Cases. v , ltl . Average . Total Total Yeabs# Strength. . £ 5 fe g Cases. Deaths, I£iaslZ £ 5 I | g | Ififlft f European Troops- 1,279 2 15 130 25 1 1 ... 174 87 imu i Native „ - 1,823 6 5 11 6 , oal f European Troops - 1,106 64 133 13 210 152 1861 1 Native „ - 1,438 1 1 ... , „,«, f European Troops - 1,048 19 21 22 4 „, ... 66 39 lSbd { Native „ - 1,629 2 14 7 5 1863 Native Troops - 1,154 1 «. 1 1 t Qf . K ( European Troops - 1,115 1 10 1 12 8 iaD0 1 Native „ - 1,165 1 8 9 7 , QRtJ < European Troops - 868 14 8 2 15 10 iyb7 1 Native „ - 1,697 11l 3 2 1868 European Troops - 784 1 1 2 , gg Q C European Troops - 1,081 37 15 5 2 79 5 2 145 92 lBDy I Native „ - 1,410 14 1 ... 16 1 ... 23 18 1870 Native Troops - 1,433 1 1 1871 European „ - 1,407 1 1 1 1872 European „ - 1,386 1 *1 ? Only one of the nine eases mentioned in the Report of the Medical Offleer has been returned us cholera. Nowgong is situate in native territory, 120 miles south-east of Gwalior. The Garrison __ AA T consisted of a battery of Royal Artillery, a detachment of No. 44, Nowgong. -k, T p j c v.- European Infantry, and a few native soldiers. 11. Details of the outbreak. — The only three cases among the troops occurred in the Artillery. Assistant Surgeon T. H. White, m.d., states, that there were three admissions; the first on the 19th August, the second on the 20th, both among men from the same barrack ; on the 6th September a woman was attacked in the family quarters. There was no prevalence of bowel complaints or fever. 111. — Importation and communication. — " No case, as far as can be ascertained, had occurred anywhere in the neighbourhood previous to the admission of the case above noted ;" the European attacked on the 19th August. " Cholera had prevailed for some time at Banda, some 60 miles off, and before this was known, there had been communication between that station and Nowgong, among the natives ; but no direct communication or connection of the disease in the Royal Artillery lines with the arrival of any one from Banda could be traced, though most careful enquiries were made, and no case occurred among the natives attached to the battery, till the 26th August, when one, and only one case occurred in the syces' lines, a syce's wife/ "No connection was apparent between any of the cases that occurred." None of the attendants suffered. V. Local conditions. — Except as regards the syces' lines, they are said to have been satisfactory. VI. Preventive measures. — The affected building was in each instance vacated, and no more seizures took place. VII. Previous Historg. Statement of cholera at Nowgong, 1864-1872. Nuhbee of Admissions fbom Choleba. . V Average h - . . Total Total IBABSi Strength. £ % % S Cases. : Deaths. lijiilfltl!] £ £ I g -Si a £ Z < tn __J3 fc O 1864 European Troops - 213 1 1 1 1867 Native „ - 423 1 1 1869 European „ - 170 3 ... 3 1 7 4 1872 European „ - 372 2 1 3 3 Cholera 79 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- Jubbulpore. (Surgeon W. R. Rice, Civil Surgeon) lies on the line of Railway across the Peninsula between Allahabad and Bombay along which there bSSmI ° n outbreakS) No ' 45> Jub " is constant traffic. The garrison consisted of the 25th foot, a squadron of 3rd Madras Cavalry and the 21st Madras Native Infantry. The non-military native population of cantonment is returned as 16,022. The city, which is about a mile distant, has a population of 44,911. The district has an area of 3,647 square miles, and a population of 380,826. //. Details of the outbreak. — The first case reported in the district was at Burghee in the Sehora Tehseel about 30 miles to the north-east of the city of Jubbulpore. It occurred on the 80th April and up to the 14th May there had been 12 cases and 8 deaths in this quarter of the district. Between the 18th and 29th June, 4 deaths were reported at Gowarree Ghat, a ferry on the Nerbudda, 4 miles from Jubbulpore. Occasional cases occurred here and there, but throughout the whole year only 64 deaths from cholera were registered in the Jubbulpore district. Between 6th July and 17th August, altogether 50 cases of cholera were treated throughout the city. In the Jail, out of a strength of 800 prisoners, a suspicious case occurred on the 20th July. Diarrhoea was prevalent among them during the time cholera was in the city. Among the troops not a single case of cholera occurred, nor is any death from cholera entered in the mortuary returns of the cantonment. ///. Importation md communication. — The first cases known in the district, those in Burghee, were attributes to pilgrims from Ajoodhia. This village is one of those included in the special cholera enquiry, and the circumstances were investigated by Dr. Edis, the Assistant Sanitary Commissioner. He states that on the 27th April a party of 7 persons belonging to this place returned from a pilgrimage to Ajoodhia in Oudh. The fair there had been broken up on the 7th April on account of cholera. They encamped outside the city of Ajoodhia, the old city of Fyzabad, for four days. An old woman named " Dokha" was there taken ill with vomiting and purging, but not seriously, for she was able to walk to Allahabad. Thence the party travelled by rail to Sleemanabad station, and thence she walked 12 miles to her house at Burghee, where she and her companions arrived on the 27th. On the 29th another woman of the party, who had been in constant attendance on " Dokha," was attacked with cholera and died on the 2nd May. On the same day died three others, all residents of Burghee, one of whom had been suffering for three days. He was thus attacked on the 29th or 30th April. On the 4th May another person, who "bad had no communication with the returned pilgrims/ died after 48 hours' illness. On the 6th May " Dokha" herself died with all the symptoms of cholera. It is said that the first case at Gowarree Ghat, a village 5 miles from the city of Jubbulpore, was a pilgrim who came from Benares and who died " immediately before the Bth June," but it is not stated when he arrived or when he was attacked. It is further said that as he lay ill in the bed of the river, " it cannot be ascertained that he had much communication with more than three " persons ; of these one was a girl " who used to go to the stream to fetch water, but was not seen to speak to the pilgrim." She was taken ill on the 18th June and died the same day; other cases followed on the 22nd, 24th, and 27th June, and on the Ist and 24th July, but there is no evidence that any one of them had been infected by the pilgrim. Between the 18th June and 24th September there were in all these weeks only 9 cases and 7 deaths from cholera in this village of 500 inhabitants. On the 30th June, a tableservant in the employ of a gentleman living on the outskirts of Jubbulpore was attacked ; on the 2nd July the master's child was attaclted. It was said that the servant bad been to Gowarree Ghat, had caught the disease there, and then given it to the child. But on further investigation there was no certainty that the man had been to Gowarree Ghat. If he had, the date of his visit is unknown. But even if he had, as soon as he was taken ill, he went to his house in the city and there he died. In the city the disease was spread over 22 different mohullahs or quarters. The 50 persons attacked were treated in their own houses, and in no instance did they form a focus for spreading the disease. The largest number of attacks in any one mohulla was ten, and only one furnished this number. In one there were five, in one four, in two three, in six two, and in eleven there was only a single case in each. At Saliwari, ten miles south-east of Jubbulpore, a village of 303 inhabitants, a carpenter, Burjhoo, had been to Jubbulpore from the 21st to 25th July. On the 7th August he was attacked. On the same day his son, who had not been to Jubbulpore, was seized. On the 2nd Burjboo's brother, who had attended him, was seized. On the 3rd another person was attacked and died. "He lived in a different part of the village and had no communication with the foregoing, either personally or indirectly." On the 4th a boy, who had often been to see Burjhoo during his illness, was attacked. Up to the 13th August 17 more cases occurred, or 22 in all, of which 9 were fatal. On the 22nd July while Burjhoo was in Jubbulpore another carpenter was attacked in the same mohulla of the city in which Burjhoo was living during his visit, but no communication between the two could be traced. Both Burjhoo and the man's friends denied that there had been any. A woman who had been staying in the house with the fourth case at Saliwari was attacked on return to her own village of Nimkera on the 9th August. It is not stated if any other cases followed. IV. Meteorology. — "The meteorological phenomena were pretty much the same as usual. The rains were very steady. It rained for 62 out of the 92 days between the 10th June and 10th September, and on 46 out of the 61 days between the first and last cases in the city." VII. Previous history. — Although a frequent visitor cholera has rarely attacked either ithe troops or prisoners at Jubbulpore with great severity. 80 [ Section I NINTH ANNUAL REPORT OF THE N ° t Jubb 1 ui O p^ reakS ' Statement of cholera at Jnbbnlpore, 1856 to 1872. Number op Casbs. Average . •; • . Total Total Yeaes - Strength. * 5 # jj j> Cases. Deaths. 1856 Prisoners - 1,733 1 51 49 101 61 1857 Ditto - 1,307 6 36 1 3 18 3 67 44 1858 Ditto - 1,287 1 1 1860 European Troops - 805 1 ... 3 1 1 1 ... 1 8 5 ( Ditto ' ¦ 861 1 1 1861] Native Troops - 533 1 1 ... 2 ( Prisoners - 1,079 2 2 1 1 Wf .q f European Troops - 820 1 1 800 'I Prisoners - 1,200 29 29 8 1864 European Troops - 757 1 1 loficf Ditto - 688 7 7 6 1800 1 Prisoners - 407 2 1 3 2 1866 Ditto - 480 2 2 2 1868 European Troops - 633 3 10 3 16 12 lftftQ f Ditto - 809 13 2 14 4 15 12 JOC lj I Prisoners - 851 1 1 12 2 ... 2 18 13 , ft7o f European Troops - 773 ... 1 1 1 18 ' u (. Prisoners - 637 1 1 1 1872 Ditto - 660 1 1 Sehoee. (Surgeon W. E. Allen,) in Central India, about No, 46, Sehore, gQ mileg tQ the nort k_ eas t o f More in a direct line. //. Details of the outbreak. — Being in foreign territory information is scanty as regards the general population. In May and June, cholera was heard of in almost every direction around Sehore. In Sehore itself a few cases occurred between the 20th May and 7th June. There was then an interval of nearly a month, when, on the sth July, a sepoy travelling from Baroda to Oudh was attacked; on the 7th another of this same party. On the 13th a resident was seized. Up to the 7th September cases were of daily occurrence, " pretty evenly distributed between the cantonments and native town." On the 28th July, and again on the 22nd August, there was a maximum of nine on one day. In all 182 were treated among the civil population, of which 82 ended fatally. In the Bhopal Battalion, there were seven admissions from cholera between the 20th July and Ist August. " During the months of July and August both diarrhoea and dysentery were very prevalent in both the Battalion and civil population. These diseases were not at all conspicuous before the invasion of cholera, but appeared to increase in frequency and severity pari passu with the spread of that disease. During the latter part of July, diarrhoea was exceedingly prevalent in the Battalion, quite half the admissions into hospital being caused by that disease or by dysentery, and a number of cases was treated in the lines which do not appear in the hospital returns/* ///. Importation and communication. — In the May outbreak the first case was that of a mendicant from Hoshungabad where cholera prevailed. The next was one of choleraic diarrhoea on the 3 1st May. It occurred in the native town, 1£ miles distant from where the mendicant was seized, a third of the same character followed on the Ist June in a place three-fourths of a mile distant from the first case. On the sth there was one of undoubted cholera. No communication coul dbe traced. In the July outbreak, the first and second cases occurred among the party of six sepoys already mentioned, of whom one was attacked on the stb, and the other on the 7th. They had come through Ashta, where cholera was prevailing. On the 13th a resident was attacked, and another on the 14th. These and the cases which followed took place in various localities, most of them distant from the place in which the sick sepoys were treated. No communication could be traced ; none of the hospital servants or attendants on the sick were attacked. In not a single house were two individuals attacked. There was no community of water supply among those who suffered. IV. Meteorology. — " The only peculiarity obvious was a deferred and very scanty rain fall. No rain fell till near the end of June, and then only I*9 inches fell. Next mouth the rainfall amounted to 103 only." V. Local conditions. — The drainage is reported to be good. There is a want of proper conservancy arrangements. VI. Preventive measures. — Movement. — -No. 1 Company moved into camp on the 21st July ; three cases followed on the 25th, 27th and 31st. " A very marked beneficial effect was immediately manifested after the movement ; diarrhoea, which had been very prevalent, soon began to abate, and had almost disappeared before the camp was broken up on the 12th August. VII. Previous history. — During the 19 years, 1854-1872, cases of cholera have been recorded among the troops and prisoners in only five of them. Cholera 81 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- Notes on outbreaks, sehore. Statement of cholera at Se/tore, 18G4-72. . , - _ — Ndmbeb of Casks. _ Vo Average . . . Total Total Ybaes - Strength 5 S S Cases. Deaths, |J_Jj_l A 1A 1 lili Lll_ 1864 Prisoners - 95 I ... 6 1 6 1865 Ditto - 108 1 1 2 18C9 Native Troops - I 812 113 5 7 1871 Ditto - 822 1 1 1872 Ditto - 757 | j 7 j 7 4 Simla, Surgeon R. Moir, m.d. — This sanitarium, which is largely frequented by Euro- peans, and is the seat of the Government of India during the hot season and rains, lies in the Himalaya, 41 miles from No. 47, Simla. the plains by the old road and 56 by the new. From Calcutta the distance is 1,091 miles by rail to Umballa, and thence 79 miles by road. The houses occupy different elevations on the hill sides. The average height may be taken as about 7,100 feet above the level of the sea. The highest point is 8,055 feet. The native population is returned as 14,84-8, and the number of Europeans is estimated at 1,500. In the cold season the greater portion of the residents,, both European and Native, move to the plains. //. Only one case of cholera occurred at Simla. The man was a coolie, who was taken ill on the 17th July at Hurreepore about half-way between Simla and Kalka by the old road. On the morning of the 18th he was admitted into the dispensary at Simla, where he remained in a separate ward for the first night. Next day he was removed to another building. He recovered. Twenty-three cases are reported to have occurred in different parts of the neighbouring country, but as this belongs to Native States, no trustworthy information is obtainable. 111. Importation and commmiication. — The man brought the disease with him. None of his attendants were attacked, nor, so far as is known, was there any other case in Simla. IF. Meteorology. — The rainfall in 1872 was 71*92 inches as compared with 0969, the average of the previous eight years. V. Local conditions. — The chief defect is in the water-supply which is very scanty during the summer months, and is at all times very liable to contamination . The springs afford a naturally excellent water, but after every shower this is more or less mixed with the drainage of the hill sides which are far from clean. VI. Preventive measures. — Along the new road there was no interruption to traffic, but by the old road on which Kussowlie lies all persons were diverted so as not to pass through that station. VII. Of the previous history. — Of cholera at Simla little is known with any accuracy, and there can be no doubt that the sanitarium has enjoyed a very remarkable immunity from the disease. lii 1867 there were 87 cases and 47 deaths among the native population, and 16 Europeans, chiefly children, were attacked, of whom six died. Excepting in this year, I can find no record of any outbreaks although solitary imported cases have been known in other years. Subathoo. — {Surgeon J. G. Leask,) a cantonment in the hills between Kussowlie and Simla, with an elevation of 4,253 feet above sea level. It is situated immediately above the old road at a distance of 12 No. 48, Subathoo. miles from Kussowlie and 22 from Simla. The garrison consisted of the 2-12 th Regiment. There is besides a large native bazar with a population of about 4,500. 11. History of the outbreak. —There was not a single case of cholera among the natives. Among the Europeans there were six, three men, two women, and a child. The first was on the 11th July, two followed on the 12th, one on the 14th, one on the 21st, and the last on the 23rd. They occurred in six different buildings widely separated. The first case was ascribed to eating freely of bad bacon. Diarrhoea was only to a slight extent prevalent among the men, but the children suffered a good deal. 111. Importation and communication .—No importation could be traced. As already observed, not a single case occurred amongst the natives. Nor was there the smallest reason to believe that the disease spread by contagion. None of the hospital attendants suffered. The sick in several cases were nursed by relatives without any bad result. IV. Meteorology. — The wind on the 11th July was south-east. On the afternoon of the 12th it veered round to south-west and continued in this direction to the 18th, when it changed to the north-west and remained so to the end of the outbreak. V. Local conditions. — The drainage is not so satisfactory as it might be. The water for drinking is drawn from springs and wells. The spring* should be better protected, and the [ Section I 82 NINTH ANNUAL REPORT OF THE reservoirs winch are filled by it more efficiently covered than by planks. The mode of drawing the water from the reservoirs by means of a leather bucket Notes on outbreaks, Subathoo. a]gQ ob j ectionablei The reservoirs should be raised so as to prevent the possibility of any surface drainage entering them, and the water should be taken from them either by taps or pumps. One well has been fitted with a pump, but it is arranged so that the man working it must stand on the cover which is not watertight. It did not look as if it were much used. At two neighbouring wells bheesties were busy drawing water in their ordinary fashion. In some barracks there was slight overcrowding. The old barracks which are leaky and ill ventilated did not specially suffer. VI. Preventive measures. — A quarantine was established on the 24th July for those leaving the station and also for those coming in. By that time the last case had occurred. It was kept up until the 18th September, but it was only nominal. Movement. — As soon as a case occurred in any building the affected room was immediately vacated. There was no further case among the inmates so removed. VII. The previous history of Subathoo in respect to cholera is not favorable for a hill Statement of Cholera among European Troops* at Sitbaihoo from 1843 to 1872. Number of Casks. . _ v Averse • . Total Total * hk *' Strength. £ ' % c 5 ji Cases. Deaths ii in i j ii i | u jjj i i 1843 - -I 816 j 2 13 2 8 1841 - - | 870 2 2 1 5 1815 - - 817 I 2 ... 2 ... 108 21 133 42 1846 - - 1,418 2 2 ... 1847 - - 1,225 | 2 ... 1 1 ... 11 6 1848 - - 1,294 1 I 9 10 1849 - - 46 1 ... I 1 1852t - ! J857 - 2 j 2 1859 - - 938 ... 1 j ; 1 1807 . . 751 ! i ... 1 I ... 8 3 26 2 40 19 18(59 - ¦ 1,010 I I 20 8 ¦ I 28 19 1872 - - 1,134 i 6 \ I 6 3 ._.'.. 1 ,_J.. , ' * The station has been occupied by European troops only. + Ouc or two eases occurred tsimuitaneously with the outbreak at Umballa, but no deaths. From 1850 to 1855 the strength is not known. In 1856 it was 834, and in the subsequent years when no cholera appeared it varied from 600 to 1,019. Dugshaie. — Surgeon William Skeen, m.d. — Dugshaie is a station in the Himalaya 3 miles off the new cart road which leads from Kalka at the No. 49, Dugshaie. foot of the hills to Simla. The distance from Kalka is 19 miles and from Simla 42. The hill rises abruptly to a height of 6,100 feet above the sea. It is very bare and rocky, without trees and with little cultivation. The garrison consisted of the 85th Regiment, and of a detachment of men of the 72nd Highlanders sent up from Umballa for the season. There is besides a small military prison in which European soldiers from the stations within convenient distance both in the hills and plains aer confined. There are no other European residents besides the military, and the native resident sare chiefly those who attend to the wants of the troops. Their number is returned as 1,680. //. History of the outbreak. — The first case of cholera was in a European soldier confined in one of the cells of the military prison. He was attacked on the 29th July. It is to be remarked that this man had been seized in the prison on the 6th March with symptoms in some respects resembling cholera. There was no vomiting or purging, but extreme depression amounting to partial collapse. The attack on the 29th July was undoubted cholera and soon proved fatal. The prison contained at the time twenty-two prisoners, each in a separate cell ; three warders and a guard of eight men at the gate. The cell in which this case occurred was disinfected and shut up. On the 30th another prisoner was attacked. On the 2nd August the inmates were all removed to tents about a mile to the east. On the evening* of the sth another prisoner was seized, and on the morning of the 6th at 6 o'clock a warder was attacked. At 5 p.m. of the 7th another prisoner attacked. The camp was then moved to about 2 miles further to the south-east, and there all remained well till the 27th September when the party returned to the prison building. Seven days afterwards a man committed two days previously was seized. The prison was at once abandoned. The same day after returning to camp another case occurred, but no other followed. At the time of my visit in the end of November the party was still in teats. In the barracks the first case occurred on the sth August in one of the new double-storied barracks lately finished and only just occupied. The affected room was vacated, and the inmates placed in tents on the parade ground. A second ease occurred in this building on the 2.2 nd, the whole barrack was then abandoned, and the Cholera 83 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- inmates removed to camp about 4 miles off on the road to Nahun. There they kept quite ' . well, but on the 28th September, the very day after their Notes on outbreaks, Dugshaie. , . , i i , . i 1 j Ir_ : j return to the barrack they had left, a case occurred among them. They went back to camp and had no more cases. On the 21st October they returned to cantonment and, as a measure of precaution, were placed in another barrack. Including the military prison, there were altogether, between the 29th July and the 4th October, 46 cases of cholera. Of these eight occurred in camp and 38 in barracks. The disease was very heavy in the prison. Here seven cases and five deaths occurred out of a strength of 25. The distribution of admissions and deaths was as follows :: — > Strength. Admissions. Deaths. Officers ... 21 Men ... 1,034 35 18 Women ... 99 6 4 Children . ... 180 5 4 The disease affected many of the buildings in the cantonments, and its course from one to another is described as " most erratic/ 3 Only two single men's barracks, two family barracks, and four depot barracks occupied by the 72nd detachment entirely escaped. The barracks generally occupy the highest part of the hill, but those occupied by the 72nd men are about half a mile distant from the others and at a considerably lower level. Diarrhoea was prevalent, but not so much so as in the previous year. The medical officer' Dr. Skeen, is of opinion that it was of the form common in the hills, but the Deputy Inspector General informs me that he saw several cases especially in the prison which he would have returned as choleraic. The bazar in which the native population chiefly live is much lower on the hill than the site occupied by the barracks. Among them the first case occurred on the 9th August. The man was a who cut grass in the cantonments, and most of the others were people employed about the barracks. Altogether there were 13 deaths, of which seven occurred in the cholera hospital, and six in the bazar. ' It is believed that no cholera existed in the neighbouring villages, but as they lie in independent territory little is known regarding them. It is said that at Nahun, which is 40 miles from Dugshaie, the Rajah dispersed his troops and liberated the prisoners on account of cholera, but the official return shows only nine cases as having occurred at Nahun. The distribution of the disease according to time was thus— Military European B # Military j European fi # Prison. Garrison. Prison, j Garrison. D * B * r " < . —- f ¦ . July 29th ... lease ... ... ¦ August 19th 2 1 „ 31st ... 1 „ ... ... !, „ 20th ... ; ... 2 1 August sth ... 11,, 1 ... „ 21st 1 „ 6th ... 1 „ j 1 ... " „ 22nd 4 2 7th ... 1 „ ... ! ... „ 23rd 2 „ Bth 1 ... ? 24th ... ! ... ... 1 „ 9th ... ... „ 25th 2 „ 10th 1 ... j' ? 26th 3 „ 11th 3 ... „ 27th 1 „ 12th 1 I ... „ 28th ... ! ... 4 „ 13th ... 1 „ 29th ... | ... 2 1 „ 14th ... ... 1 I 1 „ 30th ... i ... 2 „ 15th 1 2 „ 31st ... i ... l „ 16th 2 1 September 28th ... ... l , 17th ... ... ... ... October 4th ... I 2 cases ;, lsth ... i ... ¦- 2 I ' I II I * Deaths only. 111. Importation and communication. — The first case could not be traced to importation. "No other case had occurred nearer than Kussowlie so far as can be ascertained, and there was no instance of the disease in the bazar for several days after its invasion of the barracks." On the other hand, it is stated that " an officer who had slept at Kussowlie where cholera was prevalent visited the prison on the afternoon of the 28th, the day before the occurrence of the first case." There is not the smallest evidence that the disease was spread from the sick to the healthy. Of 70 native servants employed in attendance at the hospital not one was seized with cholera. The Assistant Apothecary was attacked. On the general question of communication Dr. Skeen observes :—": — " although the first cases in barracks were not brought into contact with the prison, there was sufficient opportunity for importing the disease through the guard, which was not discontinued for some days after the commencement of the outbreak in the jail. " IV. Meteorology. — M There being no reliable instrument at the station, the meteorology of the period must be doubtful. The prevailing wind, however, during July, was light, southerly breezes carrying mists up the valley from Kalka. During August the rainfall was often heavy and accompanied with stormy weather from every direction. The progress of the disease was not apparently influenced in ;iny way by wind or weather." 84 [ Section I NINTH ANNUAL REPORT OF THE V. Local conditions.—- As would be expected from the description given of the hill the drainage is generally excellent. To this remark the vicinity Notes on outbreaks, Dugshaie. of Nog> 4g 4 g Rnd family barrackg ig an exception, and in these the disease was prevalent. The water is drawn from a spring about half a mile below the barracks, and 150 feet below the bazar. No surface drainage can enter it, but after rain the water is sometimes observed to be milky. It is carried in skins on mules. Attached to the spring are two open reservoirs. As soon as cholera appeared the water was drawn direct from the spring by means of a tin tube which delivered it into the skins in which it was carried for distribution. There are one or two other springs on the hill which yield a small and fluctuating supply, but the water is almost entirely drawn from the one source above described. At one of these small springs which is close to the grave-yard, I saw a bheestee filling his mussuck ; it was said to be intended for the use of the bakery. The bazar people and the depot barracks are supplied from the same source as the cantonment generally. " The natives in the bazar use the same water as the troops, but the former collect it as it issues from the mountain side, while it is in the first place collected in a tank from which it is again drawn by leather buckets for the use of the troops. As there was comparatively little cholera in the bazar, the water was suspected of being defiled in the tank, and arrangements were made for filling the mussucks directly from the spring. The disease, however, progressed without change, and this suspicion was removed." There was no overcrowding in barracks. Some of the buildings are old, ill constructed, badly ventilated, and in some instances leaked ; but these were not specially attacked. The only two of the single mens' quarters which altogether escaped were two of these old buildings. The prison is very badly ventilated ; cells on each side open into a centre corridor which is almost completely shut up from the outer air. It requires much, free openings at each end and a continuous ridge ventilator along the roof. Steps are in progress to remedy the defects. VI. Preventive measures. — Quarantine was attempted, but it was merely nominal. All supplies are drawn from outside, so that perfect isolation was impossible. One of the roads was altogether unguarded, and as a matter of fact there was very little check on communication with surrounding places. Movement. — Particular rooms or the whole barrack in which cases occurred were vacated. Excepting the prison only one case occurred in camp, and that was shortly after removal. " The movement from the infected buildings was in every instance beneficial, and attended with the best result. The general health of the men in camps was good, and no special disease appeared to any extent. Of the numbers attacked in the new barracks, five occupied the upper floor and three the lower." VII. Previous history. — Dugshaie has been singularly free from cholera. The station was formed and the original barracks built between 1847 and 1851, but it was not fully occupied by troops till 1852. Statement of Cholera among European Troops* at Dicgshaie from 1852 to 1872. Number of Cases. I I I I I_ I i 1 f I I I 1852f - -i ... ! 1855 - - ... ! ! ... 1 | | ... i 1857 - - ... | 6 6 i ! ... 12 1858 - 176 : 2 11 ... I 4 i 1859 - - 566 i 1 ... 1 j 2 1865 - - 889 i ... I 1 i l 1872 - - 1.307JJ 36 1 3 40 28 I i ? The station has been occupied by European troops only. + There were one or two admissions simultaneously with the outbreak at Umballa, but no deaths. j Includes women and children. In 1853, 1854, and 1856, there was no cholera; from 1860 to 1864, and again from 1866 to 1871 no case appeared, although the cantonment was occupied in each of these years by an average annual strength varying from 727 to 1,055. The 12 eases in 1857 occurred in a small body, the regiment having marched to Delhi. Sunawur, — Assistant Surgeon F. A. Smyth. The hill of Sunawur, on which the Lawrence Military Asylum is situate, lies about a mile to the northeast of Kussowlie. The highest point is 6,100 feet above No. 50, Sunawur. the level of the sea, and the buildings generally occupy the upper part of the ridge. When cholera appeared the strength consisted of 427 children. There were in addition the European officials who, with their families, numbered 58, and a native population of 961. //. Details of the outbreak. — The first case of cholera among the Europeans occurred on the 9th August, one of the girls was attacked. The second and only other case was from the same building on the 26th August, but from a different room. Of those attacked one recovered and one died. Non-choleraic diarrhoea was unusually prevalent among the children in July and August, but great care was taken to keep it in check. During the three months Cholera 85 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- ending 30th September, there were 133 cases, compared with 57 in the same period of 1871, __ 4 ? ,_ „ but the increase may be due in some measure to the atten- JVotes on outbreaks, Sunawur. .. .•, . J ? i i • • i A»«««n»+v.^ tion paid to every case, no matter how trivial. Among the natives there was only one case, and that was on the 23rd August. In the neighbouring village of Gurkhul not a single seizure took place. ///. Importation and communication. — There is not the smallest evidence to show that the first case was due to importation, nor could any communication be traced between the several cases that occurred. IF. Meteorology. — The main characteristic of 1872 was the exceptionally heavy fall of rain in August, 32*7 inches. F. Local conditions. — The house in which the two children were attacked was somewhat overcrowded. The water-supply is drawn from a spring, a few hundred feet down the hill. Both in the reservoir attached to it, and in the mode of conveyance there was ample opportunity for contamination. FI. Preventive measures. — Quarantine was not established till the 21st July and was kept up till the 27th September. Accounts vary as to the strictness with which it was enforced. Movement. — In both instances the room attacked was vacated at once, and no more cases occurred among its inmates after removal. VII. Previous history. — Dr. Smyth has been "unable to trace fully the history of cholera outbreaks at Sunawur in former years. There is no record of the number of seizures, nor do any data bearing on native cases exist". From the burial register it appears that in 1857 there were twelve deaths from cholera among the children in June and July. In 1862 there was one death in July, and in 1867 there were two, one in August, and one in September. Kussowlie, — Assistant Surgeon C. Mackinnon. — Kussowlie, a station on the outer ridge of the Himalaya at an elevation of 6,335 feet above sea level. No. 51, Kussowlie. It lies 9 miles from Kalka, from which the ascent is very steep, and 47 from Umballa. Between Kalka and Umballa and a few miles from the former the Sewalik range of hills intervenes. Kussowlie is a convalescent depot for sick soldiers sent up for the season, and also a sanitarium in which Europeans, with their families, take refuge during the hot weather and rains. The summit of the hill and the northern slopes are covered with pines, and below this cultivation on narrow terraces extends down into the deep valleys which lie all around it. 27. History of the outbreak. — The first known case of cholera occurred on the 28th April. The subject was a native who had just come up from the plains. As will be seen presently, no other native within the place was attacked for nearly three months afterwards. Among the Europeans the first person who suffered from cholera was a soldier who came to hospital on the 2nd July with diarrhoea and ague. On the night of the 4th and sth the disease became undoubted cholera, and he died. On the sth a child was attacked and died on the Bth. Between the 4th July, when the first case occurred, and the 2nd September when it left the European troops, there were 50 cases of cholera, and by the 4th September, when the last death occurred, there had been altogether 27 deaths. The details are as follow : — Strength. Admissions. Deaths. Officers ... ... ... 22 1 1 Men ... ... ... 700 27 13 Women ... ... ... 104 3 1 Children ... ... ... 200 19 12 27 Total 1,026 50 The officer, it may be remarked, had been suffering for sometime previously from diarrhoea. Bad forms of diarrhoea were very prevalent. Commencing with July there were eight admissions from this cause in the first week, 38 in the second, 21 in the third, and 38 in the fourth. In the fifth week ending the 4th August there were 29, and in the sixth week 14. The disease then declined. Of these not less than 40 cases were undoubtedly choleraic diarrhoea, and should properly have been returned as cholera, for besides the severe purging there were vomiting and partial collapse. The only symptom not fully developed was the suppression of urine. Hill diarrhoea, it may be observed, is common at Kussowlie during the rains, but it presents no such urgent symptoms as those described. In 1871, out of a larger strength, there were 63 cases of diarrhoea in the dep6t. Among the native population estimated at 1,800, the first case of the outbreak did not occur till the 13th July, eleven days after the disease appeared among the troops. In all there were 36 cases among them, between the 28th April and the 11th September, of which 18 were fatal. Among the European residents not connected with the depot there were three cases, one 3ii the 4th, one on the 10th, and one on the 11th September. Of these two proved fatal. As the sanitarium is surrounded by independent territory little is known regarding the history of the disease in the surrounding population, but so far as can be learned the villages did not suffer. In no section of the community was the disease confined to any particular locality. Fourteen of the ranges of buildings occupied by the troops were attacked, only six escaped. 86 [ Section I NINTH ANNUAL REPORT OF THE Cases occurred in the most erratic manner, now in one place and again in another far distant. Seven cases are returned as having- occurred in hospital, Notes on outbreaks, Kussowlie- ¦> , o ,i 3 ?, ¦» _« x i !• V but oi these six were admitted with severe diarrhoea, the commencement of the disease. As so many cases of a choleraic nature were returned as diarrhoea, the chronological record of the outbreak is incomplete. So far as the data exist the cases were distributed thus — ! Date. Depot. Bazaar.* Date. Depot. Bazaar.* 2nd July ... 1 ... 6th August ... 1 Bth „ .. 1 ... 7th „ ... j 1 13th „ ... 2 ... Bth „ ... J ... 2 14th „ 1 9th ? ... .1 I 15th „ ... ... 1 12th „ ... | ... 1 17th „ ... ... 1 13th „ ... i 4 1 20th „ 1 loth „ ... | 1 21st „ ... 2 ... lGth „ ... j 1 1 23rd „ ... 1 ... 17th „ ... | 1 24th „ ... 2 ... 19th „ ... j ... 1 25th „ ... 1 1 20th „ ... j 7 26th „ 1 21st „ ... I 1 1 27th „ ... 2 ... !j 23rd „ ... | 1 28th „ ... 3 ... 24th „ ... I 2 29th „ ... 2 ... 25th „ ... | 1 31st „ ... 4 ... 2nd September ... 1 Ist August ... 4 1 4th „ ... I ... 1 2nd „ ... 2 ... 12th „ ... ... 1 sth „ ... 1 * Deaths only. 111. Importation and communication. — There was no evidence to show that the disease had been imported. The native attacked on the 28th April had evidently contracted it elsewhere, but no others were traced to communication with him. In the facts of this outbreak there is not the smallest ground to suspect that the first case was due to communication, and during- its whole course, although all the circumstances were most carefully watched by four medical officers, there was not a single case in which there was any reason to believe that the disease was spread by contact with the sick either direct or indirect. IV. Meteorology . — The season was remarkable for the unusually heavy rainfall. Between the 23rd June and 23rd September, 82 inches were registered more than in any year since 1861. V. Local conditions. — The drainage of the station is perfect. The sides of the hill are so precipitous that no water can possibly lie on it, and as it consists in the main of bare rock there is little or no lodgment for subsoil moisture. The water-swp]Ay for the troops and other- European residents is drawn from a spring about 1,000 feet below the barracks, and is carried up in skins on the backs of mules at a cost of nearly Us. 8,000 per annum. The reservoir is (juite uncovered and unprotected. The water is lifted from it by leathern buckets, and there is every opportunity for a naturally excellent water to become contaminated. An estimate has been sanctioned for covering the reservoir and fitting it with pumps. The depot was certainly overcrowded. Many of the barracks although modern are ill designed and very badly ventilated. It was intended that the men in excess of the proper complement should sleep in the inner verandahs, but they leaked so badly that this arrangement could not be carried out. But with regard to the overcrowding it is to be remarked that the depot was fuller in 1871 when no sickness occurred. In that year the maximum strength was 735, whereas the number in 1872 never rose above 700. The general conservancy of the station was reported to be unsatisfactory. VI. Preventive measures. — Quarantine was commenced on the 14th July and continued up to the 9th September. The roads both leading into and out of Kussowlie were guarded by police, and no one was allowed to go either way without a pass. Very many passes were issued. The quarantine such as it was could easily be broken, and was broken, but as the object was not to protect Kussowlie which had been attacked many days before it commenced, but to prevent the spread of the disease to neighbouring places, it has little bearing on what occurred at this sanitarium. Movement. — In accordance with the rules prescribed by the Government, whenever a case appeared in a building, the room was vacated, and if a further case occurred in any of the other rooms the whole building was abandoned, and the occupants removed to tents. At first these tents were pitched within the cantonment near the barracks, and not a single case occurred in them ; but it was considered advisable to remove the inmates of affected*" quarters to a greater distance, and so on the 2nd August a camp was formed on a ridge near (he village of Gurkhul which lies about a mile to the north of the Kussowlie hill, in a direc [me, and between 3 or 4 miles by the road. When this camp was first formed on the ond August, a party of 30 healthy men was sent to it, and at the same time 11 cases of Here and elsewhere, wherever the expression " affeoted" or " infected" quarter is used, it must be understood that it involves no theory. merely intended to indicate in lew words that a ease of uholera had ooourred in that quarter. Cholera 87 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- cholera and 8 of diarrhoea. Nine other cases of cholera were afterwards sent out as they occurred. On the 13th August, a further party of 66 men Notes on outbreaks, Kussowhe. .^^ and subsequently a number of women and children were sent from other buildings in which cases had occurred. The tents occupied by the cholera cases were 400 yards distant from those in which the healthy detachments were. The total strength of this camp was ultimately — Officers ... ... ... ... 4 Men ... ... ... ... 180 Women ... ... ... ... 10 Children ... ... ... ... 24 Total ... 218 and here they remained till the 30th September when cholera had entirely left the depot. The result was most satisfactory. Of the cases of cholera sent out four died in this camp, but not a single case of cholera occurred in it. The result is all the more noteworthy, because the tents containing 1 the cholera patients were separated from the rest of the camp by only a few hundred yards, and the approach to these hospital tents was by a road leading past and not many yards distant from the rest of the camp. Moreover, all the supplies for the whole party were drawn from Kussowlie. Every thing was the same as supplied to the troops in depot; even the water which was drawn from the same tank and brought in the same manner. On this point I made very careful enquiry. The Commissariat Sergeant among other witnesses assured me that the water for the Gurkhul camp was drawn from the same tank as supplied the depot, and that it was carried out on skins which were used indiscriminately, some days for one place and some days for the other. On the 15th August another camp was formed on a ridge which runs out below the hospital to the south-west. The ridge is very low some 700 feet below the station. The first party consisted of 56 men and 2 officers of the 1-llth Regiment, and on the 16th another detachment of the same regiment went out making up the total to 4 officers and 90 men. In this party 8 cases of cholera occurred. On the night of the 19th, there was a storm of thunder and lightning with very heavy rain, 4^ inches fell that night. Between G p.m. of the 19th and 11-30 a.m. of the 20th, 7 cases of cholera occurred, and an eighth man was seized on the 21st, just as they were striking the tents. Of these 8 cases 6 occurred among the party first sent out, and two among the men of the second party. The camp was moved half a mile further along the ridge to a more elevated spot, and no more cases occurred. After this movement the water continued to be drawn from the same spring as that which had been used in the first camping ground. It is remarkable that at or about the same time that the men suffered so severely, a small hamlet close by was also attacked. To what extent is not known, but the medical officer in charge of the detachment saw one of the sufferers. VII. Previous history.— ln 1845 there was a severe outbreak, part of the great epidemic of that year, but the statistics from that time to 1871 have been very favorable. Beyond a few isolated cases there was no cholera. In the years which were altogether exempt the strength varied from 46 in 1858 to 901 in 1856. The average may be taken at about 400. Statistics of cholera among European troops* at Knssowlie, 184-2 to 1872. Numbeb of Cases. SIS. ,; | . 6 6 - ££ fflj. iii-sd.- , i I i i i i I I I I I g I I j I : s 1843 European Troops I 989 1 1 1814 Ditto - 978 112 1 5 2 1845 Ditto - 1,045 112 120 12 1 137 38 1847 Ditto - 881 11 2 1 1852 Ditto - There was one or two admissions simultaneously with the outbreak at Umballa, but no deaths. 1865 Ditto - 606 1 1 ... | 2 2 1867 Ditto - 327 1 1 1 1872 Ditto - 991 25 22 1 48 26 ? Occupied by Europeau troops only. Umballa. — Deputy-Inspector General of Hospitals, British Forces, T. Crawford, m.d. ; Deputy-Inspector General of Hospitals, Indian Medical Department, J. N. Tresidder ; Surgeon John Ogilvy, m.d., Royal Horse Artillery; Assistant Surgeon Graves^ lloyal Horse Artillery; Staff Surgeon Major, W. A. Thomson, m.b., 20th Hussars; Surgeon P. G. Constant, m.d., 12th Bengal Cavalry; Surgeon C. E. Haddock, 32nd Native Infantry; Civil Surgeon R. S. Bateson. The military station has an elevation of 902 feet above the level of the sea and lies 3S miles from the foot of the Himalaya. When cholera appeared the strength of the garrison was 4,700 European troops consisting of the 20th Hussars, the head-quarters with the C and F Batteries of the F Brigade, lloyal Horse Artillery, and the 72nd Regiment. There were also two Native Regiments, the 12th Bengal Cavalry and 32nd Regiment, Native 88 [ Section I NINTH ANNUAL REPORT OF THE Infantry. Within the cantonment is a large native bazar with a population of 24,000, and _ . ? 5 miles distant is the city, the people in which also number Notes on outbreaks, UmDalla. n . nAA mi ? . « ' * * , „ 24,000. The district of Umballa extends over an area of 2,628 square miles, and has a population of 1,008,952. There are 2,324 towns and villages, but only 7 have above 5,000 inhabitants in each. //. History of the outbreak. — The first case among the Europeans occurred in the Artillery at 9 p.m. of the 29th August. On the 31st August at No.' 53,' 20°& a Hussarsf y ' 1-30 a.m., a man of the 20th Hussars, and at 10 a.m., another artillery man were attacked. On the third of September a woman of the Artillery. Two of those in the Artillery were from the same block of married quarters. Of these four cases, the last died, the other three recovered. There was no prevalence of diarrhoea at the time. Among the officers and the civil European population no case tvt ** , n^ t, ir, occurred. Of the Native troops one trooper of the 12th No: 54, 12th Bengal Cavalry. „ , ~ . . i , , r ,, ?,, 0 1 , . ? . Bengal Cavalry was attacked on the 11th September, the only case. Among the non-military Native population of cantonments there were 19 cases and 10 deaths. The first occurred on the 2nd June, a grass-cutter in the service of one of the officers of the 32nd Regiment, Native Infantry, and the last on the sth of October. They were confined to no particular part of the station ; three occurred in persons who had lately arrived from other places. The villages in the immediate vicinity of cantonments, as a rule, suffered little. In the city the first case occurred on the 2 1 st May. Between this and the 21st September there were 97 deaths distributed as follow, and side by side with them may be compared the deaths in the cantonment bazar, and the cases among the Europeans and the prisoners in the jail — Cholera at Umballa in 1872. 21st May - - 1 ... 19th August - 4 2nd June - - 1 ... 20th „ - 1 4th „ - - 1 21st „ - 2 13th „ - - 1 22nd „ - 8 ... 1 15th „ - 1 | 23rd „ 3 17th „ - - 1 ... I 24th „ - 4 11th July - - 1 25th „ - 2 21st „ - - 1 ... 26th „ - 8 33rd „ ¦ - 2 27th „ - 1 24th „ - -... 1 29th „ - 1 25th „ - 2 ... 1 ... 30th „ - 1 1 27th „ - .... 3 31st „ - 1 ... 1 2 28th „ - 1 1 Ist September - 1 30th „ - - ... 1 2nd „ - 1 31st ? - - 1 4 ... ... 3rd „ 1 1 Ist August - - 1 3 ... ... 4th - 2 ... 1 2nd „ - - ... 2 ... ... sth „ - 8 3rd „ - - 3 ... ... 7th „ 1 4th „ - - 1 Bth „ - 1 sth „ - - 2 I 11th „ - 1 6th „ - 4 . ... ... | 15th „ 1 Bth „ - 2 ... I 16th „ - 3 9th „ - 1 18th „ 1 11th „ - - 7 ! 19th „ 1 12th „ ¦ - 5 ... 20th „ - 1 ... 2 14th „ - 5 ... 23rd „ 1 17th „ - - 3 ... sth October 1 18th „ - - 1 1 1 In the district, according to the information furnished by Dr. Bateson, the first known case occurred on the 14th April at Jugadree, and up to the end of September there had been including the city a total of 1,119 deaths reported from the disease. The first maximum is indicated by 154 deaths in the week ending the 18th May. In the two last weeks of August there was a second maximum of 65 deaths in each. Altogether cholera was reported in 187 towns and villages. The general distribution of the disease was as follows : — Number of Number of places deaths from attacked. cholera reported. April ... ... ... ... ... 15 61 May ... ... ... ... ... 96 465 June ... ... ... ... ... 61 291 July ... ... ... ... ... 12 36 August... ... ... ... ... 14 195 September ... ... ... ... 15 71 ///. Importation and communication. — As regards the Artillery "an attempt was made to trace the whereabouts the first case, a jemadar of grasscuts, contracted the disease, but no information was elicited tending to prove he was in or near an infected locality." In another paragraph the medical officer states "on enquiry no information could be elicited as to whether Cholera I gANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 89 communication between the seat of the outbreak and any infected locality had occurred." One hospital sweeper in the Royal Artillery was attacked, Notes on outbreaks, Umballa. tfae cag() amQnj? the seryants and attendants on the cholera cases. As regards the case in the 20th Hussars, the Surgeon writes : — " on 24th July, Private Doune, a bandsman, 20th Hussars, who had been granted a fortnight's leave to Kussowlie to enable him to give evidence in a lawsuit then pending, started for that station. At the expiration of his leave he was detained at Kussowlie on account of the existence of cholera among the troops there. He however returned to Umballa without leave, and reported his arrival on the 10th August. He was made a prisoner and sentenced to fourteen days' drill. He resided the whole time he was undergoing his punishment in the band bungalow and was in constant communication with the other members of the band, occupants of the same bungalow. On the night of the 30th, or rather very early on the morning of the 31st August, Private Stewart of the band was brought to hospital with cholera. It does not appear that he had any special communication with Private Doune more than with any other bandsman, and moreover Doune's and Stewart's cots were at exactly opposite ends of the building. It would, I think, be rather stretching a point to positively assert that Private Doune carried the disease with him from Kussowlie to Umballa and propagated it in the band bungalow, but account for the occurrence of the solitary case as we may, there can be no doubt that the circumstances as related are highly interesting, and if nothing more, worthy of record as instancing a remarkable coincidence, particularly when it is remembered that the disease did not show itself in any other building or among any other body of men belonging to the 20th Hussars." As evidence of communication of the disease, the following' particulars are furnished by Dr. Raddock : — "On the afternoon of the 11th September 1872, a sowar of the 12th Bengal Cavalry at Umballa was attacked with cholera ; this was the first case that occurred in the Native Cavalry lines. How the man became affected with the disease is not known ; he was treated in a tent pitched some distance from the Regimental Hospital with two constant attendants, one a friend or relation in the regiment, the other a hospital sweeper ; both were forbidden to hold any communication with others or to enter their houses. " On the 16th September two fresh cases of cholera occurred in the 12th Bengal Cavalry, one a grass-cutter's wife in the lines of the regiment, the other a boy in the hospital servants' quarters, son of the hospital sweeper attending on the sowar attacked on the 11th instant. "On the 17th September the same hospital sweeper's mother was attacked with cholera. The family then consisted of the sweeper, his mother, and two children ; the mother and boy were sent to the cholera hospital for treatment, the other child, a boy, was put in charge of another sweeper. The sweeper himself went to the cholera hospital to attend on his mother or boy, the latter died on the 17th September, the former on the 19th. The sweeper was ordered to remain in a hut near the cholera hospital to get his clothes washed, &c. On the 21st, he took ill with cholera, was discharged cured on the 28th September. With regard to this sweeper it was known afterwards that at nights, whilst attending on the sowar, he entered his house in the hospital servants' quarters to take food ; in the house were his mother and two children, two of whom were attacked with cholera, one escaped, the sweeper himself eventually getting the disease." Dr. Bateson, the Civil Surgeon, writes : — " In the south part of the district where there was no quarantine the disease spread from village to village. At Munee Majra, where it, the cholera, was very bad, there was a staff of medical people on the alert for fresh cases, quarantine measures were adopted, the neighbouring villages escaped." Forty-five out of the 187 places attacked were placed in quarantine. As the pilgrims returning from Hurdwar fair are believed by some to have been the medium of spreading the disease over Upper India, the following facts furnished by Dr. Fairweather, the Officiating Sanitary Commissioner of the Panjab, who carefully investigated this point deserve attention. The first known case in the district as has been already stated, occurred on the 14th April at Jugadree, a town in the south of 11,600 inhabitants. The man was a pilgrim from Hurdwar. No other case occurred here till the week ending 18th August, and in all there were only five. The s.econd case was on the 15th April at the village of Belaspore, which lies about 10 miles north of Jugadree. This man also was a pilgrim. Another occurred here on the 18th April, and there were no more cases. On the 19th April another of this same party of pilgrims returning to Jummoo in Cashmere was attacked at Sadhoura, a town of 11,100 inhabitants, which lies about 12 miles from Belaspore. In the week ending 27th April a resident died ; in the week ending the 18th May and not till then there was another death in this place, and then only one. Dropping cases making up a total of 1 1 occurred up to the end of September. At Narainghur, another march, a pilgrim is said to have been attacked and died of " fever," and the same thing is reported from the next stage on this route, Ramghur. In neither of these places did the residents suffer. The town of Munee Majra had 46 deaths up to 18th May out of a population of 6,000. There is some discrepancy here regarding the facts. The death statement showg that a pilgrim died here on the 23rd April. Dr. Fairweather from personal enquiries fixed the date as the 19th. It occurred in the dispensary. The point is of much importance as the Civil Surgeon's report shows that six persons died of cholera in this town on the 22nd and 23rd. At Roopur, a town of 8,700 inhabitants, there is a difficulty in ascertaining the particulars of the first case. The death register gives it as that of a resident on the 17th April. The Civil Surgeon says it was a pilgrim on the 22nd, and that a police constable was attacked with what is described [ Section I 90 NINTH ANNUAL REPORT OF THE as " bilious or summer cholera" about the same time. Whatever may be the truth on this „ , „ point, it appears that during 1 the sixteen weeks f'rcm the Notes on outbreaks, Umballa. tw,! » -i i j_i t^i * , 1 i i_i r i i 17th April to the sth August only seven deaths from cholera occurred here. In the next five weeks there were 68, making* a total of 75 in this town. In the Pihowa registration circle of the Umballa district which lies to the south-west, and suffered much from cholera, there is, it may be remarked, no suspicion of importation. In the village of Buklee which is included in it, a death occurred as early as the 22nd April and 24 followed in it during the season. At Sarsa there were two deaths from cholera on the 22nd April, at Pihowa and Shapoor there was a death in each on the 23rd April. In the neighbouring district of Kurnal also which lies to the west there was a death from cholera in the week ending the 11th April. The total deaths in that district numbered 1,085 out of a population of 610,927. In the week ending the ] lth May and again in the week ending the Ist June there was a maximum of 164 deaths. In the week ending 24th August there was a second maximum of 35 deaths. IF. Meteorology. — The rain-fall was in excess, the amount registered up to the 11th November having equalled 524 inches whereas the average is 449 inches for the year. The medical officer of the Artillery observes :-— " During the month of August an easterly wind prevailed nearly the entire month, the days and nights were excessively warm and oppressive, accompanied with occasional heavy showers of rain.'" V. Local conditions. — The drainage of the Umballa cantonment is very imperfect, water lodges in many places, especially on the front and flanks, and no improvement can well be effected without endangering the present precarious supply of water in the wells. Before better drainage must come a better water supply. Improvement in both is very much needed. The wells in cantonments have generally run so dry that many of them have altogether ceased to be used, and others yield, especially in the hot weather, a very small quantity. For the use of the troops wells have been sunk in low lying ground on the outskirts of cantonments, four in one position and four in another, and these are worked by bullocks. The scanty stream derived from them is carried along covered masonry channels and delivered into a series of small reservoirs near the barracks. These have wooden covers, but nothing can be drawn from them until these are removed, except in the case of two which have lately been provided with pumps. The water is well spoken of, but it is far from sufficient, particularly in the hot weather when the quantity naturally diminishes, and there is the greatest demand for all purposes including the watering of tatties. The mode of raising and delivering it is also most faulty. The wells are open and may be contaminated, especially as the bullocks and their drivers are constantly moving immediately round the mouths of them in drawing the water. After being subject to possible contamination here, the water is carried in a protected channel, but after this again it may be polluted in the reservoirs. These reservoirs are sunk into the ground. The water falls into them and then there is the needless labor of raising it again. The provision of a pump to each reservoir to draw water for a single barrack is a useless expense. The pump should be at the source of supply, and the reservoirs should be so arranged that the water can be drawn off by taps. A proper scheme of water-supply for Umballa is very urgently required, which should provide ample quantity and deliver it pure at the various points where it is required. A project to effect this most desirable object is now in hand. There was no overcrowding. VI. Preventive measures. — Quarantine. — As soon as the Jugadree case of cholera was known a cordon was drawn around the station. The primary object was to prevent the ingress of pilgrims to whom an epidemic among the troops was believed to have been due in 1867. It was continued after that danger had disappeared. It could not be strict as hundreds of men were obliged to go daily to cut grass, and supplies were drawn from outside. People coming by railway were detained for four days under observation. Among these one case of cholera occurred. The Inspector of Police states — " quarantine arrangements commenced in cantonments on the 12th May, the cordon was only on the south-east side of cantonments. On the 15th May cordon was put on the Railway station, and orders were issued that all the Governor-General's servants were not to be placed in quarantine, but allowed to proceed to the hills. About the 14th or 15th July, the cordon was taken off and put on again on the 27th July, and was kept on two or three months. I cannot find out the date. I cannot state how many men were interfered with, for there were thousands/ Regarding the restrictive measures attempted among the people of the city and district, Dr. Bateson writes :— " Forty-five out of the 187 places seized with cholera were placed in quarantine. Villagers were not prevented from going to their agricultural work. My impression is that in the majority of these villages the quarantine was not strictly enforced. * * * * * *. The nearer the attacked village was, the more stringent were the segregation and quarantine measures, and the more supervised the carrying out of orders respecting them ; to the best of my power I, as health officer, prevented any person from an affected village or town from going into cantonments. * * * * * Natives dare not come out of cantonments (except to go right away and not to return) lest at the time they wished to go back they should be stopped by the health officer. # # # # # The orders issued by the civil and military authorities annoyed, vexed, and oppressed the people. In the city of Umballa, I tried to segregate the affected and take them outside the town to huts, this led to lies being told and in every possible way to the hiding of the disease ; not only was the sick relation to be taken away if information were given, but so many as went with him were put under quarantine restrictions, and the house was dealt with under operation Endemic J SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 91 of rules issued by the Sanitary Commissioner of the Province. To tell a lie and report the ¦kt * *t, v TT™i«n case as a fever, as anything but the cholera, and keep the Notes on outbreaks, Umballa. . , „ . I / » , *. , * ? sick father or the mother among them to be able to obey the traditions of their religions in the obsequies, were infinitely the better than report the truth to the sahibs with the probable result that the ties of relationship would be roughly unheeded ; and the relation, if he died, burned or buried, no one knew how or by whom, a dread so bad to them that a worse could not be. It was, indeed, difficult to try and stop the cholera, and at the same time care for the feelings of the people. On this subject Mr. C. P. Elliott, Deputy Commissioner, writes to me as under : — ' There were many complaints from villagers and the orders were quite illegal, as no rules on the subject (quarantine) were issued by Government. Some of the Magistrates punished for breach of quarantine rules under Section 271, Indian Penal Code, and the Commissioner very rightly objected. I think it both useless and oppressive to put villages in quarantine ; it is impossible thoroughly to carry out the rule, for you must let people go to the fields, and when they have got there how can you prevent their going elsewhere ; a wide door is thus opened for the police to take bribes. With regard to the cantonments, if the medical authorities consider that cholera was really kept away from the troops by this means ( JJnTcMdon ), I think any hardship or inconvenience to the public is to be justified; but there is no doubt that both the police and sepoys took money to let people pass the cordon, although passes were given pretty freely to persons wishing to pass through cantonments; yet many merchants and others were put to the greatest trouble and inconvenience, for it must be remembered that the Grand Trunk Road to Loodianah from Kurnal and Delhi, and the high road to Saharunpore and the North-West Provinces, pass through the very heart of cantonments, and although the Civil Surgeon who was the health officer gave passes to those whom he considered bond fide travellers wishing to pass through cantonments, yet from press of official duties he was obliged to fix an hour in the morning, when he received applications. Any persons arriving after that hour had to wait till the following morning, i. c. } they might be kept waiting in the road for 23 hours, and numbers were doubtless so kept daily. This remark applies to those coming from the Panjab, but the poor creatures coming from down country were in a far worse plight ; they were stopped two or three miles from cantonments and were unable to get any further : if they could not bribe the sepoys to let them in, they must have had to leave their carts and cattle and go across country for many miles till they could get round to the city and obtain a pass from the Civil Surgeon (health officer), I have no doubt many persons were thus kept waiting outside cantonments for several days. I have myself seen merchants with their carts sitting hopelessly on the other side of cantonments not knowing where to go or what to do, being suddenly stopped on their journey in the middle of the high road. If, in future, cantonments are to be put into quarantine a good pucca road should be made outside them, so that people wishing to go to places beyond them could pass round without hindrance, though the nature of the country round Umballa is such that this would not be practicable without an enormous expenditure of money/ " The Cantonment Magistrate expresses his opinion that ' the quarantine restrictions did oppress the people/ 1. ' They could not go where they liked, and probably many who worked beyond cantonment boundaries were much inconvenienced, as no one, if they went out, could come into cantonment without a pass/ 2. ' Public works were partially stopped, and laborers residing outside cantonment could not come in without passes, and thereby suffered loss of wages, &c/ 3. ' During the first quarantine was the auspicious time for marriage feasts, and people were much inconvenienced at not being able to have them/ 4. 'It affected trade also, as no one could bring in supplies without a pass. These supplies were always taken over at the cantonment boundary by the artees, and the beparu did not care to bring them in as usual, as they could not accompany them to the artees through whom they were sold, not knowing and not feeling sure how they would sell them/ w The books of four firms taken at random showed that trade suffered materially, and things were generally dearer during the quarantine than before or after it. The Cantonment Magistrate states — "it was generally supposed that the sentries on the cordon took bribes, and there is no doubt in my mind that they did so. Three accusations were made against sentries and investigated, but it could not be brought home to them." Movement. — Whenever a case occurred amongst the troops the quarter was at once vacated, and no second case appeared amongst such inmates after removal. No other diseases arose from removal into camp. The Umballa Jail lies close to the city, and on the road between it and the cantonment when cholera broke out there were 705 prisoners in confinement. 11. Details of the outbreak. — The first case occurred on the 24th July in a barrack occupied by weakly men. On the 27th, three other barracks were attacked, one prisoner seized in each, on the 28th a No. 55, Jail. fifth barrack presented a fifth case. These buildings are not contiguous, but scattered over the jail enclosure. Ten more prisoners were attacked in camp. The dates of the cases have already been given in the general statement. No diarrhoea prevailed. 92 [ Section I NINTH ANNUAL REPORT OF THE VI. Preventive measures. — Quarantine. — From the 31st July, a more strict quarantine was established than that which is ordinarily employed. All Notes on outbreaks, Umballa. new prigoners are alwayg kepfc j n ft separate barrack or some time after admission. Movement. — As soon as each case occurred, the building was vacated and the inmates removed to tents outside. The ground was shifted several times before the disease disappeared. The first move was into the garden, two other changes were made within the precints of the jail grounds. On the 3rd August a more decisive change was made to a spot, three miles on the Loodianah road, and there the several parties whom it had been necessary to keep together to economise guards, remained well. As soon as the first case appeared the well from which the prisoners were supplied with drinking water was locked up, and the vessels used for drawing it, after having been carefully scrubbed, were attached to another well. The same skins were however used for distributing the water. They were also cleaned. No further change was made in the supply for the prisoners within the walls. VII. Previous History. — Statement of Cholera at Umballa from 1843 — 1872. jz Numbeb or Cases. I 7T~~ , i ]|; |I I I 1843 European Troops - 856 1 3 5 3 2 11 16 g 1844 European „ - 1,356 ... 2 2 ... 4 ("European Troops - 2,439 ... 1 1 3 3 2 123 227 35 2 1 ... 398 205 1845 j Native „ - 7,358 ... 2 ... 12 1 2 779 25 4 1 ... 133 71 (.Prisoners - - ... ... 7 1846 f European Troops - 2,521 2 5 2 4 ... 1 14 5 (. Prisoners - - ... 1 1847 European Troops - 2,593 4 ... 2 3 ... 3 ... . 2 14 1 1848 European „ - 1,881 2 4 ... 3 .... 2 ... ... ... 1 12 1 1849 European „ - ],505 3 4 ... 3 ... 2 2 1 ... 15 -i ocn f European Troops - ... ... 1 ... 1* ±0DU l Native „ - 3,472 1 1 M , "... 2 1 1851 Native „ - 4,073 2 4 ... 1 1 8 3 -i 8i 8 - 9 / European Troops - 1 ... 67 5 ... 73* XOoa \ Native „ - 3,971 1 1 1 ... 2 13 13 2 33 15 1853 Native Troops - - 2,160 3 ... 3 ... 6 1 1854 Native „ - 1 ... ... 1 ("European Troops - 807 ... ; 6 ... ... 6 4 1856] Native „ - 2,985 .' "i ... 1 (.Prisoners - - 470 29 16 ... 45 27 /'European Troops, (at ") 1857 ) Umballa and on the > 1 62 22 ... 1 1 ... 87* y march to Delhi) - ) C Prisoners - - 594 3 4 2 9 5 10M ( European Troops - 941 2 1 ... ... 3 1 1858 1 Prisoners - - 632 1 ... "[ ." ... '" ...' 2 1859 European Troops - 1,581 2 ... ... . 2 1860 Prisoners - - 561 1 ... [[[ ... ,M, M Z ... 1 ( European Troops - .1,820 ' 10 57 4 ... ' 71 53 1861] Native „ - 823 ... ... 4 , ... 4 2 (. Prisoners - - 704 27 27 18 -. o fi9 ( European Troops - 1,767 4 ... ... 4 2 18D " (Native „ - 979 1 1 6 .".'.' ... 8 8 1863 European Troops - 1,683 1 1 1 1864 Prisoners - - 866 1 ... \\\ ... "' ... 1 1 S European Troops - 1,329 422 1 2 ... ... ... 29 22 Native „ - 937 6 ... ... 6 3 Prisoners - - 688 1 1 1 1869 Native Troops - - 913 " t [ „, ... ... "{ "] ... 1 1870 European „ - 1,554 1 ... "'" ... „" "' ... 1 r European Troops - 1,599 IS 4 1 1872J Native „ - 903 .'..' ... \" ?, ... 1 Z. Z. ... 1 (. Prisoners - - 1,159 '" 16 16 4 ... 30 12 . I ? No. of cases not recorded. Phillour, (Staff Assistant Surgeon E. C. Parkinson), a small fort on the right bank No 56 Phillour. °^ le between Umballa and Jullundur, was garrisoned by a detachment of 63 men of the 54th Kegiment from Jullundur, and 35 sepoys from the same station. The town of Phillour which is close by has a population of 7,425. Phillour is in the Jullundur district. Reference will be now made only to the town and fort. 11. History of the outbreak.— .The register shows that the first deaths from cholera in the town occurred on the 29th and 31st August. Only two others have been recorded, one on the 3rd and one on the Bth September. It appears, however, that there were two cases on the Cholera SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 93 10th August. In the Phillour Tehseel or Revenue division of the Jullundur district 16 __ . .. . _.... villages are said to have been attacked, but the people were Notes on outbreaks, Phillour. ,°, ° ? . . . . ', • i ,• / much disturbed by the rules requiring" the isolation of persons suffering* from cholera and the other measures designed to check the disease, and it is believed that very much of it was altogether concealed. In September alone the deaths in Phillour city were 56 or about eight per 1,000, but they were generally ascribed to fever. Among the Europeans the first case was on the 23rd August. Two of the men of the 54th were attacked, one in the hospital where he had been for about a fortnight suffering from fever, but was convalescent, and the other in the barrack. Both were rapidly fatal. Cases followed, one on 26th, one on 29th, one on 30th August, one on 3rd September, one on 6th, one on 13th, one on 14th, one on 15th, and one on 16th. The results were as follow : — Strength. Admissions. Deaths, Officers ... ... ... 3 Men ... ... ... 63 11 11 Women ... ... ... 5 Children ... ... ... 4 It is to be observed that every case was fatal. During the time the cholera lasted, diarrhoea was very prevalent among both officers and men, and some of the cases had a choleraic tendency. Fevers were very prevalent in the detachment prior to the 23rd August, also among the native population. During the outbreak four fatal cases of fever occurred among the Europeans. Bowel complaints and fevers also increased among the native people. The only two buildings occupied by the detachment, the barrack and the hospital were attacked. Neither the sepoys or the native followers had a single ease. ///. Importation and communication. — The first cases could not be traced to importation. The two men first attacked had had no communication with each other or with the native bazar, or at least no communication could be traced. " Three men who had been present in the fort hospital when the first case occurred there on the 23rd August, were attacked with cholera, one on the 26th August, another on the 29th, and the third on the 30th August. Two men occupying the same tent were attacked within a few hours of each other/ The same morning the first cases among the European soldiers occurred, four persons, Dr. Parkinson says, were seized in the town after a lull of several days. Nor in the course of the outbreak could communication be traced from one case to another. The cases which occurred on the 26th, 29th, and 30th, were among men who had been at the time in hospital along with the man first attacked. None of the attendants on the sick, some 18 or 20 in number, suffered. IV. Meteorology. — " The wind was very slightly from the south, the evening previous to the outbreak in the fort. A misty appearance of the atmosphere something like a dust storm without wind was observed to approach from the same direction accompanied with flights of locusts the same evening." V. Local conditions. — The fort from its small size is very confined. The hospital building which occupies one corner of it is very close and ill ventilated. The room which the men chiefly occupied is the upper story of the only barrack in the enclosure. It is airy and open, though not constructed on modern principles. There was no overcrowding. The detachment of Europeans previously quartered in the fort had been much stronger and enjoyed good health. The water is drawn from the only well inside which is in the centre, and is said to be of good quality. The sepoys prefer that of a well outside. After leaving the fort which they did on the 23rd, the very day the first case occurred, the men drank from different sources as they changed ground, and the supply was always boiled and filtered. Cases continued to occur as has been VI. Preventive measures. — Quarantine. — As regards this part of the district there was no actual quarantine, but I was informed that travellers were not allowed to enter the town of Phillour, and that they were warned not to go to villages in which cases had occurred. Practically people could with a little management have gone a roundabout way to any place they liked, but to avoid annoyance many turned back. The restrictive measures, I was informed by a very intelligent native gentleman, had been most distasteful and distressing to the people. For a week from 11th August, au attempt was made to keep the fort isolated, but the attempt was abandoned. Movement. — On the 23rd August as soon as the two first cases appeared, the Europeans were moved into camp at the site of the old cantonment. For three days they remained clear of the disease. On the 30th having had three cases on this ground, they changed to another place about 2 miles from the fort. During the 14 days they were here, there were four more eases. The hospital, with 15 patients and two orderlies, remained on this spot, and had no further attacks. The others on the 14th moved 6 miles to Goone on the Jullundur road. Twelve hours after arrival there they had another seizure, and on the 16th the last occurred. They then changed to Phugwara and went on to Jullundur on the 11th October. The married people did not move into camp. They were accommodated in a bungalow outside the fort and had no cases of cholera. NINTH ANNUAL REPORT OF THE £ Section I !>t VII. Previous history is shown in the annexed statement :•— Notes Statement of cholera at Phillour 1850— 1 872. Numbbb of Casks. **Il|i6ii I I I I j ii 1850 Native Troops - - 1,091 1 1 ... 1852 Ditto „ - - 1,067 ... 1 ... 1 2 ... 1853 Ditto „ - - 572 1 ¦ 1 ... 1854 Ditto „ 1 1 ... 1856 Ditto „ - - 731 1 1 ... 1865 European „ - - 78 1 1 1869 Native „ - - 83 1 1 ... 1872 European 70 5 6 11 11 From 1857 to 1871 the strength of the detachment of European troops has varied from 56 to 147. In 1869, 1870, and 1871 there was only a detachment of sepoys. Jullunder, (Surgeon J. J. Thomson, 54th Foot, Assistant Surgeon J. McCreery, r.a., Assistant Surgeon G. Massey, Civil Surgeon, Assistant Surgeon Juiiundur. A q Grant^ B^ 7th Native I n f an t r y), a military cantonment situated in the Doab between the rivers Sutlej and Beeas. At the time that cholera appeared the garrison consisted of G Battery, Bth Brigade, Royal Artillery, Her Majesty's 54th Foot, a detachment of the 12th Bengal Cavalry, and the 7th Regiment, Native Infantry. The nonmilitary native population may be estimated at 10,000. The city, which is 4 miles distant, has 33,673 inhabitants. One or two civil officers with their families reside near it. The jail contains 424 prisoners. The area of the district is 1,332 square miles, and the population 783,020. The towns and villages number 1,268. 11. Details of the outbreak. — In the district the first death from cholera reported occurred on the 19th June. Between that date and the end of September, 70 towns or villages were attacked. These are scattered all over the district. The disease was chiefly confined to the mouths of August and September. In June only two villages were attacked, and in July four. In August 35 and in September 52. In October the number fell to three. According to the statement furnished by the Sanitary Commissioner of the Punjab, the first death was on the 28th June, and the incidence of the disease was somewhat different. Month. Number of places Number of deaths. attacked. July '.'.'. '.!'. ... 4 11 August ... ... ... 33 177 September ... ... ... 38 169 October ... ... ... 3 41 The total deaths from cholera in the Jullundur district during these 5 months were 403. In the city the population of which taken by itself is 33,673, or with suburbs 44,821, the first deaths from cholera were two, reported on the 17th August. One followed on the 18th and others occurred almost daily up till the end of September. The total was 159, and of these 118 occurred between the 22nd August and ]Oth September. It was also between the same dates that cholera was chiefly spread over the district. As in the district geDerally the cases in the city were not confined to any particular part, but were dotted over it. The facts, however, are but imperfectly known, for there is a general impression that owing to the restrictions imposed, by the authorities the disease was to a large extent concealed. In the jail the number of prisoners when cholera appeared was 424. The first case was on the 26th August. The Civil Surgeon, Dr. Massey, is not satisfied No. 57, Jail. that this was a true case of cholera. The man was a lunatic who had been picked off the streets three days previously, and had been put in the jail for want of a better place in which he could be taken care of. This man occupied a ward by himself. On the 27th there was one case regarding which there is no doubt, and about the same time one of the guards was attacked. On the 28th the Native Doctor was attacked, and on the same day a prisoner. Altogether there were five cases. In the cantonment the first recorded case occurred on the 22nd August, a child aged seven belonging to the 54M Regiment in No. 11 family barrack. It appears, however, that another child of the same family aged No. 58, 54th Regiment. three and a half had been brought to hospital on the previous day, suffering from severe diarrhoea, which ended rapidly in convulsions and death. Dr. Thompson is now of opinion that this was also a case of cholera. Cases followed, one on the 24th from No. 11 occupants, three on the 25th, one of which was also from the occupants of No. 1 1, the second from a double-storied barrack, and the third, an officer's child. Between the 29th, when the next case appeared, and the 9th September further seizures took place at intervals of one or two days. There was then a lull till the 28th. On that day two more occurred, and the last case was on the 30th September. Cholera "1 SANITARy COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 95 w . .. .. ?, - The disease was thus spread over a period of 40 days Notes on outbreaks, Jullundur. „ . r artl , o , r , J from the 21st August to the 30th September. 54th Foot. Strength. Cases. Deaths. This does not include the officer's child who recovered. Eight different barracks were attacked. These were five old barracks, two new barracks, and the hospital. Ten barracks altogether escaped. The regiment arrived in Jullundur direct from England on the 4th December 1871, and had enjoyed good health. When cholera was about diarrhoea was somewhat prevalent, but it was not of a choleraic character. In the battery there was not a single case, nor was then? one in the Native Regiment of Infantry. In the Native ciSairJ?' detachment 12th Bengal Cavalry detachment a sowar on duty on the quarantine picket was seized on the 24th August. He had lately returned from duty in the vicinity of some affected villages. Among the non-military native residents of cantonments returned as 11,069 in number, seven deaths from cholera were recorded. The incidence of the disease in the different quarters above-mentioned was as follows :—: — nt . City and suburbs Jail Cantonment Razar European Troops Native Troops ' (Deaths.) (Cases.) (Deaths.) (Cases). (Cases.) 17th August - 2 18th „ - 1 22nd " - 3 ... ... 1 "'.. 23rd „ - 4 24th „ - 2 ... ... 1 1 25th „ - 3 ... - 3 26th 8 1 1 ... 27th 1 2 28th 7 2 29th „ -5 ... ... 2 30th „ - 15 31st ? - 13 ... ... 1 Ist September - 3 2nd „ - 6 3rd „ - 9 ... ... 1 4th „ - 6 ... ... 1 sth „ - 11 6th „ - 7 7th „ - 5 ... ... 1 Bth „ - 1 9th 7 ... 1 1 10th „ - 2 11th „ - 5 ... 1 12th „ - 2 13th „ ¦ 4 14th „ - 4 15th „ - 5 16th „ - 2 17th „ - 8 ... 1 18th „ - 4 19th „ - 1 - ••• 20th „ ••• ••• * 21st 22nd „ - 1 23rd 24th „ 2 25th „ 1 - 1 26th 27th „ - * 28th „ - - ••• - 2 29th „ - ••• - - ••• 30th „ • 1 - "• 1 For three or four weeks before cholera appeared in the 54th Regiment, colic diarrhoea and other bowel affections had been prevalent amongst them. ///. Importation and communication. — Dr. Thomson, although he carefully investigated all the circumstances of the first case, was unable to trace it to importation. Not a single case had been known in the cantonment before the children were attacked on the 21st and 22nd August. Cholera had been in the city for some days, but the men were not allowed to go there. Of the attendants on the cholera patients, including an apothecary and six or eight native servants who were exclusively employed on this duty, not one showed the smallest symptoms of cholera. Several facts are known which Dr. Thomson is inclined to interpret by contagion. The two children attacked on the 21st and 22nd came from the same quarter and slept in the same bed. Two others of the same family escaped. On the 24th a woman was attacked, she [ Section I 96 NINTH ANNUAL REPORT OF THE was a friend of these children's parents and had been with them in their illness before they went to hospital. On the 25th her husband was seized. The Notes on outbreaks, Jullundur. been g hourg m before admissioa into hospitaL After going to hospital her husband did not see her. She was attacked at 1 p.m. on the 24th, and he at 8 a.m. on the 25th August. In two other instances a case in one barrack was followed iv a few hours by a second case. The ayah who attended the officer's child was afterwards herself seized and died. The child was attacked on the Sunday forenoon and continued ill for a long time, it recovered. The ayah was seized on the Tuesday evening. She lived in the same compound and was in constant attendance on the child. The family barracks, it may be observed, were originally intended for single men, and the individual quarters are generally separated by only a low wall. These walls are now being raised to the roof, so as to divide the quarters completely. Some facts are mentioned by Dr. Massey, which appear to him to favor the doctrine of contagion. The prisoner attacked on the 27th had on the 24th surreptitiously received some tobacco from one of the guards, a burkundauz. This burkundauz was himself attacked with cholera at noon of the 27th August, the prisoner at 10 p.m. of the same day. The burkundauz lived in the city, and went there whenever his duties at the jail allowed him. I ascertained that he had been a sentry at night over the ward in which the prisoner in question was attacked. His beat was close to the prisoner's cot, and he slept in a small hut in the immediate vicinity, only 8 or 10 yards distant. The Native Doctor attacked on the 28th had been attending the previous cases. None of the other attendants suffered. The prisoner attacked on the 28th at midnight had at 5 p.m. of the same day, while at work outside the jail, received some sweetmeats and a drink of water from a fakeer, but there is no suspicion that either the fakeer or any persons living near him had suffered from cholera. In the history of the disease among the people of the district Dr. Massey believes that there is much evidence of communication, but as his investigation on this point was still in progress, I must leave the details to be recorded by the Sanitary Commissioner of the province. IF. Meteorology. — " Heavy rama," Dr. Thomson reports, " preceded the outbreak; from 26th July to 10th August it rained in torrents every day, two days only excepted, and on the 14th August heavy rain again occurred- The weather following this was oppressive and muggy to a degree. There was little or no wind experienced." On the 27th August there was again a heavy fall of rain. In September rain fell on six days. V. Local conditions. — The drainage is reported to be bad. The water-swpply is from wells. Of these there are seven in the 54th lines. They are covered, but are not provided with pumps, and water is drawn from them in the usual native method. The position of these wells close to buildings and surface drains in some cases skirting their immediate vicinity, is objectionable. The mode of drawing and distributing the water in skins is also objectionable. There is no evidence that the occupants of barracks supplied from any particular well suffered more than others. There was no overcrowding ; the rations were good, and the conservancy carefully attended to. There is no appreciable difference in the sanitary condition of the lines occupied by the 54th and of those occupied by the Artillery. In the Jail the prisoners all drink water from the same well. VI. Preventive measures. — Quarantine. — On the 15th August as cholera was known to be in the vicinity, a cordon of Native Cavalry and Infantry of Police and of Chowkedars specially entertained for the purpose, was established around the cantonment. The sentries had orders to allow no one to enter without a pass, and those who wished to go out were warned that they could not return without a pass. It is not known how many of these passes were given, they were issued by the Cantonment Magistrate, by the Deputy Commissioner, and by the District Superintendent of Police. The Cantonment Magistrate alone issued 250, so that the number was great. European passengers by the Railway entered without any examination. Native passengers who came from an infected locality were detained in quarantine for three days. Those who came from other places were seen by a Native Doctor, and if they presented no symptom of cholera were allowed to go. When a case of cholera occurred in the bazar the person was removed to a special hospital, a friend was allowed to accompany and remain with him, but all further communication with his family was cut off. The people were very averse to this arrangement and petitioned against it. It was then agreed that if a case occurred in a house the house should be put in quarantine, and this was carried out in one instance. Complaints were also made by the civil officers and others of the inconvenience of the cordon, as it interfered with supplies and even with the post. Colonel Millar, the Cantonment Magistrate, has been 18 years at Jullundur. In former years when no such precautions were attempted the disease was not worse, and indeed it was less than during the past season. The jail was isolated us much as possible, but it was impossible to maintain a strict quarantine. In the district no restriction was imposed on travellers. They were allowed to enter the city and to move about as they liked. Whenever a case of cholera was known to have occurred in a village or in the city, the person attacked was removed to a hospital set apart for the purpose, and any one of his friends who accompanied him was also isolated from the the rest of the family. Six such hospitals were provided for the city, and to each was attached a hakeem, and two servants besides the friends attending. Altogether nearly 203 cases were treated at these hospitals. None of the establishment suffered, and only one of the friends attending. The particulars of his seizure are not known. A few cases were subsequently Cholera Epidemic- 97 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. treated in their homes, and in none of them did the disease spread. The people of Jullundur city Notes on outbreaks, Juiiunder. strongly objected to the restrictive measures. They were will- ing, they said, to have their houses in which any case of cholera occurred put in quarantine, but they did not like any member of their family being taken away from them, and placed in a cholera hospital. In the case of their women they regarded such a procedure as a disgrace. They petitioned against the orders, but the petition was not acceded to. Some persons were punished under the Penal Code for not conforming to the orders regarding the isolation of cases of cholera, and the decision was upheld on appeal to the Chief Court of the province. Many people left the town from fear of the restrictive measures. When cholera appeared in a village the rules directed that sentries should be placed around it, that no one should leave it except the persons attacked with cholera, who were isolated outside. On the removal of a case to the hospital the house in which it occurred was fumigated and cleansed. On the death or recovery of the patient his clothing and bedding were either burned or disinfected. The purification of affected houses was in most instances attended to, but in other respects the rules as regards villages seem to have been imperfectly acted on. Movement. — In five instances in which buildings in cantonments were evacuated, either in whole or part, immediately on the appearance of a case, no further seizures took place among the occupants after their removal into camp on the race course. From No. 11 family barrack where the two first cases occurred on the 21st and 22nd August, the inmates were transferred on the 23rd to another barrack, No. 1, which happened to be vacant. One case followed here on the 24th. On the 25th it was abandoned and the occupants removed to a camp near the Railway station ; that night another case occurred. They remained well till about the 29th August, when, on account of heavy rain, they moved into a vacant bungalow close by. Here another case occurred on the 3 1 st. On the next day they removed into tents at Jamsheer, 4 miles to the south of the cantonment. On the 9th there was a case. They did not shift ground. No more cases occurred. They returned to cantonments, first encamping on the race course for a week as a precautionary measure, and then re-occupied their barrack on the 23rd September. In No. 10 family barrack there was a case on the 3rd September, and another followed on the 4th before they could leave it. On the sth they encamped at Jamsheer, kept well and returned on the 23rd. But on the 30th, a further seizure took place among them in this barrack. They left it, had no more cases, returned to cantonments on the 17th October, first oncamping on the race course, and then on the 23rd October reoccupying their barrack. There was some fever among the people when in camp, but it was equally prevalent in the cantonment at the same time. VII. Previous History has been very favorable. Statement of Cholera among European Troops, Native Troops and Prisoners at Jullundur ', 1846 to 1872. NUMBEE OP CASBS. v Average . . Total Total ¦ !•¦¦. ibab. Strength. . s » * Cases. Deaths. I lid .• ¦ - . 1 j I I I ._ i I J I a. j I I I. -I _&_ | _____ 1846 European Troops (including Loodiana) - 1,216 ... ... 1 3 2 ... I ... j 6 : ... 1847 European Troops (with Hooshiarpore) - 673 j 1 ! 1 1848 European Troops - 1,173 2 ... 2 1 5 1849 Ditto „ - 1,390 2 ' 1 I 3 1850 Ditto „ - 1 1 i » 2* 1851 Native „ - 3,429 1 1 1 3 1 1852 Ditto „ - 3,406 1 .. ! ; 1 1853 Ditto „ - 3,486 ... 1 ... | ... ! j 1 1854 Ditto „ - 3 j 1 ... i ... j 4 1855 Prisoners - 345 1 j ... ! 1 IB . fl C Native Troops - 2,247 1 i ; ; 1 .. IHo6 l Prisoners - 367 1 j ... ... j j 1 I ... 1857 Prisoners - 350 4I 16 ... j 20 j S 1858 European Troops - 898 23 ;11 j ... 84 22 1861 Ditto „ - 1,015 ... 1 ... j ... | ] 18fi -f Ditto „ - 788 12 ... ... „. 12 9 1867 l Native „ - 486 2! | 1 J ... 3 1 IHPQ f European „ - 1,022 1 1 2 2 180J I Native „ - 476 1 I 1 ( European „ - 1,028 ... j ... 6 6 2 ; 14 12 1872] Native „ - 593 j 1 1 1 (. Prisoners - 340 j ... 2 2 2 i ! * Number of cases not recorded. Feuozepore. — Tho district lies to the south-east of Lahore. It has an area of 2,692 square miles, a population of 533,416, and contains No. 60, Ferozepore. -.^.o , mna onA -sfi.iL. vv v ,^ „? ?i lrtDrt r *„„ u n , rrt No. 60, Ferozepore. tQWn& an( j viUages> but of thege only twQ haye mor( than 5,000 inhabitants in each. 98 L Section I NINTH ANNUAL REPORT OF THE 77. Details of the outbreak. — According to the Police returns there was one death from cholera in March and two followed in two different places ro?epo?e° n outbreaks> No# 60> Fe " in June. In July 25 deaths from this cause were registered in three places, the village of Mehraj contributing 22 out of this number. In August the disease continued in Mehraj, no less than 104 deaths from it were registered in that month. At Nathanah there were 14, and at a third place, Danah, 5, altogether the total for the whole district in this month was 123, divided among, and confined to these three places. In September the deaths were distributed over 12 places and numbered 125 in all. In October there were 45 in five places, and in November a single death from cholera was registered. In the city of Ferozepore with a population of 20,592, no death from this cause was recorded. The garrison of cantonments consisted of 2 batteries of artillery, the 39th Foot, the 18th Bengal Cavalry and the 28th Native Infantry. Among the troops no case of cholera has been recorded and no report therefore received, but during my visit to Peshawur I had the opportunity of obtaining some information from Surgeon J. H. Boss, M.8., and Assistant Surgeon A. S. Davis, of the 39th Regiment, which had moved to Peshawur in course of the annual relief. From them 1 learned that on the 30th July a man of the Regiment was attacked with severe vomiting, purging and collapse, but no suppression of urine. The attack was attributed to drinking ginger beer while heated. His case was not believed to be, nor was it returned as cholera. This man, it may be remarked, seems to have been susceptible to such attacks, and had one of a similar nature at Deolalee on first arrival in the country. This was attributed to eating the wild castor oil seeds. Before this man was admitted into hospital diarrhoea had become very prevalent in the regiment, so much so, that on the 31st July, a regimental order was issued " warning the men of the danger of letting looseness run on and directing them to go to hospital for a dose of medicine at once." Dr. Davis, who was in medical charge of the regiment at the time, stated that this prevalence of diarrhoea lasted for about six weeks, and at one time there were as many as 60 and 70 applications for astringent medicine daily. The extent of this prevalence of diarrhoea however varied much during this time. In the return for the week ending 9th August, Dr. Davis remarks. — " There is a general tendency to diarrhoea/ Next week, he says, " the tendency to diarrhoea is much less." In the week following, " some tendency to diarrhoea still continues." In the week ending 27th September he notes, " there is an increase of dysentery and diarrhoea." It is worthy of notice that at Nathanah, 54 miles south-east, and at Mehraj, 6 miles east from Nathanah, two of the few places in the district which suffered with any severity, the first deaths from cholera were registered on the 25th and 26th July. In Mehraj the outbreak continued severe till the 14th September, and after a lull, fatal cases were again registered on the 25th and 28th of that month. VI. Preventive measures. — The Civil Surgeon, H. F. Williams, M. D v writes — " Especial care was, by the assistance of the Police, taken to isolate villages where cholera appeared, and strict quarantine was instituted at the different ghauts leading from Lahore, also on the routes from Loodiana, at both of which places cholera was prevalent." F77. Previous History has been as a whole very favorable. In the great epidemic of 1861, the European troops almost altogether escaped, and in 1869 again thers was but one solitary case among them just as there has been in 1872. Statement of Cholera at Ferozepore, 1844 to 1872. Numbeb of Cases. Yirttt Average ? . . Total Total Strength. . £ « . S g Cases. Deaths. lIItIJ i } f 1 I I ~~ ! 1844 European Troops - 375 5 2 7 2 C European „ - 1,130 2 36 46 2 14 ... 1 ... 101 45 1845] Native „ - 6,530 1 ... 4 3 ... 25 29 9 ... 1 ... 1 73 21 (. Prisoners - ... 1 1846 European Troops - 1,023 1 4 1 1 2 9 2 ... 1 ... 21 6 1847 „ „ - 1,206 4 ... 1 ... 5 3 1848 „ „ - 1,647 1 1 1 3 1849 „ „ - 355 1 1 ... 2 ! ... 1851 Native ? - 3,249 1 3 4 ! 1 1852 „ „ - 3,984 1 3 1 5 j ... 1853 „ „ - 2,233 1 1 2 ( European „ - 1,025 165 35 200 131 1856] Native „ - 2,120 11 26 37 17 ( Prisoners - 495 8 g 2 1858 Native Troops - ... 1 ... 1 1860 European „ - 1,086 1 ... ... 1 J 1 . orM ( European „ - 889 ... 2 ... 2 ... 4 : 1 18bl [ Native „ - 512 48 6 54! 30 1862 European „ - 967 ... 1 4 5 4 .(European „ - 773 3 12 1 16 ! 8 1867 1 Native „ - 583 5 I 6 1 RO f European ? - 1,145 j ... 1 1 1 1869 l Native „ - 594 ... 1 1 ! 1 In 1852 one or two cases occurred among the European Troops simultaneously with the outbreak at Umballa, but no deaths. Cholera Epidemic. SANITARY COMMISSIONER WITH THE GOVERNMENT OF JNBIA. 99 MoOLTAN (Surgeon R. Rouse, Civil Surgeon, Surgeon Curtiss Martin and Assistant , ? , Surgeon M. Gallwey, M.D., 41st Regiment), lies to the south- Notes on outbreaks, Mooitan. of th / district of Montgomery intervening, has a population of 459,780 in an area of 5,882 square miles, and contains 1,211 townships, of which only four have more than 5,000 inhabitants in each. In cantonment the garrison consisted of C. Battery, 19th Brigade, Royal Artillery, the 41st Foot, 19th Bengal Cavalry, 31st Native Infantry. In the fort which immediately adjoins the city of Mooitan there were 80 men of the 41st, 50 sepoys and a few families of the 41st, for whom there was not sufficient room in cantonments. In the jail, in August, there were 780 prisoners. //. Details of the outbreak. — In the whole district only two deaths from cholera ,T, T „. „ were recorded in 1872. In the artillery there were No. 61, Cantonment. rui ij.l j j? t i iX. no cases ot cholera, in the end of July there were six cases of slight diarrhoea, and a few occurred in August. In the 41st there were three cases of cholera among the men, neither officers, women or children suffered. They occurred lon the 12th August, lon the 14th and lon the 15th. None of the Native troops were attacked. About the 20th August a child died in the bazar with suspicious symptoms, and a water-carrier was attacked on the 25th, but recovered. In the jail a prisoner who had been nine months in confinement was attacked with all the symptoms of cholera on the 3rd No. 62, Jail. August. Beyond these few cases none are known to have occurred either among the troops, the prisoners or the general population of Mooitan, nor during the outbreak was diarrhoea prevalent, but a few cases occurred in July and August, in which there was violent purging and vomiting. Among the Europeans fevers increased when cholera appeared, and became very prevalent later in the season. In November the 41st suffered from them so severely that it was considered advisable to move them into camp. The change was attended with excellent result. The prevalence of fever in the jail observed a similar rule. Neither among the troops or prisoners was it of a fatal character. ///. Importation and Communication. — In no instance could the cases be traced to importation or infection. Of 15 persons who came in contact with the three sick men in the 41st, none suffered. In none of the other instances either were the attendants attacked. IV. Meteorology. — Dr. Martin states — "The meteorology during July and August was quite exceptional, the monsoon or rain bearing wind rarely reaches the Mooitan district, but this year it was to a great extent under its influence." The south-east wind blew, and locusts were seen. V. Local conditions. — The drainage is reported to be bad. The water is drawn from wells, which are for the most part covered. VI. Preventive measures. — Quarantine was established on the Ist August, and all people arriving by rail were detained under observation for some days. The people much objected to the arrangement ; only one case of cholera occurred among the new arrivals. A woman who arrived from the Sealkote district on the 22nd was attacked on the 24th August. In the 41st Regiment the quarters in which cases occurred were immediately vacated. VII. Previous History. — Cholera has never been severe among the troops at Mooitan and in very few years have any cases occurred. Statement of Cholera at Mooltan, 1852 to 1872. Nr mii i! 11 of Cases. •• v Average .¦ • Total Total IBAR Strength. >. £ . jj » Cases. Deaths. 11-g-.oJ 1 1 I 1 1 _i_tIIII I I I J I I 1852 Native Troops - 2,467 ... 1 1 1 1 ... 1 ... 5 4 1853 Ditto - 3,464 j 1 ... j 1 1 1854 Ditto -| ! 1 ... 1 1858 European Troops - j 80 3 ... 5 i 8 3 1859 Ditto - 1,030 ... 1 j 1 j 2 1862 Ditto - 1,117 1 1 I 1867 Native Troops - 1,040 ... 3 3 2 1869 European Troops - 1,123 ... 1 1 1872 Ditto -j 1,094 3 3 2 100 [ Section I NINTH ANNUAL REPORT OF THE SEALKOTE. — The district to the east and south-east of Goojrat has an area of 1,969 square miles and a population of 994,458. It contains Notes on outbreaks, Sealkote. o 01*7 +„,„„„ nr *A *riU n ~™ T^~ » nn *-~ nmnn 4- ~»A „;„;! 2,317 towns and villages. The cantonment and civil station adjoin the city, which has a population of 25,337. The garrison consisted of E. Battery, A. Brigade, Royal Horse Artillery, the sth Lancers, the 58th Foot, the 17th Bengal Cavalry, and the 12fch Native Infantry. 11. Details of the outbreak. — In the district, omitting a doubtful entry in January, two deaths from cholera were registered in June, 27 in July, 38 in August, 188 in September, and 27 in October. Both iv June and July the disease was confined to one or two places. In August, 19 suffered, and in September, 31. But in very, few of the places attacked does the outbreak appear to have been violent. In August the highest number of deaths registered in any one place was fourteen. In thirteen of them it did not exceed two. In September the highest number in any one place was 27, and in 16 it did not exceed two. In the cantonment among the European troops only five cases occurred. In the sth Lancers (Assistant Surgeon John Atkinson) a man was attacked on the 22nd April; he died. No other case occurred in this regiment till the 4th September, when an officer was attacked. He had just returned from Murree where cholera then was, but the precise dates are not given. In the o . 58th Regiment (Surgeon E. L. Lundy) there were three No. 64, 58th Kegiment. . occurred Qn the game the 25th Ma^ &nd were fatal. Among the native population of cantonments two deaths from cholera are registered in May, the first on the 20th, and the second on the 24th. The only other death assigned to this cause is entered on the 12th October. ///. Importation and communication. — The first cases could not be traced to importation. The first attack in the sth Lancers was attributed to bad ginger beer. The first man attacked in the 58th had had diarrhoea for three days. The second had been intoxicated and lay in the wet all the previous night. The third case in the 58th Regiment was an attendant in hospital ; he was attacked the same day as the other two. IV. Meteorology. — Dr. Lundy states that " cholera was present in the territory of the Maharajah of Cashmere in one village at a distance of about 40 miles. The day previous to the attack in the 58th Regiment a strong wind was blowing from the direction of this village and was followed by very heavy rain lowering the temperature 11 degrees." VI. Preventive measures. Quarantine. — The authorities were very active in adopting measures which they believed would arrest the progress of the disease. The buildino- in which any case occurred was promptly evacuated and the occupants removed to camp. The Deputy Commissioner, Major C. V. Jenkins, writes — " On the 6th May a telegram informed me that cholera had broken out amidst the pilgrims assembled at the annual fair at Hurdwar. 1 immediately gave orders for the Ravee to be watched closely at the Shahpore ferry adjacent to the Riah Tehseel, and I also gave orders for all parties to be examined by the native doctor at Riah dispensary, and not to be allowed to proceed onwards if they showed any symptoms of the disease, but before the telegram reached me the greater portion of the pilgrims from these parts had returned to their homes, and on being examined showed no signs or symptoms of the disease. Of course I could only watch those in the larger towns who were known to have gone to Hurdwar, but the result of the reported examination by the native doctor was highly satisfactory." On the 22nd May when news arrived that cholera had broken out at Jummoo and that 20 persons had died of it in one day, quarantine was established at Dallowwallee, three miles from the station, the point where the Jummoo high road bifurcates to the city and cantonments. These approaches were carefully watched both by the civil and military authorities. The ferries on the Chenab at Gondal and Chaprar were also quarantined. Wherever a case was known the village was placed in quarantine. But in spite of these measures "cholera flitted about the district in no very fatal or epidemic form, making periodical pounces as it were, carrying off two or three at a time, and then flitting elsewhere." On the 17th August two cases were reported at Lidra, two miles southwest of the city. It soon showed itself in other villages ; they were isolated as much as possible, and other ferries quarantined. On the 26th August cholera appeared in the city of Sealkote. The cases were removed to a hospital set apart for the purpose, 64 seizures and 36 deaths out of 30,000 up to the 20th September. About the middle of August, when cholera was most prevalent in the city, a case occurred at the Post Office in cantonments. The disease left the district on the 21st October. Altogether 532 were seized and 262 died. " I fear," remarks Major Jenkins, the Deputy Commissioner, " that a considerable loss may accrue to Government in awarding compensation to choongee, ferry, as well as serai contractors, owing to the restrictions it was necessary for me to carry out in endeavouring to stave off the spread of the disease." The amount of loss thus incurred is estimated at Rs. 5,842-6-0. VII. Previous history. — The remarkable immunity from cholera which the station of Sealkote has enjoyed is shown in the annexed statement, Cholera 1 gANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 101 Notea seaikote breaks> Statement of Cholera at Sealkote, 1853 to 1872. Number of Cases. I V Average • . . Total Total 1A Bi Srength. • £ jj> . J jS Cases. Deaths. ald.l a I a | 1853 Native Troops - 2,814 1 1 1 3 1854 Native Troops - 1 1 ... ... 2 C European Troops - 1,494 1 1 1861) ( Native „ - 431 1 „. 1 Troops - 1,438 ... ... 5 9 14 10 1862-! Native „ - 400 3 3 L Prisoners - 277 33 33 10 1865 Prisoners - 308 1 1 1 1572 European Troops - 1,516 ~. 1 3 4 4 Umritsur — Assistant Surgeon F. M. Mackenzie, Civil Surgeon — The town of Umritsur No 65 Umritsur es on t * ie ne °f r&il, 32 miles to the east of Lahore, and has a population of 136,609. The district covers 1,556 square miles, and the inhabitants number 832,750. The garrison consisted of a battery Royal Artillery, 80 men and of about 200 European Infantry, of whom 70 were with the Artillery in the fort and the remainder in the cantonment. In the cantonment also there was a wing of 17th Native Infantry. The prisoners numbering, 935, were accommodated partly in the old jail, which is within the city walls, and partly in the new jail, which adjoins the station. //. Details of the outbreak. — Among neither the troops or followers nor among the prisoners did a single case of cholera occur. Altogether 94 deaths from cholera were reported in 37 out of the 1,574 towns and villages in the district. The first death occurred on the 9th June and the last on the 27th September ; only three deaths were reported in June and five in July. In August there were 45 and in September 38. This does not include three deaths reported during January, February, and March. The places of attack were widely scattered over the district, and in only one of them, Futteahbad, was the disease severe. Here, with a population of less than 5,000, there were 34 deaths from cholera, 29 of which occurred between the 14th and 31st August. In most of the villages there were only one or two isolated cases. In the city twelve cases were known to have occurred ; they were from different quarters. ///. Importation and communication. — The disease could not be traced to importation, nor could its spread in any instance be ascribed to communication. The sick were treated in their own houses, and the house subsequently disinfected. In no case were any of the other members of the family attacked. V. Local conditions. — In 1869, after a very severe outbreak of cholera, the sanitary condition of the city was reported on by a special Committee, and the great defects under which it labored, especially as regards drainage, conservancy, and water-supply, were brought to notice. Since then nothing may be said to have been done to remedy these evils, and the state of the place in 1872 remained practically the same as it was in 1869. VI. Preventive measures. — Dr. Mackenzie believes that the disease was not concealed. No attempt was made to take the sick from their homes or to isolate villages in which cases occurred. Throughout there was free and constant communication with Lahore where cholera was prevailing. At one time it was proposed to stop the trains by which the local traffic is mainly conducted, but this was over-ruled. Quarantine was thought of, but given up on account of the expense. All that was done was to have a native doctor to inspect the passengers as the trains arrived. If any cases of cholera had been discovered among them, they would have been removed to the temporary hospital which had been built for their reception. But only one case of diarrhoea was detected. [ Section I 102 NINTH ANNUAL REPORT OF THE VII. — Previous history. — The statistics of cholera among the troops is given in the following statement : — Notes on outbreaks, No. 65, Umritsur. Statement of Cholera among the Troops and Prisoners at Umritsur from 1852 to 1872. Numbeb op Cases. v^ An Avprai?p • . Total Total YBABI Strength. . * I I J CaB€S - DelM^ llaii i t i i i ii i 1852 Native Troops - 1,135 1 ... 1 ... 1 ... 2 ... 5 i 1854 Ditto „ - 1 3 1 ... ... 5 f European Troops - 73 8 1 ... ... 9 <> 18564 Native •• - 2,017 1 ... 2 ... 3 1 - 787 3 3 6 2 ( European Troops - ... 26 ... 1 ••• 27* 18575 ( Prisoners - 720 3 1 30 14 ... 1 ... 49 17 (" Native Troops - ... ] 1 1 1858] ( Prisoners • 647 2 ... 1 3 C European Troops - 407 1 1 1859] ( Prisoners - 408 ... 1 1860 European Troops - 470 1 ... ... 1 ( European Troops - 481 ... . ... ... 50 50 i 41 1861] | (Native „ - 260 16 16 10 ( European Troops • 532 ... 2 11 17 30 15 1862] (Native „ - 449 4 ... ; 4 2 1863 Native Troops - 475 1 1 f European Troops - 138 1 1 1 1867^ Native „ - 144 I 1 ... ... ?. 1 1 (^Prisoners - 571 3 3 5 11 4 ( European Troops - 125 . 8 1 9 7 1869] ( Prisoners - 583 7 7 6 * Deaths only recorded. The cholera history of the city and district previous to 1869 is obscure. The Committee already mentioned, state that the former suffered in 1805, 1813, 1827, 1845, 1856, 1862, 1865, 1867 and 1869. In 1869, 3,041 persons died of cholera. It is worthy of notice that in 1861 when Lahore and other places in Northern India suffered severely, Umritsur appears to have escaped. Lahore — Surgeon Major J. B. Scriven, Civil Surgeon, Surgeon T. E. Burton Brown, M.D., Principal of the Lahore Medical College, Lahore. Assistant Surgeon W. P. Warburton, M.D., Superintendent, Central Prison. The population of the district is 775,551, area 3,647 square miles, contains 1,455 towns and villages. 11. Details of the outbreak. — Omitting four which were registered in the three first months of the year, the first death from cholera was reported at the town of Kussoor on the 4th May. In that month five places in different parts of the district were attacked, and there were 13 deaths. In June four places registered a total of 18 deaths. In July there were 74 deaths in six places. In August, omitting the cantonment of Meean Meer, 39 places were attacked and there were 454 deaths. In September 24 places, and 63 deaths. In October one place furnished one death. In November two, and two deaths. The violence of the outbreak fell chiefly on the Lahore Pergunnah of the district. In Anarkullee, the civil station lying on the outskirts of the city, the first two deaths were reported on the 7th, and another followed on the Bth of May, but they are considered doubtful. Cases continued at intervals till the beginning of August. During that month they were of daily occurrence. 'Hie last was on the 3rd of September. In the city, with a population of 85,346, the first death was on the 26th May. The violence of the outbreak here also was in August, and it Cholera 1 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 103 ceased here on the same day as in Anarkullee. The daily record of deaths for both these places will be given in conjunction with that for the cantonment of Meean Meer. Among European and Eurasian residents Notes on outbreaks, Lahore. at Anarkullee there were 22 cases between the 26th May and sth September. Doctors Scriven and Brown both remarked that for sometime before the outbreak commenced cases of fever with purging and vomiting had been unusually prevalent. 111, Importation and communication. — The disease could not be traced to importation. In the Mayo Hospital 45 cases were treated. Each case had one student in close attendance. There were four hospital servants. The professors and 50 students also visited in the wards. None of all these were attacked. Four patients in the hospital were seized. Of these one was in the habit of having his food and water brought from his home in the city and the others are reported to have visited the city against orders. Altogether 945 cases were attended in the city and suburbs, of which 823 were treated in their own houses. There is no evidence that these acted as centres of infection. Sub-Assistant Surgeon Brij Lall Ghose at my request was good enough to prepare a statement showing the distribution of the disease. From this it appears that the 570 cases which were attended in the city were spread over 138 mohullahs or wards. In only 33 instances did more than one occur in the same house. In 28 of these there were two cases in each. In four there were three cases in each, and in the remaining one there were four cases. In one-half of the instances again the cases in the same house occurred either on the same day or with only one day's interval. On the other hand, it is to be observed, that in some of the lanes " the houses are so close together that if they had no separate doors opening on the street they would have been considered as one house." V. Local conditions. — The city lies on the left bank of the Kavee. The drainage is defective. There are 1,100 public and 300 private wells. VI. Preventive measures. — Quarantine was attempted between Lahore district and Ferozepore, and also between Meean Meer and Lahore, but it could not be effectively carried out. When cases occurred in the city they were attended and treated by a staff organized for the purpose. On death or recovery the house was disinfected and the person's clothes burned and compensation paid to the owner. For the friendless a hospital was provided. The disease, the Sub- Assistant Surgeon in charge of the arrangement says, was much concealed. The people greatly disliked the cleansing and disinfection of their houses. Not unfrequently, they offered an old bed for destruction instead of the better one which had been used by the sick person ! In all the villages, except those near the city, no such measures were taken. In many of these villages only a single death was reported in each. Lahore Lunatic Asylum. — Contained 273 inmates and the establishment were 50 in number. 11. Details of the outbreak. — The first case was a female lunatic, who was attacked on the 12th May and died in 14 hours. Another woman was attacked on the 23rd May, a third on the 25th, and a No. 66, Lunatic Asylum. fourth on the 2nd June. Other cases occurred on the sth, 7th and Bth, one on each day. On the 13th there were two ; on the 14th three ; on the 15th one ; on the 16th four ; and on the 17th four ; nine others followed at short intervals up to the 30th June. There was then a lull for 15 days when the disease re-appeared and 9 more lunatics were attacked by the 6th August. Altogether there were 39 cases among them and 25 deaths. Of the establishment 6 were attacked between the 16th and 27th June. Six different buildings were attacked and the disease distributed widely over the asylum. On the 26th May two children belonging to the family of a Eurasian who had been formerly employed in the asylum, and who resided in a house within an old native garden lying low and watered by the canal, were attacked simultaneously, and died within a few minutes of each other. A third was attacked the same afternoon and died next morning. On the 27th a fourth child of this family was attacked, and on the 28th one of the servants. ///. Importation and communication. — Although most careful enquiry was made, it altogether failed to trace the first case to importation. The woman had been for two years in the asylum and had not been out of it. So far as could be ascertained, this was the first undoubted case in Lahore. Nor in the course of the outbreak was there any evidence of the disease having spread by infection. None of the attendants on the sick were attacked. V. Local conditions. — The previous health of the lunatics had been good, and they were very carefully looked after. There was no overcrowding, the food was excellent, and the asylum was kept on an excellent state of cleanliness. The water was drawn from a well of good repute near the railway station and was carefully filtered. Throughout it was derived from the same source for all those in the asylum. " The filtering material of the filters was not changed during the whole epidemic. The water that the lunatics drank when they returned to the asylum passed through the same sand, &c, as it had passed through before they were moved out." When parties moved out they were supplied from elsewhere. The family in the garden drank from a very filthy well inside. VI. Preventive measures. Movement. — On the morning of the Bth June the female lunatics, 56 in number, were moved out, and not another case occurred among them till the 28th July. A second followed on the 4th, and the third and last on the 6th August. The 104 [ Section I. NINTH ANNUAL REPORT OP THE women were first moved to the leper asylum, three-fourths of a mile distant, and when this was required for a cholera hospital they were transferred on the 19th June to a place near the village of Chintghur, a Notes on outbreaks, Lahore. mile further on. They returned to the lunatic asylum on the Bth August, after two months' absence. On the morning of the 15th June, after 7 cases of cholera had occurred among them, the harmless male lunatics to the number of 149 were moved to Alee Murdan Khan's tomb, close to Chintghur. One of them was attacked immediately on arrival. Four cases followed next day and six more between that day, the 16th June, and the 19th July. All but one were of a mild type and recovered. There was then a lull till the 31st, when one case occurred (it will be remembered that among the women close by there was a case on the 28th). Two others followed, one on the 4th, and the other on the sth August. The party returned to the asylum on the 13th August. On the morning of the 20th June the criminal lunatics, 50 in number, were moved to the leper asylum which had been vacated the previous day by the women. Five cases had occurred among the criminals, four on the 17th and one on the 18th. After moving they remained free for five days, from the 20th to 26th. On the 26th there was one case, two followed on the 27th and two on the 28th. On this last date the criminals returned to the asylum. No more attacks took place among them. In all the moves the lunatics left every personal appendage behind them, each individual was bathed and dressed in clean clothes before starting. VII. Previous history. — In 1 869, 44 of the lunatics were attacked, and 33 died of cholera. The outbreak was then attributed by some to the sand used in the filters, which it Was supposed had been poisoned by cholera discharges. Lahore Female Jail. — Contained 150 prisoners. 11. Details of the outbreak. — Among them there was no case of cholera, but Dr. Warburton states that while cholera was prevailing there were several cases attended with cramps, vomiting No. 67, Female Jail. and purging. V. Local conditions. — The well from which their water is drawn belongs to a fukeer close by. It is extremely liable to pollution, as there is an enclosure for bathing immediately beside the parapet. VI. Preventive measures. — No special preventive measures were adopted. Lahore Central Prison. — Strength when cholera appeared 2,281 prisoners, and a guard of 230 men. The jail consists of two enclosures, the main one with about 1,900 prisoners and a smaller one known as the No. 68, Central Prison. Gola Serai which contained 369. The general health of the prisoners had been good until a few weeks before the cholera commenced when fever began to be prevalent. On the 21st July the number in hospital altogether was only nine, but it rapidly rose, owing to fevers, to 149 on the 29th. In the middle of August the number was 193. The fever continued extremely prevalent after cholera had disappeared. The guard as well the prisoners suffered from it much. //. Details of the outbreak. — The first case was on the 14th August, and the second on the 15th August. Five followed on the 16th ; two on the 17th ; five on 18th ; eight on 19th ; six on 20th ; seven on the 21st ; seven on the 22nd ; two on the 23rd ; and then there were two on the 25th, and one on the 27th, or a total of 47, of which 22 died and 25 recovered. In the main enclosure six different buildings were attacked and eight in the Gola Serai at distant points. Of the 47 cases, 26 were admitted from buildings, and 21 from camp, but of these latter nine were from among a party of 100 men who had been sent to cleanse the jail. Diarrhoea was somewhat prevalent. There were 36 cases in August and 24 in September. Among the establishment there was only one case of cholera on the 24th August. Cholera had been for some time in the city, and was severe in the neighbouring villages of Mozung and Ichrah. In Mozung the first case was reported on the 3rd August. Dropping cases continued there till the 11th, when there were four in one day. From the 14th August to the 4th September, between which dates the disease chiefly prevailed, 67 cases and 34 deaths were reported. In Ichrah the first seizure was reported on the 10th and the second on the 13th. Between the 15th and 27th August there were 45 cases and 22 deaths. ///. Importation and communication. — All attempts to trace the first case to importation altogether failed. The prisoner had been in confinement for several years. Nor in the course of the outbreak did Dr. Warburton observe any fact favoring the idea that the disease was spread by contagion. The only case that seemed in any degree to warrant such an inference was that of a prisoner who was attacked after attending one of those ill of cholera. The attendant was seized on the 27th, the man whom he was attending had been attacked on the 22nd. They were friends, and both came from camp where they had lived together. Of the other attendants, about 25 in number, not one was seized. V. Local conditions. — The jail was in an excellent state as regards cleanliness. There was no overcrowding. All the water used in cooking is drawn from one well. In the main jail the water for drinking and other purposes is taken from a number of wells ; one situated on the line of each divisional wall serves for the two barracks, one on either side. In no instance could the prevalence of cholera be associated with the use of any particular well. In the Gola Serai enclosure there is only one well from which all the inmates drink. The Cholera ] SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 105 contingent guard, 160 in number, whose work lies inside the jail, and who to a great extent 4 . . _ . drink the same water as the prisoners, had not a single case Notes on outbreaks, Lahore. „ , , r • ' ot cholera. VI. Preventive measures. Quarantine, — The jail was isolated as much as possible. Great pains were taken to secure this object. Supplies had been laid in to last for some months and the jail establishment were prohibited from going away from the premises and mixing with the outside world. Movement. — On the morning of the 18th, after seven cases had occurred, the prisoners in the main jail to the number of 1,787 were moved into camp at Shajumal, about a mile and a quarter from the jail. Five fresh cases occurred that day — three at starting, two after arrival in camp. On the next day there were seven more, then followed two on the 20th, three on 21st, four on 22nd, two on 23rd, and one on the 25th. Of these, however, as has been already stated, nine occurred in gangs who were sent daily to disinfect the jail by replastering, leeping and fumigating. The prisoners returned on the 14th September. In the Gola Serai there had been 13 cases between the 17th and the 22nd August. On the 23rd they also, to the number of 369 were moved into the camp, and no more were attacked. When the main jail was evacuated, the bad cases were left in hospital, as they could not readily be moved. Among them and their attendants, numbering in all 71, there were three cases, one on the 22nd, one on the 25tb, and one on the 27th. The inmates of the boys' ward which is completely isolated from the rest of the jail, strength 34, did not move. They had no cases. Throughout, some 1 50 prisoners worked daily at the press coming in from the camp in the morning and returning at evening ; none of them were attacked. They did not sleep in the jail. Lahore Fort — (Staff Assistant Surgeons W. R. Kerans and J. D. Sainter, Assistant Surgeon Rattray and Assistant Surgeon McCracken) — may be said to form part of the city of Lahore. The garrison No. 69, Fort. consisted of 16 men of the 7th Battery, 13th Brigade, Royal Artillery, the head-quarters of which were at Meean Meer, of 68 men, one woman, and two children of the 37th Regiment from Meean Meer, and of a company of sepoys. There were also four Staff Serjeants and their families consisting of two women and four children. 11, Details of the outbreak. — Among the artillery there were no cases. The first was in a man of the 37th on the 16th July. A second followed on the 18th and two more on the 25th. Nearly all the garrison then moved out of the fort to camp at Bheekawal. One man was seized on the way out arid another on the 27th, Among the few that remained, there were two cases on the 18th August, one on the Ist and another on the 2nd September, or a total of ten cases among the Europeans. Only two of the sepoys were attacked, one on the 17th and the other on the 23rd August. There were many cases among- the followers who number about 250, but no particulars of the dates are recorded. Six different buildings were attacked. ///. Importation and communication. — In the Peshawur Mountain Battery, in which, as already stated, there had been a case of cholera at Meerut on the 12th April,* there was a further seizure at Lahore on the 14th April, when encamped outside the walls of the fort. Dr. Thomson informs me that this was the only case among them at Lahore, and it was the last which occurred amongst them in 1 872. The first case could not be traced to importation, nor was there any evidence of infection during the course of the outbreak. Dr. Rattray says " The cases at Bheekawal were distinctly traceable to communication, as they had occupied contiguous beds to one of the men who died from the disease at the fort on the 26th July." V. Local conditions. — The fort is well raised and the drainage good. The men had ample room. The water was taken from a branch of the Ravee, as the wells within the fort are not considered so good. In camp they drank from the canal. An ordinary chattee filter was taken with them, and fresh sand and charcoal were placed in it on the 27th, when they reached Bheekawal. VI. Preventive measures. Movement. — The day after the first case occurred, the 16th July, the men of the 37th were moved from No. 1 barrack to Nos. 2 and 3 : No. 2 was then partly occupied by the artillery. On the 18th one man was attacked in No. 2. The two cases of the 25th were one from No. 2, and one from No. 3. On the 26th July all the Europeans, both artillery and infantry, excepting 16 men of the 37th, moved into camp at Bheekawal, about 10 miles on the Ferozepore road. One man was seized on the march, another was attacked the following morning, the 27th, and then the disease entirely ceased. Cases however continued among the followers in the fort, and on the 18th August one of the ]6 men of the 37th, who had been left behind, and also one of the staff Serjeants in the fort were attacked. This detachment had re-occupied No. 2 barrack some days after it had been scraped and fumigated. It was here that the case of the 18th occurred. When it occurred the detachment were removed to the married quarters, and on the 21st they joined the camp. From that date to the 30th of September, when the European Infantry and * Vide notes on Meerut No. 33. [ Section I 106 NINTH ANNUAL REPORT OP THE Artillery returned, the fort was garrisoned entirely by natives. During the absence of the Europeans two cases of cholera occurred in the fort in a Notes on outbreaks, Lahore. conductor's family, one on the Ist, and the other on the 2nd September. VII Previous history. — The annexed statement shews the statistics of cholera amongst the troops in Lahore and also amongst the prisoners. Statement of Cholera amongst Troops and Prisoners at Lahore, 1846 to 1872. Number of Cases. Vain Average .• ,• . Total Total A Strength. >, « • jj Cases, Deaths. !ISIiI t ! I I 1 1 1846 European Troops - 1,121 1 2 ... 2 5 1848 Ditto „ - 2,534 ... ... 1 6 ... 5 2 2 1 ... 1 •» 18 3 1849 Ditto „ - 2,867 1 ... 3 ... 3 ... 1 ... 1 9 1 1850 Native Troops - 5,132 1 ... 1 5 1 1 9 1 1851 Ditto „ - 5,677 ... 1 1 2 1 1 ... 1 1 .. 8 1 ,Q, Q . 0 C Ditto „ - 6,829 ... 1 1 ... 1 1 4 2 18W l Prisoners 1 1856 Ditto - 2,454 1 302 181 I 484 244 1857 European Troops - ... 1 If 1858 Prisoners - 2,363 .. 2 2 1859 Ditto - 2,167 ... 2* ... IQA , ( European Troops - 149 39 7 46 29 18bi I Prisoners - 2,101 1 1 , Qfl9 ( European Troops - 154 5 4 1 10 5 18t^i Prisoners - 2,109 1 81 12 94 41 , aM ( European Troops - 140 2 11 4 2 Lm ' I Prisoners - 2,083 11 ... 1 12 9 I 1869 Ditto - 2,234 2 2 2 , e79 ( European Troops - 77 6 1 7 7 18/< H Prisoners ¦ 2,504 47 47 22 * Month not specified. t Number of cases not recorded. Meean Mccr — (Deputy Inspectors General of Hospitals, T. Hastings, Indian Medical Department, and W. G. Trousdell, M.D., British Forces) — Meean Meer, the Milifcary sta tion of Lahore, lies six miles to the southwest of it on considerably higher ground. It covers an area of about 12 square miles, the lines of different regiments being far apart, and the buildings widely separated. When cholera commenced the garrison consisted of — A. Battery, A. Brigade, Royal Horse Artillery. H. Battery, Bth Brigade, Royal Artillery. Head Quarters and No. 7 Battery, 13th Brigade, Royal Artillery. 37th Regiment, Foot. ]Bth Bengal Cavalry. 17th Native Infantry, and the 24th Native Infantry. The non-military native population residing in the different bazaars and scattered over the station in officer's compounds is estimated at 8,462. //. Details of the outbreak. — Royal Artillery. — The strength of the artillery and the extent to which each battery suffered from cholera are shown in the following statement : — A. Battery, A. Brigade, Royal Horse Artillery. Strength. Admissions. Deaths. Officers ... ... ... 6 1 1 Men ... ... ... 129 17 14 Women ... ... ... 11 Children ... ... ... 21 7 3 Cholera 107 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- MHoteB M Hote8 on outbreaks, Meean H battery, Bth Brigade, Royal Artillery. Strength. Admissions. Deaths. Officers ... ... ... 2 Men ... ... ... 122 13 8 Women ... ... ... 21 1 Children ... ... ... 38 2 1 Head Quarters ISth Brigade, and Ho. 7 Battery. Strength. Admissions. Deaths. Officers ... ... ... 6 Men ... ... ... 77 14 11 Women ... ... ... 21 4 3 Children ... ... ... 38 3 2 A. Battery, A. Brigade, R. H. Artillery came from Peshawur in February 1872. They had suffered very much from fever there, and the disease continued prevalent among them at Meean Meer. In the Royal Artillery Division generally fever and diarrhoea had increased much by the middle of August when cholera began to prevail. From that date the records are imperfect. H. Battery, Bth Brigade, Royal Artillery — (Staff Assistant Surgeon, J. S. Cogan), Notes on outbreaks, Meean Meer, was /«* attacked on the 31st July j a man was seized while No. 70, h-8 Royal Artillery. on duty on one oi the two picquets furnished by the artillery as part of the sanitary cordon round the station. Each of these picquets consisted of three men. The man attacked is said to have had diarrhoea before he went on picquet. He went on picquet that day for the first time. In the afternoon he was brought to hospital in a state of collapse. In this battery no other case occurred till the 15th August, when a man from one of the married quarters was attacked. On the 16th three cases were admitted from No. 4, the barrack in which the man first attacked had lived, and one of these was from the same section of the barrack which he occupied. As he had been brought from the picquet and not from the barrack, even this section had not been vacated. On the morning of the 17th, the main body consisting of — Officers ... — ... ... ... 2 Men ... ... ... ... ... 93 Women ... ... ... ... .. 4 Children ... ... ... ... ... 8 moved into camp at Soonetta, seven miles south of Meean Meer, on the Ferozepore road. Before going out, there had not been a case among the native establishment of the battery. As soon as they arrived in camp, and throughout the day there were many applications for medicine, some from looseness, others feeling " queer." In the afternoon there were 2 admissions from cholera. Several cases of diarrhoea followed, of which 2 passed into cholera. With these 2 there were 4 entered on the 20th, 3 men and 1 woman, on the 22nd, 1 a child. On the Sunday a man of C-19th (attached to H-Bth) was attacked. In this camp at Soonetta there were also 7 admissions and 3 deaths among the native followers. On the 26th, H-Bth marched to Doolun, 2£ miles south-east of Soonetta. On the 26th, a man was seized (he was one of 5 men who had joined fiom Meean Meer on the 24th) and then a lull till the 16th September when a Native was attacked, and on the 22nd, a Serjeant, the last case. Battery returned to Meean Meer on the 2nd October. The sick, ten in number, went out with A- A, Royal Horse Artillery, on the 16th August. The main body of the women and children of this battery, numbering 16 women and 29 children, on the 17th August, the same morning as the men of their battery moved into camp, were sent by rail to Hurrapa, 116 mites on the line to Mooltan, along with the 7th Battery, 13th Brigade. On the 22nd August one child was attacked, and this was the only case that occurred amongst them. ///. Importation and communication. — The first case was from the quarantine picquet, but the man had diarrhoea all day before he went on duty there. It could not be traced to importation. So far as is known it was the very first case in the station. Nor could the subsequent attacks be referred to contagion. Of about 40 native attendants, none suffered. In one instance a European attending his brother was attacked. His brother was attacked at 3-30 P.M. of 17th, he was in attendauce at 6, and was attacked at noon on the 20th. Both came from different barracks in Meean Meer. In another instance the Serjeant Major's wife was in attendance on another Serjeant's wife. Next day her eldest girl was attacked, but neither she nor her baby in arms, and three other children suffered. A Battery, A. Brigade, Boyal Horse Artillery. —Assistant No. 71 A-A, Royal Horse Artillery. SurgeO n J. Anderson. * 11. Details of the outbreak. — The first case was on the morning of the 13th August, a corporal was attacked and died the same day. On the 15th three cases followed, all patients in the same ward of the hospital. Two of them were under treatment for diarrhoea. On the 16th the battery leaving the women and children behind in cantonments marched four miles on the Ferozepore road and encamped at Chundrai. The sick of the whole artillery division, excepting the cholera cases, accompanied it. These iucluied ten of H-Btli, 108 [ Section I NINTH ANNUAL REPORT OF THE and 9 of 7-13 th. That day another patient who had been in the same ward of the ? hospital as the three men attacked on the 15th, was seized Notes on outbreaks, Meean Meer. in camp> Qn thig dfty Lieutenant Bumford was attacked. He had been for some time in a bad state of health, and was much exhausted by the heat and work. On the 17th there was one admission from cholera and numerous cases of diarrhoea, two of which became cholera on the following day. That night the battery marched eight miles eastward to Leeda and arrived there at 2 A.M. of the 19th. On that day there were 16 admissions into hospital, chiefly from fever and diarrhoea, three of them were from sunstroke, but none from cholera. On the 21st one case of cholera. At this camp, on the 23rd, the battery was joined by their women and children, of whose history mention will be made presently. On the 25th a married man, who had gone into Meean Meer on the morning of the 23rd to bring his wife and family and returned on the evening of the same day, was attacked. On the 26th there was another case. That evening the battery marched to Bengalee, three miles to the eastward, but on account of want of water had to move four and a half miles to Birkee on the 29th. On the 30th there was a fresh case ; on the 2nd of September two, and on the 3rd one, the last of the outbreak among the Europeans of this battery. That evening they marched four miles to Ooderara on the bank of the canal. On the 16th moved to high ground at Khuleera, 18 miles from Meean Meer. Of four men in cantonments one was attacked on the 27th August. The man had gone in to Meean Meer on the 22nd to bring out his family to camp, but was detained by the illness of one of his children who was suffering from cholera. When the battery left Meean Meer on the 16th August, the families consisting of eleven women and twenty-one children remained behind. On the 23rd all of them joined the camp at Leeda, but three women and ten children, who were not moved, because the mothers were engaged in nursing children, suffering from diarrhoea which afterwards showed itself to be cholera. None of the women were attacked with cholera, but among the children there were seven admissions between the 18th and 26th August, viz., on — 18th August ... ... ... .. ... 1 19th „ ... ... ... ... ... 2 21st ...» ... ... ... ... ... 1 23rd „ ... ... ... ... ... 1 25th „ ... ... ... ... ... 1 26th „ ... ... ... ... ... 1 Among the native followers, about 250 in number, there were 14 cases of cholera between the 18th August and 9th September. All occurred in camp. 111. Importation and communication. — The first case could not be traced to importation. None of the attendants on the sick attacked with the exception of a man in A-A, who was seized at Birkee camp on the 3rd of September. He had attended Lieutenaut Bumford who died on the 22nd August, and when he was seized was attending a fever patient in hospital. Almost simultaneously with this man's attack, another man in the same hospital tent was also attacked. In another instance a man of A-A in camp had had his clothes washed in cantonments and returned. Next day he took them again into wear, and the following day was attacked with cholera. It was said that the washerman who washed them died of cholera, but the date of his death is not stated. The washed clothes came on the 28th. The gunner took them into wear on the 29th and was attacked on the 30th. no. 72,7-13 Royal Artillery. 7th Battery, ISth Brigade,— Aaußtont Surgeon W. R. Stewart. 11. Details of the outbreak. — The first person attacked was a woman on the 15th August, and about the same hour a man in hospital. Early on the 16th another man was seized. On the 17th three others were attacked, two men at the Railway station while waiting to start for Hurrupa and another at 9 P.M. after arrival there. On the 18th another woman. No other case occurred in this party excepting a child belonging to H-Bth, whose women and children went out with 7-1 3 th, who was attacked on the 22nd. The party remained at Hurrupa, 116 miles from Lahore, till the 24th September and arrived at cantonments on the 25th. Diarrhoea was prevalent before cholera appeared and continued for some days after going into camp. When the battery left Meean Meer, eight men remained in the cantonment. Of these five were attacked, two on 17th, one on 19th, one on 25th and one on 28th. In addition there were seven men left belonging to the head-quarters of the brigade. Of these two were attacked. On the 28th what remained of both these small parties went into camp with a detachment of the 37th Regiment. None of the native followers of this battery were attacked throughout. In the artillery lines 11 different buildings here and there were attacked. The disease was confined to no particular part. Cholera Epidemic- 109 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. ///. Importation and communication. — The first case could not be traced to impor- Notes on outbreaks, Meean Meer. !f tlon > nor c ° uld th r e subsequent cases be connected with the first case. None of the attendants on the sick sutterea. 37th Regiment — Surgeon J. Ekiu, m.b., Assistant Surgeon Rattray, M.D. — The regi_, _ o __.. „ . ment arrived from Shajehanpore and Moradabad in Decem- No. 73, 37th Begiment. m^ q( men hftd beon indifferent. //. Details of the outbreak. — The strength at the time cholera appeared, excluding the fort detachment and other men absent from head quarters, as well as the number of admissions and deaths from cholera during the outbreak, were as follows :—: — Strength. Admissions. Deaths. Officers ... ... ... 12 Men ... ... ... 691 91 55 Women ... ... ... 101 9 5 Children ... ... ... 143 24 22 124 82 Among the native followers who went with the regiment into camp, and who are therefore not included in the general statement of the Staff Surgeon, there were only two cases which occurred at camp Khana. The first case in the 37th Regiment occurred on the 4th August. It did not appear at first to be one of cholera. The man had eaten largely of peas and seemed to be suffering in consequence. About the same time there were three other cases of diarrhoea, which also showed unmistakeable symptoms of cholera on the following day. On this day, the sth, diarrhoea became prevalent, and one of the patients in hospital was attacked with cholera. These first cases were from buildings in widely different parts of the lines. Taken in chronological order, the cases in the regiment were thus distributed : — Admissions. Date. Men. Women. Children. August 4th ... ... ... ... ... 1 sth ... ... ... ... ... 4 ... 1 6th ... ... ... ... ... 1 7th ... ... ... ... ... 9 Bth ... ... ... ... ... 7 1 9th ... ... ... ... ... 7 ... 3 10th ... ... ... ... ... 5 ... 2 11th ... ... ... ... ... 6 ... 5 12th ... ... ... ... ... 1 4 13th „ ... ... ... ... 3 3 2 14th ... ... ... ... ... 3 15th ... ... ... ... ... 9 1 16th ... ... ... ... ... 4 ... 3 17th ... ... ... ... ... 7 2 2 18th ... ... ... ... ». 1 19th ... ... ... - «. 2 20th ... ... ... ... .» 8 21st ... ... ... - ... 1 22nd ... - - .» «. .» 1 1 23rd ... ... ... - ... 3 24th ... ... ... .. - 2 25th ... ... ... ... .» 2 26th 27th ... ... ... ... - 1 ... 1 Total ... ... ... 91 9 24 There is no exact record of the number of buildings attacked. Dr. Ekin states that the disease was very widely scattered over the lines, and that hardly a single room escaped. •No diarrhoea was prevalent before the cholera appeared in the regiment. In the week ending 2nd August there was only one admission into hospital from this cause, but it was extremely prevalent during the outbreak. Some of the many cases of this kind were attended with vomiting and cramps, and " were stopped ou the verge of cholera by appropriate treatment." c 1 110 [ Section I NINTH ANNUAL REPORT OF THE To complete the history of the outbreak, the details of what occurred in the various , ? camps must be considered. The regiment moved from can- Notes on outbreaks, Mean Meer. r . „ ° , , , . . tonments in four distinct parties, and the history of each will now be separately recorded. 1. Head Quarter 'party. — On the evening of the sth August, after six cases had occurred in the regiment, the head quarters, composed of 4 officers and 252 men, including nearly all the sick, moved by rail to the temporary barracks at Hullokee, 11 miles to the south-west. On the afternoon of the 6th they were joined by 2 officers and 137 men of the regiment from Meean Meer. This second party brought tents, but before they could be brought from the train unfortunately it began to rain. Only a few of them could be put up. The men were thus overcrowded, the tents, the cots, and bedding in many instances were wet. Some of those in the barrack had no cots. On the 6th there was no cholera, but in the evening of that day diarrhoea greatly increased, and there were numerous applications for medicine. At 12-15 of the morning of the 7th a case of cholera was admitted into hospital, another followed 2 hours after. That day there were altogether seven cases. Diarrhoea continued very prevalent. During that night there were 70 applications for astringent medicine. On the Bth there were five cases. That evening the party moved into tents at Khana, 4 miles nearer to Meean Meer and close to the Railway station of that name. Diarrhoea continued very prevalent. On the 9th there were four cases of cholera. On the 10th four, on the 11th four, on the 12th three, and on the 13th three more. Diarrhoea was not so prevalent. On this last day the party moved into camp at Okara on the Railway, 80 miles from Lahore, and arrived the same day. No further case occurred till the 15th, when there were nine, of which four proved fatal the same day. On the 16th there were three cases, on the 1 7th five, and the applications for diarrhoea medicine again became numerous. On the 18th there was one case of cholera, on the 19th one, and on the 20th five, but they were of a less severe type, and four of them recovered. On the 21st another case occurred, and the last one in this party followed on the 24th. Twelve women and 12 children joined at Khana on the 12th. No case had occurred in these families before leaving Meean Meer, and none occurred afterwards. In addition a woman came to Hullokee to attend her husband, who was ill of cholera. On the 1 5th she was attacked there and died. Water was drawn from wells at each ground. At Hullokee the well had been recently cleared out in preparation for its being required. At Khana and Okara the well used was that of the Railway station. No filters were taken out with this party, but earthen vessels were obtained and made into the usual filter at Okara on the 16th. 2. Nyaz Beg Party. — Assistant Surgeon Charles Rattray and Staff Assistant Surgeon W. P. Smith. On the 6th August, at 9 A.M., three officers and 133 men marched to Nyaz Beg temporary barracks, 10 miles distant. There had been two cases of cholera among them before leaving, and several cases of suspicious diarrhoea occurred on the way out. On the 7th four cases of diarrhoea were admitted into hospital and two of cholera. On the Bth there were nine admissions from diarrhoea, and there were two more cases of cholera, and then the disease ceased entirely. These four cases of cholera at Nyaz Beg all occurred in one of the two barracks. On the Bth it was vacated, and the inmates moved into camp. On the 11th five women and three children joined from the Shalimar party, to be presently referred to. These families had had no cases of cholera before they came to Nyaz Beg, and none followed. The whole party remained in their temporary quarters till the 25th September, and then returned to cantonments. Water was drawn from the canal close by. The party took with them two Macnamara filters from the hospital, all ready charged, and no change was made either in the sand or charcoal during their stay at Nyaz Beg. 3. The Families. — Assistant Surgeon Charles Rattray. — On the evening of the 6th the main body of the married people, consisting of 56 men, 85 women, and 116 children, moved 3 miles to Shalimar. Some were encamped outside, and some were accommodated in a house within the gardens. Before moving they had had only one case among them, a child attacked on the sth. On the 7th there was no case. On the Bth a woman was attacked. On the 9th three children of different families. On the 10th, two more children from different families. On the 11th five from different families. On the 12th four children and one man. The party then moved the same day to camp at Chunga Munga, 44 miles on the Mooltan line of rail. On the way one woman was attacked. On the 13th two women. On the 14th two men and two children. On the 16th one man and one child. That day they shifted ground a few hundred yards. On the 17th a child was attacked, and on the 23rd a man, the last case. The party returned to cantonments on the 21st September. Two Macnamara filters were taken with them, which had been in use at Shalimar. These filters are said to have been cleaned on the 31st July, and not tojiave been opened again till the 21st August, when the cholera had ceased. 4. The Gogaira Party. — Staff Assistant Surgeon George Shaw. — On the 26th August, one officer, 84 men, 15 women, and 24 children, joined on the 27th by some of the Artillery, moved by rail to Gogaira, 87 miles on the Mooltan line, and encamped near Cholera I SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- -i 11l the station of Cbuueewal; only one case occurred among them after leaving cantonments — i*r «. tKMOto Waaan j* aar . one of the Artillery on the 28th. Two followers also Notes on outbreaks, Meean Meer. «•«*..•« % mr n i , j... 1 i • suffered, but the dates of these two attacks are not given. They took with them and used a Macnamara filter, all ready charged, as it had been in barracks. 5. Party left in cantonments. — Staff Assistant Surgeon W. H. Climo, m.d. — On the 6th there were four cases in cantonments. Before the last detachment left on the 27th August, the strength in cantonments consisted of 3 officers, 101 men, 20 women, and 36 children. Among them, between the 9th and 27th August, 27 cases occurred. Dr. Climo gives the number as 35, viz., 19 men out of an average of 93, 4 women out of 17, and 12 children out of 26. Of the 35, 26 were fatal. According to these figures the attacks were in the proportion of 25 per cent, of strength. Dr. Ekin states that of 82 men 17 were attacked and 11 died, of 16 women 4 were attacked and 2 died, and of 26 children 5 were attacked and all 5 died. From time to time as buildings were attacked, the inmates were removed to cantonments on the parade ground, until ultimately the whole of the small party left in cantonment was in camp. Among the party left behind in cantonments after the 27th August, consisting of 2 officers, 17 men, 5 women, and 12 children, no further seizures occurred, but many of these remained because they were already suffering either from diarrhoea or cholera. 111. Importation and communication. — The punkah-coolies were at work, and in spite of the cordon round the station many people must have passed in daily, but the disease could not be traced to importation. Tn the whole course of the outbreak only one case occurred, which might perhaps be construed as having been due to communication. The first man attacked before his symptoms were recognized as those of cholera was treated in an inner verandah of the hospital. Within a few feet of this spot, a man in the ward, who had been long under treatment, was attacked with cholera next day, the sth August. At the same time it is to be noted that another patient, who also had been some time in hospital, was attacked on the 6th in another ward. The place where the first case had been treated had been carefully cleansed and disinfected. Every case of cholera had three or four native attendants. Of these, so far as is known, only two were seized with cholera. They were attacked about the same day at Khana. Frequent changes, however, took place in these men, and the subsequent history of those who left was not traced. No. 74, isth Bengal Cavalry. \Bth Bengal Cavalry. — Surgeon G. K. Poole. 11. Details of the outbreak. — There were only three cases in this regiment, one on the 27th August, one on the 2.9 th, and one on the 30th ; only the first was fatal. Among the followers four cases, one on each of the following dates, August 27th, 29th, 30th, and September 13th. 111. Importation and communication. — The man first attacked "is supposed (against order) to have gone to Lahore the evening before he was attacked." " A patient suffering from fever was the next attacked. This man occupied the bed next to the one where the cholera patient was put by a mistake of the .Native Doctor. The third sowar attacked had been in attendance on the first cholera patient." This third man was attacked in camp, the only case there. In the account of the movement it is said that "this man had been looking after his comrade who was the second man attacked, making the third case among the sowars. Another strange fact is this, that the first case among the camp-followers was that of a barber, who shaved one of the men in attendance on the sowar first attacked." No dates are given. VI. Preventive measures. — On the 28th August, the regiment, leaving about one-third of their number for duty in cantonments, moved into camp at Dhoree, 9 miles to the east of cantonments, and remained there till the Ist October. None of the men left in cantonments were attacked, but two cases occurred among the camp-followers there. 24£/ i Regiment Punjab Infantry. — Assistant Surgeon H. Linton. — Strength, officers 5, men 536, women 61, children 50. No. 75, 24th Native Infantry. //. Details of the outbreak. — First case occurred on the 14th August. Between that day and the 3rd September there were eight cases among the men and eight among the followers, distributed thus : — On the 14th two, 15th one, 17th one, 18th one, 22nd three, 24th two, 25th one, 26th one, 27th one, 29th one, 30th one, September 3rd one, or a total of 16. Of these the one on the 17th occurred in the fort as already mentioned. The regiment came from Rawal Pindee in 1870, and had been in good health. Diarrhoea had not been prevalent among the men before cholera appeared, nor did it become so while the outbreak lasted. On the 15th August the regiment moved into camp, 112 [ Section I NINTH ANNUAL REPORT OF THE one-fourth of a mile west of the lines. The five cases among the sepoys that occurred after that day were in camp, but the men were employed Notes on outbreaks, Meean Meer. much Jn F J 111. Importation and communication. — The first three cases occurred among sepoys, who had formed portion of a fatigue party employed in striking tents at Shalimar, which had been used by the married people of the 37th. These families had suffered severely from cholera at Shalimar, as has been already detailed, and had abandoned the place on 1 2th August. On the ]3th the fatigue party of the 24th Punjab Infantry, consisting of 100 men, went to Shalimar at 4 A.M., and were busily employed in striking the tents until 6 p.m. All this time they were without food. Immediately on their return two of them were attacked with diarrhoea, which rapidly assumed all the symptoms of cholera ; another man of this party was afterwards attacked ; all three died. The other sepoys who suffered from cholera recovered. Neither the first case nor the subsequent ones were traceable to infection. Each of the sepoys had eight comrades to attend him in turns, so that 64 of them were brought in immediate contact with the sick ; not one of them got cholera nor did any of the hospital establishment. 17 th Regiment Native Infantry. — Assistant Surgeon No. 76, 17 th Native infantry- E. Eades. — Strength at Meean Meer, officers 5, men 350, followers 300. //. Details of the outbreak. — The first case was that of a follower on the 15th August ; on the 16th August a sepoy was attacked. Between the loth August and the 2nd September there were in all 19 cases, distributed as follows: — On the 15th one, on the 16th one, on the 17th one, on the 19th one, on the 22nd one, on the 25th two, on the 26th three, 27th three, on the 30th one, 31st three, September 2nd two. In addition there was another in the fort detachment on the 23rd August. Diarrhoea was never prevalent. On the 26th regiment moved into camp, about 600 yards from the lines. On the next day there were three cases, and on the 28th a change was made to Teera, a place 4 miles off. On the 31st there were three more cases; the camp was shifted to Tulseepore on the Ist September; then on the 2nd there were two more. Only one case among the followers occurred ; this was at Teera on the 30th. ///. Importation and communication. — No importation of the disease could be traced, nor was there any evidence of contagion. Of 18 attendants on the sick none were attacked. Nos. 3 and 4 Companies suffered most. Among the Europeans who have not been included in the regimental statements already given, a few were attacked. The facts, so far as they are known, may be best given in chronological order. On the Bth August diarrhoea was prevalent in the military prison. On the 11th "a large number of cases admitted into hospital with diarrhceaand one prisoner with cholera." On the 19th the Provost Sergeant attacked. On the same day the wife of a Commissariat Sergeant and child attacked. Meean Meer Bazars, &c. — Among the natives in the bazars, officers' servants and others, 178 cases of cholera have been recorded, but the dates of occurrence of only 144 of these are given. Of the 178 cases 115 were fatal. The first occurred on the Ist August, and the last on the 6th September. The period of greatest prevalence was from the 11th to the 29th August, between which dates 119 of the 144 occurred. The disease was not confined to any particular locality. It occurred in all the bazars more or less, and in many of the officers' compound. The first case was in a man in the sudder bazar, who had arrived from down country on the 29th July. He was attacked on the Ist August. In the village of Meean Meer, which lies near this bazar, there had been a case on the 29th July. There were two more on the 31st July. The only other villages in the immediate vicinity of cantonments from which cholera deaths have been reported were Bagbanpura near the Shalimar gardens, where one was registered on the 11th August; Gunge near the cattle-yard, where there was one on the 23rd, and Keer, near the Artillery lines, where there were 31 between 22nd and 30th August, and one on the 6th September. ///. Importation and communication. — In none of these cases has any evidence of importation been adduced, nor in the course of the outbreak among the native population of cantonments did Dr. Climo, the Staff Surgeon, see any evidence of spread from one case to another. Of two Native Doctors and eight servants belonging to the Cholera Hospital one was attacked. The sick were generally attended by friends. So far as is known none of them suffered. Summary of the facts regarding the outbreak at Lahore and Meean Meer. — The annexed statements show the daily incidence of the disease as it affected the different communities. In the first of them, embracing the period from May to July, it was confined to the city and its vicinity. In the second, commencing with the 31st July and ending with the termination Cholera "| SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic j 113 „ ¦of the outbreak, Meean Meer, the various camps, and the Notes on outbreaks, Meean Meer. , ' 1 • i j j central prison were also included :—: — Cholera at Lahore, 1872, May to July. a s & i a w £¦ 2 fr Date. S Ji " ¦"< Date. go ° o ¦< 1911 g j s I I I i 1 111] May 1 - - Junl6 - - 2 5 „ 8 - ?17 - - 2 4 „ 3 - ?18 - - 2 „ 4 - ?19 - - „5--„ 20 - - „ 6 - ?21 - - 1 „ 7 - 2 ... ?22 - - 1 „ 8 - 1 ... „ 23 - „ 9 - ?24 - - „ 10 - .. ?25 - 1 1 ?11 - - ?26 - - 4 „ 12 - 1 „ 27 - - 3 „ 13 - „ 28 - 2 „ 14 - 2 ... „ 29 . - - ?15 - - ?30 - - 1 ?16 - - July 1 - „ 17 - ?2 - - 1 „18-- , 3 - 2 ?19 - - „ 4 - - 1 „ 20 - „ 5 - - ?21 - - ?6 - 1 22 7 ?23 - 1 „ 8 - 1 ... 1 „ 24 - „ 9 - - ?25 - - 2 1 „ 10 - - 2 ?26 - 1 ?11 - - ?27 - - ?12 - - 2 ?28 - - ,13 - - 1 ?29 - - ?14 - 1 ... 5 ?30 - - „ 15 - 1 „ 81 - - ?16 - 1 1 2 June 1 - - ... ... ... ... ?17 - - 2 ,; 2 - 1 „ 18 - - 2 l ?3 - 2 ?19 - - 2 2 „ 4 - ?20 - - 1 ?5 - - 1 1 I„ 21 - - 2 ... 2 „ 6 - 2 ... I „ 22 - 2 ,7 - - 1 „ 23 - - 1 ... 2 „ 8 - 1 „ 24 - 4 ... 1 ? 9 - - ... ... ... ... ?25 - - 5 ... 3 ?10 - - „ 26 2 3 3 „ 11 - - ... ?27 - 2 1 , 12 - ... ?28 - - 2 ... 2 1 „18 - - 2 2 „29 - - 2 ... 2 ?14 - - 2 3 „ 30 3 ... 1 ?15 - - 1 1 „ 31 - - 1 1 I L 1 114 [ Section I NINTH ANNUAL REPORT OF THE Notes on outbreaks, Meean Meer. Statement of Cholera at Meean Meer, at the Camps, in Lahore, fyc, from %\st July, the date of the first case at Meean Meer. H-BR. A. A-A R. H. A. 7-13 R. A. 37th Regiment.* § g" I Canton- ,-..„,. Canton- n Canton- n , MT , j§ >, § . MENT. CAMP - MENT. CAMP - MENT. OAMP - 2 v | £ a I . «g s » * « » rf D• !& ill I i i a s i i a i a if !JJ! II!l t!lf 11? II |{ || |i || || 1 tip if 1 | li I 111! July ... 31 1 ... 1 1 ... August ... ] ... ... 1 2 ... 2 2 ... ... 4 ... 2 3 ... ... ... 6 .. 2 „ 4 ¦•• ... ... 3 1 6 ... 4 2 ... 5 ••• • ... 3 S ... 4 1 ¦•• 6 ... ... 1 ... 1 6 ... 3 1 ... 7 .« ... ... 7 2.. ... 7 ... 3 ... ». 8 ... 15 2 1 ... 12 ... 2 ... ¦•• „ 9 ¦ ... 1 4 ... 4 14 5 ... •«• 10 ... ... 4 .. 3 ... 2 7 ... 5 ... ••¦ 11 ... 2 4 ... 5 ... 4 !5 ... 4 ... ••• 12 ... ... 3 ... 8 ... 7 !8 ... 3 ... - 13 1 ... - 1 3 ... 3 ... 1 6 ... 1 ... ••• „ 14 ••• •¦• 1 2 2 5 4 ... 4 ... 1 15 1 •» 3 2 ... ... 12 ... ... 1 1 3 13 ... 5 ... l ... 16 3 2 ... 1 ... 3 1 ... 2 ... ... 1 ... 5 13 ... 1 ... 6 17 2 ... l ... 4 1 4 5 ... 1 ... ... 1 1 14 9 1 1 ... 2 18 ••• 1 ... 2 1 2 1 ... 1 1 10 9 2 2 ... 5 ""¦ 19 1 2 1 - 11 ... ... 1 ... 7 25 ... 3 ... 8 20 4 ... 3 5 3 9 ... 4 ... 6 „ ... 21 ... 4 1 ... 11 ... ... ... 1 ... .. 1 16 ... 1 ... 7 22 2 1 2 ... ... 1 .., ... 1 3 7 5 ... 2 ... ? 23 1 1 ... ••• 2 ... 8 7 13 ... 2 ... 21 ••« 2 ... 1 ... ... 2 1 2 7 4 ... 4 ... - 25 1 ... 15 1 1 ... 1 2 1 5 13 ... 3 ... 2 26 - ••¦ It ... 1 ... 12 ... ... 3 14 5 ... 7 ... - 27 - I 1 1 1 ... ... 2 ... 13 13 4 ... 2 ... l ... 28 1 »¦ 1 ». I|| 1 9 3 ... 6 ... — .. 29 ... 1 ••¦ 1 ... ••• 1 16 5 ... 3 ... ••• ... 30 ... 1 •¦• ... 1 1 1 2 2 ... - „ ... 31 2 ... 6 ... 6 ... 3 ... 3 1 ... 2 ... - September ... 1 ... ... S ••• c ... 3 4 1 ••• 2 ... 2 1 ... * ... £ 2 ... S 1 1 1 ... - 3 ... l 1 ... ... 112 ... 3 ... ••¦ 4 ... ... — 2 — 5 "• ••• ... ... 2 •¦• 6 ... ... 1 - ... 7 ... 1 ... „ - 8 •• ... — .. 9 1 ... ... ... - ... 10 ... ••• ... 11 - - ... ... - ... 12 - ... ... - ... 13 ••• ... ... ... - ... 14 ... - ... 15 .. ... - ... 16 ••• .» ... 1 .. ... ... ••• ... 17 »¦ ... - „ ... 18 ... •• ... — ... 19 ... ••• ... 20 ... - ... 21 ••¦ ... •" ... 22 1 ... - ... ... .- - ... 23 ... ... ••¦ ... 24 ... . ... ... ... - ... 25 ••• ... - ... 26 ••• •¦¦ ... •• ... |27 - ». - ... - ... 28 .. ... ••• ... 29 ... ... •• ». 30 ... ». October ... 1 . ... 2 ... ••• 3 ... - 4 ... ... ... 5 If .• Not including the detachment at the Lahore Fort. f Deaths only. X Came from Meean Meer on the 24th. § Had returned from Meean Meer 36 hours previous. || An Artillery man belonging to the small detachment of his Regiment who joined this camp. f One followed on 15th November. Cholera 1 SANITART COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 115 IV. Meteorology. — Dr. Cogan states, "on the Ist August heavy rain fell in the afternoon, and a severe thunderstorm with lightning passed over Notes on outbreaks, MeeanMeer. the unugual rain .f a H this year, and at times the weather was very oppressive. The wind was usually from the east, but for the most part, the atmosphere was perfectly still, and charged with electricity.'* Dr. Anderson corroborates the statement that " during the epidemic easterly winds prevailed for the most part/ Dr. Stewart also says that " the wind was easterly as a rule." Dr. Ekin observes, "in July the fall of rain was much above the average, being about 6"50* inches, and the atmosphere and earth were loaded with moisture. The prevailing winds were south-east and east, and I may add that flights of locusts were numerous this month/-' Dr. Climo appends to his report a statement prepared by Major Basevi of the Bengal Staff Corps, in which the rainfall and temperature at Meean Meer in 1872 are compared with those of the two previous years : — Statement showing the rainfall and temperature at Meean Meer in 1872, compared with those of 1870 and 1871. »_!,_ S_, tj. ^ to"g O O O O O >2 ** a> *5 «.d and an area of 1900 squar e m il es . The towns and villages number 1,429. //. Details of the outbreak. — According to the police reports, one death from cholera was registered in each of the first three months of the year. There was one death in May, but none in June. In July 2 ; in August 27, and in September 35. In August, deaths from the disease were reported from 13 villages or towns, and in September from an equal number. In the town of Goojrat, with a population of 15,907, two deaths only were reported, one in May and one in August. 111. Importation and communication.— According to the Civil Surgeon's report there was no case in the district till the 3rd August, when a Mahomedan priest, who returned from Lahore on that very day, was taken ill immediately on arrival at the village of Futtehmusa, and died on the 6th. ( ' On the 7th no less than ten persons were attacked, most of whom were friends of the deceased, and had remained present with him during his illness." On enquiring exactly how many of these ten persons had been with the deceased after his attack, Dr. Quinnell states, — " The ten persons attacked on the 7th were amongst those who had assembled at his house to welcome him, and they afterwards took part in attendance upon him during his three days' illness." At Koonjah, a town of about 6,000 inhabitants, also the disease is believed to have been brought by a Bunneah from Jummoo. He returned on the morning of the 25th August, was seized the same night, and died the following day, the 26th. Between that and the Ist September twelve people, all of the one mohulla to which the disease confined itself, were attacked, and of this number only two escaped. The Police Returns, however, do not agree with this statement, and show three deaths from cholera on the 26th. At Khallas again, a remote village, 25 miles to the north of Goojrat, and 10 west of Bhimber, it is said that the disease was traced distinctly to communication. A coolie who was engaged on the railway works at Nowringabad, near Jhelum, and who was in the habit of re-visiting his home in this village, returned on the 26th August. He took ill on the afternoon of the 27th, and died in a few hours. Eight others, who, it is stated, shared their meal with him during the evening previous, were seized the same night. Then followed in succession two fresh cases on the 28th, ten on the 29th, eight on the 30th, two on the 31st, and two on the Ist September. The Police Returns show a death from cholera at this village on the 25th, but on further enquiry the Civil Surgeon is satisfied that it was really due to fever. Throughout the whole district deaths from cholera were recorded at only 23 places. In many of them only one occurred. Some of these were either travellers or persons who had been to infected quarters ; others had not left their homes. Excepting the three places already mentioned, not one suffered with any severity. In many of them there was only one death in each VI. Preventive measures. — At the various ferries leading into the district, arrangements were made for examining all travellers. Those from infected No. 78, Goojrat. localities who were in good health were allowed to proceed after washing their clothes. Those who were found suffering from cholera were detained for treatment. It is estimated that at the seven main ferries about 3,500 persons were examined daily, and 22 cases of cholera were treated. Along the Cashmere frontier, a stretch of about 50 miles, the heads of groups of villages were called on to prevent people from coming- into the district. As soon as a case occurred in a village a cordon was drawn round it ; a shed was provided inside the cordon to receive the sick. Medical aid was supplied, and houses attacked were disinfected. The inhabitants were allowed to go to their fields, but their fields are generally isolated patches attached to the village. Practically these measures were applied to only four places. In eleven others they were not required, as before the reports were received, the disease had either disappeared or showed no sign of spreading. For the town of Goojrat a regular quarantine was established. Persons who came from healthy places were allowed to enter at once after washing their clothes, but those coming from quarters where cholera was present were kept for seven days under observation. A cordon was placed round the city. The inhabitants strongly objected to these measures. JIiELUM. — Assistant Surgeon E. Gardner, Civil Surgeon. — Population 500,988. Area 3,909 square miles. Number of towns and villages 998. The town, which is on the right bank of the River Jhelum, has a population of 5,148. No. 79, Jhelum. //. Details of the outbreak. — The first case in the town was on the 10th July, and this is said to have been the first case in the whole district ; but the police returned two deaths from cholera in May, one in each of two different villages, and in June six, of which two occurred in Cholera 119 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic the town of Pinddadun Khan. In July altogether there were fifteen in five different places ; in August 252 spread over twenty-five places ; in September Notes on outbreaks, Jhelum. fiye months are doubtful ; one on the 10th July was verified. The five villages attacked in that month were widely scattered. As a whole, the disease was confined chiefly to the towns of Jhelum and Pinddadun Khan, and to villages within 10 miles round each. In Jhelum, between the 11th July and 2nd September, there were 122 cases and 53 deaths. In Pinddadun Khan, a town of 17,538 inhabitants, there were between much the same dates 652 cases and 172 deaths, as reported by the hakeems. The two places are 50 miles separate. There was no cholera in the district beyond the salt range of hills, at the foot of which Pinddadun Khan is situated. In the cantonment, which is about a mile from the city, both lying close by the Grand Trank Road, there were nine cases in all. On the "4th July ... ... ... ... ... 1 25th „ ... ... ... ... ... 2 „ 27th „ ... ... ... ... ... 1 „ 29th „ ... ... ... ... ... 1 ? 6th August ... ... ... ... ... 2 7th „ ... ... ... ... ... 1 9th „ ... ... ... ... ... 1 9 All but one occurred in the sth Bengal Cavalry, either among the men or followers After the cholera, fever was very prevalent. Dr Gardner states that in 1869, although there was no cholera, fever was epidemic, attended in many cases with diarrhoea. ///. Importation and communication. — Neither in the district, the city or the cantonment, could the first case be traced to importation. In many of the villages only one or two deaths from cholera were reported. As a rule, the persons attacked were treated in their own houses, and no spread of the disease was caused by this arrangement. The outbreak, although not very severe, was widely spread over the town, and its spread observed no definite order. Two cases are given in which the disease may have been spread by infection. A Eurasian woman was attacked with cholera on the 18th ; took her child in her arms on the 20th. On the 28th the child was seized. Both lived in the same house throughout. A child was attacked on the 3rd August. " She was living with several brothers and sisters in the greatest possible squalor. Their clothes and very food were defiled by the copious vomits. One sister was seized on the 6th ;" none of the others were attacked. VI. Preventive measures. — All people coming into the district were examined at the ferries. It was intended that any suffering from choleraic symptoms should be stopped and treated, but no such cases presented themselves. People who wished to enter Cashmere from Jhelum were subjected to the same surveillance by the Jummoo authorities. Orders vvere given at Jhelum and Pinddadun Khan to destroy all clothing and bedding of cholera cases, but it is doubtful how far these orders were really carried into effect. In the villages no such measures were attempted. VII. Previous history. — The remarkable immunity from cholera which Jhelum has enjoyed is very strikingly shown in the annexed statement, from which it appears that during the twenty-three years, 1850 to 1872, cases have appeared among the troops or prisoners in only seven of them, and in nearly every instance the disease was limited to isolated cases. Statement of Cholera at Jhelum, 1850 to 1872. Numbbb op Cases. Ybab Average .. . . Total Total Strength. . £ * . 5 £ Cases. Deaths. tli*** ± t 1 I 1 1 1850 Native Troops - 2,439 1 ... 1 1851 Ditto „ - 2,113 1 II ... 1853 Ditto „ -j 2,481 112 4 1 1854 Ditto „ - 1 1 1855 Prisoners -I 278 1* ... 1Q _ ( Native Troops -i 1,459 2 9 ... 1 ... 12 8 1856 { Prisoners - 267 1 1 ... 1862 Ditto - 311 3 3 , Q - o C European Troops - ... ... ; i IS72 l Native „ - 1,538 1 ... 2 3 6 2 * Month not known. Rawul Pindee. — Surgeon J. Ince. — The district has a population of 699,647, and an area _ ,_. . of 6,215 square miles. It contains 1.658 villages and towns, Rawul Pmdee. i . ' , jT I •• , X ?„„ . . ?. . ° , but only four have above 5,000 inhabitants in each. 11. Details of the outbreak. — On the 9th June the first death from cholera occurred ; in that month three were reported from three different places. In July two more deaths were 120 [ Section I NINTH ANNUAL REPORT OF THE registered in two other places. In August thirty in ten places, In September 107 in twentyfive places, and in October six in four places. The earlier Notes on outbreaks, BawulPindee. cages^ ere wide , y scattered over t he district. In August and September the disease was chiefly confined to the Pindee and Murree Tehseels. In the city, which has a population of 19,228 there were 101 cases between the 21st August and the 14th September. ///. Importation and communication. — The first cases were nowhere traced to communication. The disease in the city and cantonment appeared in August in three separate places on the same day, and at or about the same time, two in the city and one in the cantonment. The man attacked in the cantonment is said to have been in the city on the previous day. In the cholera hospital where 31 cases were treated, none of the attendants were attacked. Seventy persons were treated in their own houses and in no case did they form a centre from which the disease spread. V. Local conditions. — The drainage of the town is naturally excellent, and it is kept very clean. The water is drawn from wells, but as they are expensive to construct, they are not so very numerous as in other towns. No connection could be traced between the cases of cholera and the use of any particular water. VI. Preventive measures. — Quarantine was attempted at several places. On this point the following details have been furnished by the Deputy Commissioner, Major H. B. Urmston :—: — " Quarantine was established first against Jhelum on the 9th of August 1872 at the Sohan River, 3 miles from the cantonments, and removed on the 25th September 1872. No case was detected by the guard here." " Against Cashmeer, at Kohala Bridge, River Jhelum, at a distance of 20 miles from Murree, established on 19th August 1872, and removed on 25th September 1872." "Against Murree and Cashmere, established on 22nd August at the 3rd mile stone, on the Murree road, and subsequently (Ist September) at Barakow, 13 miles out on the same road, which was reduced on the 25th September 1872. Three cases of cholera were detected at this post, nameJy, one on 12th September and two on 13th idem." "A military cordon was also established on 22nd August round the north and east side of the cantonments of Rawul Pindee to cut off all communication between the city and cantonments." "On the outbreak of cholera at Peshawur quarantine was established at Khyrabad across the Indus near Attock on 11th October 1872. It was partially reduced to three days on the 29th idem, and wholly removed on sth November 1872. Four cases were detected here on the following dates : — On 14th October ... ... ... 2 99nrl 1 jj ——I Ml ? ... ... ... X „ 23rd „ ... ... ... 1 The Cantonment. — Deputy Inspectors General of Hospitals, British Forces, T. Best, Indian Forces, G. Banister. — The combined Civil and Military station about 2 miles from the city. The garrison consisted of three Batteries of Royal Artillery, the 36th and 70th Regiments of Foot, the 9th Bengal Cavalry, sth Company of Sappers and Miners, the 14th Native Infantry, the Depot of the 23rd Native Infantry, and the 25th Native Infantry. The population of the bazar, &c, is estimated at 7,140. //. Details of the outbreak. — In the 36th Regiment (Assistant Surgeon Leslie) there no. 80, 36 th & 70th Regiments. "•" tvv ° c ™ e * 0 L ch ° lleur v a ' one on the 17th July and the other on the 17th September. In the 70th Regiment (Surgeon Fuller and Assistant Surgeon Knox) three cases have been recorded, one on the 9th September and two on the 12th. But three cases with cramps, collapse, and suppression of urine, in fact all the symptoms of cholera, occurred, one on 18th June, one on 27th, and the third on the 30th July. In the 25th Punjab Infantry one man was attacked on 23rd August. In the bazar, „ Q1 __.. _, ? x , there were seventeen cases, of which ten were fatal. With No. 81, 25 th Punjab Infantry. , . . ' , , , T . .. , the exception of two returned on the 1 9th July, all these persons were attacked between the 25th August and 22nd September. In no section of the community was diarrhoea prevalent, nor was fever. 111. Importation and communication. — In the 70th the case of the 12th was the father of the child attacked on the 9th. The child was a patient in hospital suffering from fever and diarrhoea, but had been allowed to sleep in the father's quarters on the nights of the 7th and Bth. The father did not nurse the child after it was seized, but. was with it at times. He was much depressed having lost his wife only a few months previous. None of the attendants in any of the hospitals were attacked. V. Local conditions. — The cantonment lies high, and the natural drainage is excellent. Water is drawn from wells, many of which are covered, but none yet provided with a pump. They are no better defended than the wells in many other cantonments. VI. Preventive measures. — As regards the cantonment cordon, it is to be noted that the passes issued were very numerous, at least 200 or 300 a day. Persons as they returned were supposed to be fumigated. VII. Previous history of Rawul Pindee as regards cholera has been very favorable. Cholera j SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 121 No Xiw O u n iPiidee aks> Statement of Cholera at Rawul Pindee, 1849 to 1872. Number of Cases, y-a.j. Average . . Total Total Strength. >, « S3 S3 Cases. Deaths. £«^ 4 I i i 1 1849 European Troops - 882 1 ... 1 1 1 ... 2 3 1 10 1 1850 Native „ - 2,377 3 3 1 1Q _. f European Troops - ... 1 1* Jy&1 1 Native „ - 2,225 1 1 ... IQ - O f European Troops - ... 1 1* iysJ l Native „ - 2,740 1 1 1853 Ditto „ - 2,850 1 1 1 1 4 1854 Ditto „ - 2 1 3 lfi «.f Ditto „ - 3,770 2 1 ... 3 1800 \ Prisoners - 649 1 1 2 1 1857 Ditto - 886 1 1 1 TQwif European Troops - 1,039 4 ... 2 6 12 8 ISO8 C Native „ - 15 1 ... 1 8 4 1859 European Troops - 1.467 1 1 1861 Prisoners - 754 1 1 1 i o an and 45 from Peshawur. The garrison consisted of 5 officers, 71 men, 10 women, and 10 children of the o-13th K. A., and 105 men of the 2nd Battalion 60th Rifles. Of native soldiers there were 176, and about 150 followers. 7/. Details of the outbreak. — One Serjeant of the Rifles and 2 men of the Artillery were attacked ; all died. The first case was admitted on the 2nd October. The man was suffering from fever and diarrhoea, but undoubted cholera supervened on the 3rd ; the second was on the sth and the 3rd on the 6th, both in hospital, but in a ward two wards removed from that in which the first man was ill. Among the general population of the small town of Attock, only one death from cholera is recorded. It is entered on the 13th October. Diarrhoea was not prevalent, but there were a few cases. Fever commenced to be very prevalent about the middle of August, and continued so till near the end of December. ///. Importation and communication. — The first case could not be traced to importation^ nor the others to contagion ; none of the attaudants were attacked. V. Local conditions. — The fort stands very high. The drainage is said to be good. The water is brought from a well outside the fort. It is locked up at night and has a sentry over it during the day. There is no pump, and the water is drawn in the ordinary way. The same well was used throughout. The natives drink generally from the river. There was no overcrowding, and the conservancy was good. VI. Preventive measures. — Quarantine. — In September, when it was reported that cholera was prevailing at Murree, extra sec tries were posted round the fort, and natives were prevented from coming into the fort except tradesmen and others who were absolutely required, and who were provided with passes. Forty-six permanent passes of this kind were issued. " Officers' servants and camp followers were also provided with passes, so that nearly 200 natives were daily admitted, and at night they returned to the native town where their houses were." From the 14th September, by order of the Peshavvur authorities, all officers returning from M urree were detained at the Attock Dak Bungalow for seven days. After a short time, however, the term of detention was reduced to three days. JMo symptom of cholera appeared amongst them. No servants were allowed to accompany them. These were detained for seven days at Barralow on the road between Murree and Pindee. Natives coming from the Pindee direction were examined and diverted, so that they should not enter Attock. " They Cholera SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 123 Epidemic- were escorted by the Police three times a day along the Grand Trunk Road to the ferry boat above the Serai, where they were taken across the Notes on outbreaks, Attock. Indus to Khyrabad. While the quarantine lasted, six or seven hundred natives a day were taken across the Indus." None of them were found to be suffering from cholera. When cholera appeared at Attock, quarantine was established at Khyrabad on the opposite side of the river, as will be explained more fully in the notes regarding Peshawur. When Peshawur was attacked, quarantine was established against it, and all travellers thence were kept under observation for three days at Khyrabad ; those whose destination was Attock were kept in a separate place for seven days. Among people coming from Peshawur 5 cases of cholera occurred. Sometimes there were as many as 800 people in detention at one time. It was impossible to keep each day's arrivals separate, so that those who were allowed to go on had been mixed for six days with new batches. The people, excepting the very poor, arranged for feeding themselves ; they had no shelter, but were on the open plain. The quarantine caused much inconvenience and discomfort. Movement. — On the 6th October the hospital was vacated and the inmates encamped outside the fort ; no more cases followed. VII. Previous history. — Although Attock has been garrisoned since 1858 by about 150 European troops, not a single case of cholera has occurred among them during 15 years. In 1867 there were three cases among the native soldiers. In the great epidemic of 1869 Attock entirely escaped. Statement of cholera at AttocJc, 1858 to 1872. Number op Cases. v,,,, Average . . Total Total Strength. . >, I S S Cases. Deaths. iII*Ii * ! f I I I •j q-q ( Native Troops - ... 1 1 ( Prisoners( a gang)- ... 1 ... 1 1861 Native Troops - 461 1 1 1867 Native „ - 148 2 1 3 2 1872 European „ - 204 i 3 3 >i I | I Nowshera. — A military station, 19 miles above Attock, and 26 below Peshawur. Garrison consisted of 2-60 th Rifles, 10th Bengal Cavalry, No- 84, Nowshera. A OA , i M ,. T f ° J and 30th Native Infantry. //. Details of the outbreak. — No cholera. — Assistant Surgeon Martin of the Indian Medical Service, the only Medical Officer at Nowshera, during my visit, who had been there in 1872, states that there was no case of cholera in the cantonment, but that there were several suspicious cases of fever with vomiting, purging, and much depression. The dates of these are not known, but they occurred at the time cholera prevailed at Peshawur. In the Nowshera Tehseelee of the Peshawur district a few deaths from cholera are recorded. Seven places give 32 deaths between the 28th August and 4th November, but of these nearly all occurred at Wurg Ismael Kheyl where it was severe between the 19th October and 3rd November. V. Local conditions.— -The drainage of the cantonment is bad. I visited the station just after a moderate shower, and the water lay in every direction. The wells are covered, but there are no pumps. Near several of them were hollows full of water, the product of surface drainage. The soil is very sandy, and any impurity might easily sink into the water-supply. VI. Preventive measures. — Quarantine was established at each end of the station. Persons not intending to remain at Nowshera were passed along the trunk road which runs through it. Those intending to stay at Nowshera were kept under observation for 7 days. Among them one case of cholera occurred, a sepoy returning from Peshawur. None of those who attended him suffered. VII. Previous history. — In no year since its first occupation has Nowshera suffered from cholera beyond a very few cases. Statement of cholera at Nowshera, 1855 to 1872. Number of Cases. Years. Average . Total i Total Streugth. . >. £ . I S S Cases. Deaths, I I I d * * a i I I I I I _ . . __ 1855 European Troops - ... 1 1 1856 Native „ - 720 11 2 1858 European „ - 412 2 2 2 1859 Ditto „ - 771 1 1 1862 Ditto „ ¦ 722 ... 2 2 2 1867 Ditto „ - 730 5 5 2 1869 Ditto „ - 669 | 6 6 5 i I [ Section I 124 NINTH ANNUAL REPORT OP THE Hoti MURDAN. — (Surgeon S. C. Courtney), 13 miles north-east of Nowshera, garrisoned Notes on outbreaks, No. 85, Hoti J>7 the guides one of the Regiments of the Punjab Frontier Field Force. In May the strength was 674 men. Murdan. //. Details of the outbreak. — On the 26th May a Bunneah in the bazar was attacked, and died next day. He is said to have eaten largely of cucumbers. This was the only case, and the whole of the neighbouring country called the Yoosufzai was free of the disease. Diarrhoea was not prevalent. In October fevers were very common. ///. Importation and communication. — The Bunneah had returned from Hurdwar on the 18th April 40 days before he was attacked. It appears that on the 12th April he was taken ill on his way back with purging and vomiting, and " continued to be purged often daily till a few days before his death." Violent symptoms set in on the 26th. Dr. Courtney has no doubt it was a true case of cholera. V. Local conditions. — The drainage is said to be good. The uater is drawn from four wells. To two of these masonry troughs are attached which were out of repair, and might prove a ready source of contamination. The barracks are badly constructed, and in the cold season especially are greatly overcrowded. VII. Previous history. — The history of Murdan as regards cholera has been singularly favorable. Statement of cholera at Murdan, 1856 to 1872. Number op Cases. Years. Average ,j . I , Total Total Strength. . £ « _g j J Cases. Deaths. IllllllllJlJ 1856 Native Troops - 876 1 1 1862 Ditto „ . 2 2 1869 Ditto „ - 867 1 2 ... 3 1 1871 Ditto „ - 897 1 1 The Peshawur district lies to the north of the Indus. It consists of a valley about p ha 50 miles in length by 40 in breadth. It is intersected by three considerable rivers, the Bara, the Cabul, and the Swat. From these the land is largely irrigated, but in the Yoosufzai division, which lies to the west, the crops are dependent on the rainfall. The total population is 500,443, and the area 1,929 square miles. There are 654 villages, but only one town, which takes the name of the district, and is situated about 2 miles from the cantonment. 11. Details of the outbreak. — The first known case of cholera in 1872 occurred in the Fort of Shubkudder, 20 miles to the north of Peshawur, on the Bth of May. The man, a trooper of the Bengal Cavalry, recovered. On the evening of the 7th May, however, a sepoy of the 26th Native Infantry had been admitted into hospital, and died at 3A.M. of the Bth. The medical officer states that the man " had been suffering from severe fever for two days before admission, and on the evening of the third day suffered from a severe attack of vomiting and purging — no unusual accompaniment of Peshawur fever. There was nothing in the post-mortem appearances to account for death." On the 28th of that month a death from cholera took place at Murdan in the Yoosufzai division of the district. In May also the Sub-Assistant Surgeon treated a case in Peshawur, but the exact date of attack is not recorded. In June one death was registered on the loth among the general population. July was entirely free, but in August two deaths are entered, one of which took place in the city on the 23rd. On the 14th September one death from cholera was registered in the city of Peshawur, and a case occurred at Shubkudder on the same day. In October 310 deaths from cholera were registered at 25 different places, of which 247 occurred in the city. In November 76 deaths were reported, of which three were in the city, and the remainder in nine villages. Excepting the solitary case at Murdan, Yoosufzai, so far as is known, escaped altogether. In these numbers for October and November are not included the cases which occurred in the cantonment, of which mention will be made hereafter. The City. — (Surgeon H. W. Bellew, Civil Surgeon, Sub-Assistant Surgeon Cheytun Shah), has 58,555 inhabitants. It appears that the case which proved fatal here in August was only suspicious, but No. 86, City. that which occurred on the 14th September was one of undoubted cholera. The man was a traveller who had come from the Kohat direction and had been in quarantine for seven days at Umul Chubootra on this side of the pass. On the night of the 4th October a Jemadar, who had been on duty at this quarantine, was brought into the city surreptitiously suffering from cholera. On the morning of the sth October two cases cf mild cholera were seen by the Sub-Assistant Surgeon. These persons lived in different houses, one about 100 and the other 130 paces from that to which the Jemadar had been taken. On the 7th a case occurred on the opposite side of the city. On the Bth two in different quarters. The subsequent distribution of disease according to dates will be given in a general statement. In all, according to the Sub-Assistant Surgeon's account, there were '352 cases and 219 deaths ; the cases were widely scattered over the city. E^ltairic J SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 125 Diarrhea was somewhat more frequent than usual. Fever was extremely prevalent. _ . .. . _. . The Sub-Assistant Surgeon saw many cases of fever. It Notes on outbreaks, Peshawur. , 3 ? •, •% T . r , was severe and not unfrequently fatal. It was often attended with vomiting, purging, temporary suppression of urine, and collapse. These symptoms are frequently found in cases of fever in the valley, and such cases are for the time almost undistinguishable from true cholera. They are known under the name of "Peshawur fever." The bad symptoms often cease as rapidly as they appeared. On the 7th September the Sub-Assistant Surgeon records, — " In many cases of fever of this week there was vomiting and purging of a bilious character. A few have showD symptoms of collapse." On the 19th October he wrote, — " Scarcely a household has escaped fevers. Often they run into cholera." On the 26th October again, — " Fevers of this season have been very weakening in their effect ; a single day's attack is prostrating." As in 1867 and 1869 fevers began to be prevalent before the cholera showed itself and continued for some time after it left. The amount of severe sickness may be estimated from the fact that while in September there were 313 deaths recorded in the city, in October there were 1,152, of which only 247 were from cholera ; in November there were 472, of which cholera contributed only three. ///. Importation and communication. — The disease is supposed by some to have been introduced by the sick Jemadar on the 4th October. The two persons who were suffering from mild cholera on the morning of the sth had been ill for some hours, and must have been attacked at the same time as or very shortly after the Jemadar arrived. None of the persons in the Jemadar's own house were seized. The case of the 7th could not be traced to communication. Persons generally were treated in their own houses, and there is no evidence that these cases acted as centres from which the disease spread. The Sub-Assistant Surgeon, 2 Hakeems and 14 native doctors were constantly employed in treating the sick during the outbreak. None of them had any symptoms of cholera nor any member of their families. Seventy-five poor people were treated in a special hospital. Of the fifteen attendants who waited on them none suffered. V. Local conditions. — The drainage of the city and its conservancy had been much improved since 1869. When cholera was known to be at Kohat in the end of August, exertions to keep it clean were redoubled, an increased staff of sweepers was employed ; disinfectants were freely used, and fumigation by means of some 300 bonfires carried out. The water-supply is derived partly from a cutting from the Bara river, but the drinking water is chiefly drawn from wells, of which there are 798 in the city. VI. Preventive measures. — Quarantine was established at Umul Chubootra on the Peshawur side of the Kohat pass on the 20th August as soon as the existence of cholera at Kohat was known and maintained till the 14th October. All persons coming from the Kohat direction were detained here for 7 days. Among them there was one death from cholera. How many cases occurred is not known. On the 14th September similar measures were taken at Khyrabad, a place on the Indus immediately opposite Attock. For the first few days the term of detention was 7 days, but it was then reduced to 3 days. Between the 14th September and Ist October about 2,000 people were so detained. There were no means of separating one day's arrivals from those of another. No case of cholera was found amongst them. The quarantine was strict as the bridge of boats was up, and the name ot every one who crossed was entered in a Register. Officers proceeding to Peshawur were detained at the Attock Dak Bungalow. As the disease appeared to have ceased downcountry, the quarantine was raised on the Ist October, but, when it appeared at Attock, it was renewed from the 7th to 16th. During that time no cases of cholera were found among persons proceeding towards Peshawur, but five occurred among those who had come from the valley. By the 16th cholera had become general at Peshawur, and the quarantine at Khyrabad, so far as related to the attempted protection of Peshawur, was removed. It may be mentioned that as early as May, when it was supposed that pilgrims from Hurdwar were disseminating cholera, a native doctor had been posted at Khyrabad for the relief of travellers, but none were found suffering from the disease. In the city an attempt was made to prevent the spread of the disease by isolating the first cases, but it was given up as useless. In addition to other precautionary measures, it may be mentioned that all sepoys returning from leave were isolated on the skirts of cantonments and detained under observation for 7 days. About 400 were thus kept under supervision, but no case of cholera appeared amongst them. A detachment of time expired Europeans under orders to march downcountry were detained lest they should spread cholera ; of these, several died of it. VII. Previous history. — The statistics of the three outbreaks of cholera in the city f Peshawur of which particulars are known are as follow :—: — Years. Cases. Deaths 1867 ... ... ... Not known. 1,020 1869 ... ... - 2,642 1,572 1872 ... ... ... 352 219 In 1872, the individual cases were as severe as in the previous years, but the number was much smaller. The Jail. — Number of prisoners, 736. No. 87, Jail- //. Details of the outbreak. — One case of cholera on the 14th October in a woman ,vho had beeu 27 days in confinement. 126 [ Section 1 NINTH ANNUAL REPORT OF THE ///. Importation and communication. — No communication could be traced, _ . nor did the disease spread. None of the guards were Notes on outbreaks, Peshawur. , , r ° The Cantonment at its nearest point is about 1,000 yards from the city. In October 1872 it was garrisoned by three Batteries of Royal Artillery, two Regiments of European Infantry, two of Bengal Cavalry, two Companies of Sappers and Miners, and 4 Regiments of Native Infantry. It occupies a ridge which slopes down to the surrounding country with a fall of from 20 to 60 feet per mile. The natural drainage is excellent, but in many parts advantage has not been taken of these facilities, and the water stagnates in the lines and close up to the quarters occupied by the men. The soil is chiefly a stiff clay with boulder strata underneath. About a mile from the station, a cutting from the Bara river divides, sending one branch to the city and another to the cantonment. The cantonment share equals I*lB cubic feet or about 7 \ gallons per second. The channel is altogether unprotected ; in many places it receives the surface drainage, and is in reality a road-side ditch. In the lines both of the European and Native Regiments it is received into reservoirs, some of which are open and others covered. In most of them there is some rude contrivance for filtering the water before it enters. From all of them the supply is drawn as required by means of some kind of vessel which is dipped into the reservoir. This water is almost exclusively used by the Native Troops for drinking, but the Europeans are supplied from wells. //. Details of the outbreak. — Royal Artillery, Surgeon Major J. Kellie. — The strength „ QO _ , . ..„ and the number of cases are shown in the following state- No. 88, Royal Artillery. ° ment : — Head Quaktbrs, parka a otv. p » q ttiii A. Bbigade. L-A. R. H. A. A-Bthß. A. 3-XXIII. Detaiis. g « iS S J 1 .2 . •* -2 . 5 .2 j= .2 to 3 2 to 3 J to m J2 to m « is-o^iiTs 9 h 73 9 h m OS 11. Details of the outbreak. Strength. Admissions. Deaths. Officers ... ... 3 ... ... Men ... ... 349 6 4 Followers ... ... 566 3 1 The first two cases occurred on the 12th October. On the 13th one, on 15th two, on 16th one, on 17th one, on 19th one, on 28th one. Cases of diarrhoea were admitted, on the 14th one, 16th two, 30th one, November sth one, and on the 9th one. Dr. Morice who had medical charge of the civil station and the staff at the time, says, that " diarrhoea was very prevalent all over the place." The fever admissions were in — Week ending 6th September ... ... ... 26 13th „ ... ... ... 21 20th „ ... ... ... 24 27th „ ... ... ... 28 „ 4th October ... ... ... 23 11th „ ... ... ... 17 „ 18th „ ... ... ... 30 25th „ ... ... ... 16 „ Ist November ... ... ... 28 Bth „ ... ... ... 10 After cholera appeared many cases of fever were not admitted into hospital, and so do 111. Importation and communication. — The first case could not be traced to importation. One man while in attendance on a cholera patient was himself attacked. He had been in attendance only a few hours, belonged to the same troop and came from the same part of the lines. With this exception none of the attendants or of the hospital establishment numbering 27 persons in all were attacked. IV. Meteorology. — " The atmosphere was thick and hazy, the wind in the east." V. Local conditions. — The drainage is bad. The cutting from the Bara runs through the lines and is practically the main drain, but there is an excellent well in the front, and from this the men drink. VI. Preventive measures. — The third troop in which all the cases but one occurred, after the second case, moved to tents on the parade ground, and when the third case appeared, marched to Hurree Sing's Boorj, 4 miles to the west. No cases occurred after this move. 11. Details of the outbreak. Sappers and Miners. — There were four cases, of which three were fatal. They occurred, one on the 17th, two on No. 93, sappers and Miners. the 18th, and one on 20th October. Diarrhoea was prevalent both before and during the outbreak. 1 5th Regiment, Native Infantry — Surgeon J. J. in?ant?y.' 15th Regiment Native McDermot, M.D. } — -arrived from Ferozepore, December 1869. // . Details of the outbreak. Strength. Admissions. Deaths. Officers ... ... 5 Men ... ... 500 13 8 Followers ... ... 72 2 1 The cases occurred :— On the 7th October two, Bth one, 12th one, 13th three, 14th one, loth one, 16th one, 17th one, 18th one, 20th two, November 19th one. Between the 6th September and 25th October 18 cases of diarrhoea were treated. The hospital returns do not show any marked increase in the prevalence of fevers. 111. Importation and communication. — The hospital establishment, numbering 19 and many attendants came in contact with the sick; none of them were attacked. The firs Cholera 1 SANITAII y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Jbpiaemic. J 131 man who was seized had been in the city daily for some days before he was attacked. He .._-,,. had been eating raw vegetables and uncooked Indian corn Notes on outbreaks, Pesnawur. ? j_,_ v*• *. r i~ i *¦ ' the day before symptoms of cholera set in. IF. Meteorology. — " I noticed nothing peculiar in the atmosphere when the outbreak commenced, and indeed as far as sky and temperature were concerned, I rather think the weather would have been considered fine. I cannot of course speak of the more subtile conditions of the atmosphere, as its electrical condition, etc., but most likely there was disturbance in this respect. The weather was calm until eight days after the beginning'of the outbreak, when atmospheric disturbances commenced in the valley, the wind rising, falling, and veering. It continued so until the 21st of the month, (October,) on which date and the date following towards midday, a very violent gale set in from the westward, and apparently came from the surface of the valley just under the very high range of mountains which forms its boundary in that direction. The gale each day commenced about one and a half hour before noon, and ended about one and a half or two hours after it. I consider that the phenomenon was a local occurrence, as the gale swept directly along the surface of the valley from the westward, and could not, I think, have come from beyond the very high range which bounds it in that direction. The gales on each day had a very marked cyclonic motion and clouds of dust and fine sand were borne along with them. It struck me at the time that the phenomenon might be due to electrical disturbance. After the first gale on the 21st October, the atmosphere became remarkably clear, and the epidemic ceased in the regiment on and from that date. One month afterwards, 19th November, a last and final case occurred, but in the interval we had no sign of the disease. The subject of the isolated final case was a man who had recently returned from Fort Michnee in the north of the valley where he had been on detachment duty." VI. Preventive measures. — On the 20th October, the regiment moved into camp on the parade ground. No cases occurred after this move until the solitary one on the 19th November long after the epidemic in the valley had ceased. 2,lst Regiment, Native Infantry. — Assistant Surgeon W. A. C. Roe,— arrived at Peshawur, No. 95, 21st Native Infantry. November 1870. 11. Details of the outbreak. Strength. Admissions. Deaths. Officers ... ... 3 Men ... ... 409 5 3 Followers ... ... 219 1 The first two cases were admitted on the 9th October from different quarters. On the 13th a man who had been under treatment for fever for four days was attacked in hospital, one occurred in camp on the loth. Two followed on the 21st, but the men were attacked on a guard, 3 miles out of the station. Diarrhoea was not prevalent. During September and October only four cases of it were treated ; nor was fever prevalent, but this may have been due in part to the small doses of quinine which were given to each man every third day. The fever admissions in the week ending 30th August were ... ... 8 Ditto ditto 6th September „ ... ... 8 Ditto ditto 13th „ „ ... ... 17 Ditto ditto 20th „ „ ... ... 13 Ditto ditto 27th „ „ ... ... 7 Ditto ditto 4th October „ ... ... 5 Ditto ditto 11th „ „ ... ... 10 Ditto ditto 18th „ „ ... ... 12 Ditto ditto 25th „ „ ... ... 8 Ditto ditto Ist November „ ... ... 8 ///. Importation and communication. — The first case could not be traced to communication, nor was there any evidence of contagion during the outbreak. Of 24 attendants on the sick none suffered. IV. Meteorology. — " For a short time before and during the epidemic, the weather in this station was most oppressive, although the heat was by no means great, nor were punkahs required, yet there was a stifling sensation complained of by every one that could not be accounted for. The hills surrounding the valley were quite obscured by a misty dust cloud which never seemed to clear away either morning or evening; the air was perfectly still, and no rain fell. This state of things continued till about the last week of October when several dust storms followed by rain took place, and from that time the disease seemed gradually to die away." V. Local conditions. — The drainage of the lines is said to be fair. The water is taken from three tanks which are fed from the Bara cutting. It is all filtered in ghurras charged with sand and charcoal. The lines are of a better construction than those of the other Native Regiments at Peshawur. There was no overcrowding, as 100 men were on duty at Cherat, and 90 at Shubkudder. VI. Preventive measures. — On the 13th October the occupants of the barrack in which the two first cases occurred moved to camp at Hurree Sing's Brooj. Only one occurred here on the loth. On the 26th the party returned to cantonments. no. 96, 26th Regiment n. i. T 2 ?/* Regiment Native lvfantry— Assistant Surgeon C. J. McKenna — arrived at Peshawur, November 1871. 11. Details of the outbreak. Strength. Amissions. Deaths. Officers ... ... 6 Men ... ... 642 14 3 Followers ... ... ... 1 1 [ Section I 132 NINTH ANNUAL REPORT OF THE One of the cases was returned as " Peshawur fever," but the man died in 6% hours. Of the others nine were entered as " diarrhoea/ but from Notes on outbreaks, Peshawur. gymptoms there C£m fee nQ douht that they were in reality cholera of a mild type. Including all these the cases occurred as follow, but among them is not entered the suspicious case of May which was probably also one of cholera :—: — Bth October ... ... ... ... ... 1 9th „ ... ... ... ... ... 1 10th „ ... ... ... ... ... 1 11th ? ... ... ... ... ... 1 12th „ ... .- ... ... ... 1 13th „ „. ... ... ... ... 4 15th „ ... ... ... ... ... 1 16th „ ... ... ... ... ... 3 28th „ ... ... ... ... ... 1 31st „ ... ... ... ... ... 1 15 The admissions from fever were in the week ending 30th August ... 23 Ditto ditto ditto 6th September «. 53 Ditto ditto ditto 13th „ ... 94 Ditto ditto ditto 20th „ ... 84 Ditto ditto ditto 27th „ ... 95 Ditto ditto ditto 4th October ... 101 Ditto ditto ditto 11th „ ... 77 Ditto ditto ditto 18th „ ... 49 Ditto ditto ditto 25th „ ... 57 Ditto ditto ditto Ist „ ... 65 Ditto ditto ditto Bth November ... 48 ///. Importation and communication. — There is no evidence that the first case had been due to importation, nor is any fact mentioned in the course of the outbreak which points to contagion as a means of spreading the disease. Of 25 persons who came in constant contact with the sick, none were attacked. V. Local conditions, — Drainage is said to be bad. The water is got from two tanks which are fed by a branch of the Bara channel running through the lines. Attached to each is a very imperfect filtering apparatus. VI. Preventive measures. — No general move was made into camp, but individual huts were vacated as they were attacked. _ . .__ , 36th Regiment, Native Infantry, — Assistant Surgeon A. B. No. 97,36thKegiment, N. I. o , y ' J • y ' J Strahan, M.B. 11. Details of the outbreak. Strength. Admissions. Deaths. Officers ... ... ... 5 Men ... ... ... 604 5 4 Followers ... .. 2 The cases occurred on the 9th, 10th, 11th, 12th, 13th, 14th, and 15th October. A considerable number of cases of diarrhoea occurred about the same time. There was no very marked increase in fevers. ///. Importation and communication. — The disease could not be traced to importation, nor was there any evidence of contagion. Of 14 persons who came in contact with the sick, not one was attacked. In the Sudder Bazar there is a population of about 3,000. 11. Details of the outbreak. — Here there were only twelve cases and nine deaths ; all between the 9th and 25th October. Taking all the bazars and Commissariat and other establishments amounting to about 13,000, there were 70 deaths. In 1867 and again in 1869 it may be noted, that the deaths in the sudder bazar alone were over 80. The water for the different bazars is taken from the cutting, a branch of which supplies each of them. The artillery bazar suffered very little, only three deaths were reported in it, and these were chiefly grass-cutters whose work took them away from the station. In addition to the cases which have been already enumerated, a civil officer was attacked on the 9th October, and died next day. Two Staff Sergeants were attacked on the 15th, the children of one of them on the 16th, and an officer of R. E. on the ]7th. Peshawur Fort lies close to the city. Garrison consisted of two officers, — 43 Europeans Peshawur, No. 98, Port. and 64 Sepoys. 11. Details of the outbreak. — On the Ist October as has been already stated, six men of the 6th Regiment were sent to hospital suffering from vomiting and purging, and of these one died after ten hours' illness. On the 7th October the detachment cf the 6th Regiment was relieved by a party of similar strength of the 55th Regiment. Among them altogether there were six cases, two on the 9th, one on the 10th, one on 12th, one on 13th, and one on 16th. None of the natives suffered. These cases have already been entered in the statement for the 55th Regiment. 111. Importation and communication. — The first case could not be traced to importation, nor was there any evidence that the disease afterwards spread by contagion. V. Local conditions. — The fort is well raised, and the natural drainage excellent. TV./-* nnaao A ciofri Horl «ia liiivincr Affnrrprl on thp Ist. Ontnlmr niovo otfriKn+orl +/\ 4-V.r, «••>*«.. Cholera ~| SANITUIY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 133 which was then drawn from a well near the fort which is specially liable to contamination, both from its construction and from the fact that the Notes on outbreaks, Peshawur. Comm:Ujsariat e i e phants are washed close by it. From the 7th the water was supplied from Mackeson's well in cantonments, and sent down in barrels daily. The natives drew their water from a well outside and opposite to the gate-way. The barrack occupied by the Europeans is low and not well ventilated. VI. Preventive measures.— On the 10th this barrack was vacated, and the detachment which was not relieved as usual, but continued on duty at the fort from the 7th October to the end of the outbreak, encamped inside the fort. On the 16th they were removed immediately outside. The same water was continued in use, and no more cases occurred. When the Europeans moved outside, the native guard, which had remained unrelieved, was increased to 114 men. Summary. The general distribution of the disease among the different communities of Peshawur is shewn in the annexed statement Statement showing the distribution of cholera at Peshawur in 1872. — | jj> A -8 Royal (^ 6th Keqi- 55th Regi- CITY - 5 ABTILLKBY. S3 MENT. j MENT.* . it • £ iS "ISII I I I I Date. * . 1 j • 5 « 3 5 « ~ lll i d-?llßJlJJi3liliiJ Ist October 2nd „ 3rd „ 4th „ ... 1 ... sth „ ... 2 ... 6th „ 7th „ ... 1 1 2 Bth „ ... 2 1 2 , 1 ... 1 9th „ ... 6 3 2 1 ... 2 ... 2 2 11 ... 10th „ ... 15 10 1 2 ... 2 113 llth ... 13 ... 1 ... 4 ... 4 11l 12th „ ... 46 13 1 3 1 2 ... 1 ... 1 1 ••• 13th „ ... 25 29 1 4 3 ... 1 ... 3 1 4 1 2 14th „ ... 26 16 ... 1 ... 1 ./. ... ... 14 1 1 3 15th „ ... 17 10 ... 1 2 2 ... 1 1 1 1 5 16th „ ... 36 28 1 2 13 4 ... 1 ... 1 ... 3 •¦• 4 17th „ ... 24 19 1 2 1 1 ... 1 1 1 5 18th ? ... 47 27 1 a 4 ... 1 2 1 4 10th „ ... 21 18 1 ... 3 ... 1 ... 1 6 20th „ ... 18 12 1 ... 1 1 2 5 2lst 16 9 1 1 2 7 22nd „ ... 11 9 1 1 3 23rd „ ... 9 11 2 5 24th „ ... 6 5 2 1 25th „ ... 7 5 » 26th „ ... 6 4- 1 6 27th „ ... 2 ¦• ••• ••• 28th „ ... 2 1 1 •¦• ? 29th „ ... 1 3 1 1 1 30th „ l 1 •• ». f 31st „ ... 1 •¦• 1 Ist November 1 1 j 2nd „ 3rd „ ... 1 4th sth „ 6th „ 7th „ ... 1 | Bth „ 9th , 1 10th „ ... llth „ ... 12th „ ... 1 1 13th „ ... 2 14th „ 15th „ 1 16th , ... 17th „ ... 18th „ : .. 1 19th , I 1 20th „ j 21st „ I 22ud „ ! 1 8 1 1 4 111 9 18 22 17 12 9 4 15 6 15 7 70 I _ I -—======================¦ * Deaths registered, t The sum of these two eolunms with 6 cases in the Fort makes up the total of 45 casea in this Regiment. I 1 NINTH ANNUAL REPORT OF THE [ Section I 134 VII. Previous history. — Though generally free from cholera, violent outbreaks have occurred in several years, notably in 1867, 1869, and Notes on outbreaks, Peshawur. 1 »72 Statement of cholera at Pes/iawur, 1849 to 1872. Number op Casks. Average . . Total Total Years. Strength. £ f . J It Cases. Deaths. iilb*i * i i j I i ¦gaasa.g.gsJ'Sg.s 1849 European Troops - 1,191 3 2 1 1 1 ... 2 10 2 1850 „ „ - 2 1 ... ... 1 1 5* I ( European Troops - ... 2 ... 1 3* 18515 C Native „ - 6,649 1 ... 2 1 ... 2 I ... 6 4 ( European Troops - ... ... 1 ... 1 ... j 1 3* 1852 s ( Native „ - 7,563 1 3 1 j 3 ... 8 2 f European Troops - „. ... j ... 3 2 ... ... 5* 18535 (. Native „ - 6,765 1 2 1 ... j 11 6 f European Troops - ... ... j 1 1* 1854] ( Native „ - 1 214 1 1 ... 1 ... 10 3 ( European Troops - ... ... ... 1 1* 18555 ( Native „ - 18,486 ... ... 1 1 j I | 1 3 3 1856 „ „ - 7,632 j ... ... ... 1 ... 4 1 1 ... 1 ... | 1 9 4 f European Troops - I 2,027 i ... ... 4 3 I ... 7 7 I i 1858 j Native „ - ... 1 ... 2 ... 2 2 ... 7 7 1 22 I 14 L Prisoners - 420 i 6 ... 6 4 fEuropean Troops - 1,955 ... ... 1 1 2 1861 «! Native „ - 1,993 ... 1 2 3 1 l_Prisoners - 451 2 I j 2 1 fEuropean Troops - 1,970 ... 73 14 13 63 5 ... 168 97 1862 H Native „ - 2,908 ... ... 1 ... 13 ... 121 2 ... j 38 | 22 ! L Prisoners - 371 ... 23 ... ... 23 46 | 23 i 1863 „ - 355 ... ... ... 1 l! ... I f European Troops - 1,754 ... 163 106 5 ... 274 163 I '"¦ ! 1867 -{Native „ - 4,395 ... 25 \32 4 ! ... 2 ! 63 | 27 I I I Prisoners - 406 ... \ m 211 ... I \ 13 5 1868 Native Troops- 4,062 1 1 f European „ - 2,050 ... ! ... 359 16 2 ... 377 j 241 1869 1 Native „ . 3,380 3 |158 17 1 ... | 179 111 (_ Prisoners - 411 124 3 4 ... 31 13 fEuropean Troops - 1,703 ... j 80 2j ... 82 62 1872 <{ Native „ - 3,356 44 1 ... 45 29 L Prisoners - 620 ... 1 1 1 * Fatal cases only have been recorded. C lolera Epidemic. 135 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Doaba Outposts — Assistant Surgeon Macdonell — consist of three small forts, each of Notes on outbreaks, Doaba Out- which is garrisoned by 50 Native Cavalry and 90 Native » osts - Infantry. 11. Details of the outbreak. — At Shubkudder, which lies 20 miles north of Peshawur, bkudder a sowar was attacked with cholera on the Bth May. On the 14th September another sowar was attacked here, and three days afterwards there was a very suspicious case which presented many of the symptoms of cholera. The medical officer, however, believes that it was one of Peshawur fever. 111. Importation and communication. — There is no history of importation or contagion in any of these cases. None of the attendants were attacked. //. Details of the outbreak. — At Abuzai, which is situate 8 miles further on, a sowar was _ , ' . attacked on the 22nd October, the only case within this No. 100, Abuzai. r . ' J 111. Importation and communication. — It could not be traced to importation. Michnee, 8 miles to the west of Shubkudder, entirely escaped. Cherat is a hill 27 miles from Peshawur, on which at a height of 4,400 feet above the sea, a portion of the Peshawur garrison has been encamped of late years during the hot weather and rains. In 1872 the strength was 720 Europeans and 80 Native soldiers. //. Details of the outbreak. — On the 25th October a Private of the 55th Regiment was attacked with cholera ; he recovered. 111. Importation and communication. — His seizure was attributed to indulgence in fruit. It could not be explained by importation, nor did any other attacks follow. KOHAT — (Surgeon H. Thorn, M.D., Assistant Surgeon E. Sanders) — lies to the south and south-west of Peshawur, separated from it by a range of hills through which there is only one communication over the K.otul. Along the east and south-east it is bounded by the Indus, so that it is much isolated from Hindoostan. The district is very rugged, and consists of numerous barren, hills with cultivated valleys between. With an area of 2,838 square miles, it has a population of only 1,45,419. There are 343 villages. The city has a population of 6,064, and lies close to the military station. When cholera appeared the garrison, which is composed entirely of Native Troops, consisted of 2 Batteries of Artillery, one Regiment of Cavalry, and three of Infantry. 11. Details of the outbreak. — The registration returns show 351 deaths from cholera in the Kohat district throughout the year, 94 of which occurred in August, 228 in September, and 29 in October. Except in the valley of the Toey there is not much irrigation, and it was this portion of the district which chiefly suffered. Unlike the system followed in the places which have been already included in these notes, the deaths among the troops are included in the statistics of the district. Taken by themselves the number of cases and deaths among the different regiments was as follows :—: — Fighting men. Followebs. Strength. Admissions. Deaths. Strength. Admissions. Deaths. - . .1 , I | Hazara Mountain Battery ... 118 2 2 150 7 _ Garrison Company of Artillery ... 38 2* ... 35 1 Ist Punjab Cavalry ... ... 277 12 8 517 25 21 2nd Seik Infantry ... ... 576 17 14 433 7f 5 4th „ „ ». »• 563 16 11 303 8 4 3rd Punjab „ ... ... 466 41 23 275 22 15 Sudder Bazar .« ... ... ... ... ... 6 4 * One of these was a European Sergeant. t One of these the European Bandmaster. or a total of 166 cases and 111 deaths. The first case recorded as cholera occurred at 2 a.m. of the 20th August. The man was a pensioned servant of an officer and lived in the lines No. 102, Hazara Mountain Battery, of the second Seik Infantry. Towards midnight of that No! lot' i_t r p^ab f cav£iiryf y ' same day three cases were reported in the Ist Punjab No.'io6;lthllikiDfanS: Cavalry lines. At the same time a case occurred in the No". 107,' 3rd Punjab infantry. village of Bezadi, or Chickurkote for it bears both names, which lies on the skirt of cantonments and close to the 4th Seik Infantry lines. "From noon on the 20th till noon on the 21st August 11 cases of NINTH ANNUAL 11EPORT OF THE [ Section I 136 cholera of a malignant type had occurred in cantonments, six cases had proved fatal and the rest appeared to be moribund/ The daily distribution Notes on outbreaks, Kohat. of the disease throughout the outbreak is given in the following statement : — Cholera at, Kohat in 1872. 20th August ... ... ... 2 1 3 1 21st „ ... 1 ... 3 ... 13 ... 8 22nd „ ... 1 ... 1 ... 1 ••• ... 8 23rd „ ... 1 ... 1 1 ... 1 ... 4 2 3 24th „ ... 3 ... 4 2 ... 9 2 i ... j 25th „ ... 1 ... 2 1 1 1 i ... 6 2 26th „ ... ... 3 ... ... | ... 3 27th „ ... ... 2 j ... 2 1 ... 2 28th „ ... 1 ... 9 ... 2 8 ... 18 3 ... 4 29th „ ... ... ... 4 3 2 5 j 2 i 16 l 30th „ ... 1 ... 2 1 2 7 ... 13 2 ... 3 31st „ 4 ... 1 6 i 11 1 ... 4 1 ! Ist September ... 1 2 1 3 ... 7 4 ... 1 2nd „ 1 2 2 3 i 9 4 ... 3rd „ ... j ... 1 3 8 ... 7 l ¦¦¦ "¦• l I 4th „ 2 3 5 1 ... ••• 3 sth „ ... 1 3 ... 2 6 3 ... ... 3 6th „ 1 1 ... ... 2 2 m< .. 6 7th „ ... 1 ... 1 3 ! ••• 5 3 •¦• '" 3 Bth „ 1 1 2 ! 4 ... ... - 4 9th „ ... j 1 ... ... 1 3 ... ... 2 10th „ 2 ... 2 2 i ... 2 11th „ ... 1 ... ... 4 5 ... ... ••• 4 12th „ ... 1 ... 1 3 ... 1 13th „ 1 1 2 2 3 ... 3 14th „ 1 ... 1 ... 2 1 15th „ ... ... 3 16th „ 1 ... 1 ... 2 2 . ... 4 17th „ , ... 1 3 ... 4 1 1 ••• 1 18lh „ 1 1 2 4 4 19th „ ... ... 1 ... 23rd „ ... 1 ... 1 »• ... 26th „ 1 ... 30th „ 1 1 I — — _______ _____; _________ __————. — — — — — — — — — -— — — Total ... 9 3 37 24 24 63 6 166 51 5 22 43 j In the city the disease was prevalent chiefly between the 28th August and 18th September. The Deputy Commissioner's special returns show 48 cases and 24 deaths here in all. The mortuary register, which is evidently most imperfect, records only four deaths from Cholera Epidemic 137 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. cholera. The village of Juogulpeer Kheyl, which lies close to the small fort, and about half , _ . a mile from the city, suffered much. Here 43 cases were Notes on outbreaks, Kohat. repO rted, of which 36 we ™ fatal - From the information furnished by the Deputy Commissioner columns have been added to shew the prevalence of cholera in the city and in the villages of Jungulpeer Kheyl and Bezadi, but from enquiries made on the spot, I believe that the extent of the outbreak is greatly understated in these figures. Other villages near the station also suffered. At Gurree Atta Khan, a hamlet close to the General Hospital, there were two cases, one on the 28th August, and the other on the 31st. At Baguugger further down the small stream to which reference will be made hereafter, there were four cases, the first on the 26th August, and the last on the 13th September. At Hungoo, 26 miles from Kohat, the disease appeared on the 24th August, and lasted till the 28th October. Altogether in the district there are said to have been 517 cases. The disease was not so severe as in 1869, but it was more widely diffused. Even among the troops, many cases of cholera appear to have been returned as diarrhoea. The great increase of this affection while cholera prevailed is shown by the weekly returns of admissions into hospital, from which the following figures have been extracted. Not a few of the cases were severe and attended with vomiting. Number of admissions into hospital from Diarrhoea among the troops at Kohat for each week from 19th July to 18th October 1872. Hazara Garrison ? „ . , „,_, ? . .. 0 ., _ ? , . , Weekending. Mountain Company ls * Pu "J ab T 2l f S f eik _ 4t _ h S " k 3"U'unjab Battery. ofArtillery. Cavall > tototaj. Infantry. Infantry. 26th July ... ... ... 1 ... 1 2 2nd August ... ... ... 1 2 3 6 9th „ ... ... ... 1 2 2 5 16th „ ... ... 2 1 1 4 S 23rd „ ... ... 3 ... 1 3 2 4 13 30th „ ... ... 2 .. 3 1 4 9 19 6th September ... ... 3 ... 8 8 6 19 44 13th „ ... ... 1 ... 2 5 ... 7 15 20th „ ... ... 3 3 1 7 14 27th „ ... ... ... 2 4 7 18 4th October ... ... ... 2 1 5 8 11th „ ... ... 1 ... 1 1 2 4 9 18th „ ... ... ... 2 2 5 9 With the appearance of cholera fevers, the ordinary malarious intermittents, became prevalent and continued so for some time after cholera had ceased. Number of admissions into hospital from Fevers among the troops at Kohat during each week from 19th July to 18th October 1872. Hazara Garrison \ „ . , 0,0-, ... c ., o j « •t I Weekending. Mountain Company j ls * Pu ».» ab fnd Seik 4th Seik 3rd Punjab: Battery. ofArtillery. Cavalr y- J'^try. Infantry. Infantry, j 26th July ... ... 3 ... 8 7 9 5 32 2nd August ... ... 3 1 2 9 6 19 40 9th „ ... ... 8 2 3 19 16 17 65 16th „ ... ... 8 1 6 15 10 28 68 23rd „ ... •• 3 ... 4 14 31 30 82 30th „ ... ... 7 1 4 18 17 46 93 6th September ... ... j 10 1 9 38 39 59 14G 13th „ ... ... 8 4 12 32 33 48 137 20th „ ... - 8 4 15 51 27 50 155 27th „ ... - 12 3 15 36 24 50 140 4th October ... ... 5 1 13 70 21 51 161 11th „ ... ... 12 1 II 58 22 54 158 18th „ ... ... 4 1 12 29 22 47 116 111. Importation and communicatio7i. — The first case could not be traced to importation. The man had been for 10 months in Kohat. So far as could be ascertained, he had been nowhere and had received no visitors. It was supposed that perhaps the large party of native soldiers, between two and three hundred in number, who returned from leave on the 15th August, might have imported the disease, but enquiry altogether failed to elicit any fact in favor of this idea. No symptom of cholera had appeared among any one of them. Moreover, although the date of the first case of cholera at Kohat is set down as the 20th August several very suspicious cases had occurred before that date. On the 12th August, a sepoy of the 2nd Seiks came into hospital with severe vomiting, cramps, and suppression of urine ; he recovered. In the end of June or beginning of July, the exact date not known, there had been another suspicious case of a similar character in the 4th Seiks ; he also recovered. A man of the 2nd Seiks who was attacked with cholera on the 20th had been admitted on the 16th August, suffering from diarrhoea. As regards evidence of contagion k 1 [ Section I 138 NINTH ANNUAL REPORT OF THE some instances are cited. Dr. Thorn states that a sepoy was attacked on the 23rd September while in attendance on a man ill of cholera. He had been in attendance for eleven days. A khalasee was seized on Notes on outbreaks, Kohat. the 29th August. His attendant after being with him for nine days, was attacked. Dr. Sanders states that on the 23rd August a man, who had attended the first case on the 20th, was himself attacked. With regard to this case it must be noted that on the 22nd August, a patient in this same hospital and who had not come in contact with any case of cholera, was also attacked. Each case had at least one attendant, so that the number of those who came in immediate contact with the sick must have been large. It is stated that of 51 sepoys who were employed on this duty in the 3rd Panjab Infantry, 12 were seized. Of these four were attacked in hospital while actually in attendance, one had been on this duty for 20 days before attack, another eight days, a third six days, and a fourth seven days. The remaining eight were attacked in the lines. The first was seized five days after returning to the lines, the second on the fourth day, the third on the third day, the fourth and fifth on the fourth day, the sixth on the third day, and the seventh on the seventh day. Regarding the eighth, the date of returning to the lines is not given. The European Sergeant assisted in putting the Band Master into his coffin on the 18th August. He was attacked the same evening. A sepoy who went to the burning of a person who died of cholera was attacked, but the dates are not known. The last cases in the district occurred on the Kotul on the 7th and Bth November after cholera had for some time ceased elsewhere. They occurred, two in the towers not far from the camp in which the arrivals from Peshawur were then quarantined, and three in this camp. The watchmen attacked had no duty to bring them in contact with this camp, but it is supposed that the disease may have been imported by the camp arrivals. The guard over the camp did not suffer. In three of a few cases in which witnesses came into Kohat to give evidence, they were attacked by cholera. In the city the sick remained in their houses. There is no reason to conclude that the cases served as centres from which the disease spread. It was widely diffused. IV. Meteorology. — On this point Dr. Thorn writes — M On the afternoon of the 19th August Kohat was visited by a terrible gale of wind followed by heavy rain. Trees were uprooted and thrown down in many places, and several parts of the solid brick roof of the station hospital were stripped off by the violence of the wind. On the following day there was bright sunshine, but the weather was excessively sultry and oppressive." V. Local conditions, drainage. — The cantonment occupies high ground, and has excellent natural drainage. On the skirts of it, however, the land is comparatively low. Water. — The supply is mainly drawn from a fine spring which issues close to the village of Jungulpeer Kheyl. Formerly this flowed on in an open channel, but arrangements were sanctioned for conveying it in a covered duct to the different regiments. The work, however, had not been completed when cholera appeared. The duct after running about 250 yards from the spring divides into three branches, one to the 3rd Panjab Infantry lines, one to the 4th Seik lines, and the centre one to the second Seiks. The branch for the 3rd Panjab Infantry is prolonged to the General Hospital, but had not been used. There are two covered reservoirs in the 2nd Seik lines, one for the 3rd Panjab Infantry, one for the 4th Seiks, and one for the hospital compound, but the two last were not in working order. One of the two reservoirs in the 2nd Seik lines was closed on 20th August, as the duct which supplies it runs through a filthy neighbourhood, and the ducts although covered are by no means impervious. In addition to the water conveyed in the ducts a considerable open stream which takes its rise in the same spring which feeds the ducts flows through the station dividing the cavalry and 3rd Panjab Infantry lines. It commences at the village of Jungulpeer Kheyl, and after passing through the cantonment, supplies the villages of Atta Khan ka Gurree and Bagnugger which have no wells. Another stream rising from a different source after passing through a portion of the city, skirts the city wall, and flows past the 4th Seik lines. The sepoys seem to use this most. It goes on past the village of Chickurkote in which there are no wells. The people in Jungulpeer Kheyl all drink from wells of which there are many. The water-supply of the city is drawn chiefly from wells, of which there are 166, but in addition there are two springs led in underground channels with openings here and there, and there is also a branch of the Kohat river or Toey. The drinking water, it appears, is drawn from the wells. It is doubtful how far the men in any of the regiments drank from the reservoirs, and how far from other sources, but this is of less importance as the ducts had not been covered. In the 2nd Seik lines there are some wells and there are also wells in the sudder bazar. The duct carries two gallons per second. The stream which carries off the spring and flows between the 3rd Panjab Infantry and Cavalry lines, is of considerable size and flows rapidly. Conservancy. — There are no latrines, and the neighbouring country is resorted to. VI. Preventive measures. — From the 21st August to the 17th October quarantine was established at the three ferries on the Indus between the districts of Rawul Pindee and Kohat. At none of them was a case of cholera detected. Movement. — On the 21st August the first Panjab Cavalry moved into camp on their parade ground. As the disease continued the main body marched on the 23rd to Mahomedzai 5 miles on the Hungoo road. Here there were only seven cases, six of which occurred among grass-cutters, who had been into cantonments. The detachment left behind on the parade ground suffered severely. Of a strength of between 50 and 60, there were sixteen cases between the 23rd and 28th August. At Mahomedzai, the cavalry drank from the Toey river before it reaches Kohat. The Epidemic 1 SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 139 detachment drank from the spring stream which runs through the cantonment. The parade ground is in the immediate vicinity of ground used for latrine purposes. On the 24th the Mountain Battery Notes on outbreaks, Kohat. joined the Ist Cavalry at Mahomedzai. Three cases followed, one in camp on the 30th August, and two in the detachment left behind in cantonment. On the 27th the 2nd Seiks marched to Dhoda, leaving a detachment of 300 in cantonment. Eight cases had occurred in this regiment before moving. Of the sixteen which followed, seven were in cantonment, and nine in camp. Dhoda is near the Toey after it has passed Kohat. It is here a considerable stream, but the men drank chiefly, if not altogether, from an abundant spring. On the 28th the 3rd Panjab Infantry encamped on the Rawul Pindee road about £ of a mile from cantonments, leaving the married people and guards behind them. Dr. Thorn writes : — "Every sepoy in the 3rd Panjab Infantry attacked by cholera after the 28th August had been employed on some duty or other in cantonments either on the day of attack or on one or two days previously/ To this camp water was supplied from the 2nd Seik Infantry lines. On the 29th the 4th Seiks marched to Chumbai, 7 miles to the south-west. Only two cases occurred in camp, one on the 7th, and one on the Bth September. The other 15 noted after this date were all among the party left in cantonments. In camp they had spring water. The fort is very small and lies close to the city. It was garrisoned by a company of artillery and 54 men of the 2nd Seiks who were kept isolated as much as possible. There were three cases among the artillery — a native gunner, his child who, however, lived in the city, and the European Sergeant already mentioned. On the 23rd August a sepoy of the 2nd Seiks, one of the detachment sent on guard that day, was attacked. The water is drawn from a well inside. In the Jail and Lock-up which immediately adjoin the city, there were 189 prisoners. On the 10th September the first case occurred, a prisoner was attacked in one of the workshops. On the 13th a case ap- No. 108, the Jail. peared in the lock-up, and the same day one of the police in the barrack in front of the lock-up. There was also a doubtful case in the party which had been encamped in the jail garden. On the 17th September another case followed in the jail. 111. Importation and communication. — The cases could,in no instance,be traced to contagion. V. Local conditions. — The prisoners drink from one well inside. A bathing reservoir has, within the last few years, since 1869, been sunk immediately beside this well. It is very objectionable, especially as the floor was out of repair. VI. Preventive measures. — Buildings attacked were vacated at once, and the inmates placed in tents in the garden. " The water-supply was all along derived from the jail well, when the prisoners were in camp, and the police and the prisoners in the lock-up got their supply from two wells in front of the lock-up." The policeman attacked on the 13th had just received a reward of Rs. 100 for some special service, and had expended a portion of it on a feast of sweetmeats. VII. Previous history. — The outbreak of 1872 although severe was much less violent than that of 1869, in which among the troops alone not including followers there were 190 cases and 136 deaths. The outbreaks in other years were comparatively trivial. Statement of cholera at Kohat, 1851 to 1872. NIMIIRK OF CABBS. Yvißs Average . . Total Total Strength. f, S *; Cases. Deaths. S ff J 4 1 fe' I I Ililli'S'llllJ 1851 Native Troops - 2,387 2 2 2 1852 Ditto - 1,964 1 ... 13 5 3 1853 Ditto - 2,331 ... 1 1 2 1 1854 Ditto j 1 1 ... | 2 1856 Ditto - 3,268 1 1 1858 Ditto 21 18 ... 39 18 ( Native Troops 1 8 31 12 52 25 1862J (. Prisoners - 114. 1 1 1863 Native Troops 3 1 4 2 r Native Troops - 2,395 188 2 ... 190 136 1869] (. Prisoners - 144 1 ... 1 ... 2 1 r Native Troops - 2,222 44 46 1 91 59 1872] C Prisoners - 181 3 3 3 [ Section I 140 NINTK ANNUAL REPOET OF THE A. Statistics of general population. Statement showing the deaths registered from cholera in Bengal Proper during each month of 1872. NUMBEB OiP OnOLKKA DEATHS REGISTERED IN EACH MONTH. Population Total Distbicts. according to . „• y ? deaths of Census of 1872. sA t? . 1 a 5 J the year, s§-S- • 1 a J S "g lla3glg 5 g I I |_ 24-Pergunnahs ... 2,210,047 968 468 236 122 87 50 17 43 38 73 261 729 3,092 Calcutta ... 447,601 80 81 64 70 66 55 71 79 61 86 181 248 1,142 Howrah ... ] 1488556 ( I*l 83 47 47 28 7 8 23 9 25 90 258 776 Serampore and Hooghly * <¦ 87 46 72 39 17 16 30 92 30 44 83 93 649 Nuddea ... 1,812,795 584 474 168 357 236 7 50 21 2 5 3 82 1,989 Jessore ... 2,075,021 755 251 212 J7B 92 36 18 9 17 7 76 520 2,171 Burdwan ... 2,034,745 140 91 113 196 170 216 130 213 288 106 97 398 2,158 Bancoorah ... 526,772 34 16 ... 1 44 50 53 20 17 ... 2 31 268 Beerbhoom ... 695,921 26 7 32 29 24 8 21 51 84 32 156 256 726 Midnapore ... 2,540,963 108 192 82 94 65 26 31 7 ... 6 43 106 760 Dacca ... 1,852,993 62 31 27 95 90 35 30 7 13 6 73 296 7*o Furreedpore ... 1,012,589 291 41 21 37 12 1 1 2 1 ... 4 17 428 Backergunge ... 2,377,433 111 86 186 234 122 28 29 13 21 8 33 209 1,080 Mymeiwing ... 2,349,917 51 26 29 71 41 8 1 2 1 1 96 554 881 Daijeeling ... 94,712 22 43 57 52 28 12 205 Julpigoree ... 418,665 8 2 2 7 11 21 35 16 5 29 97 298 531 Gowalparah ... 444,761 91 74 8 4 2 30 124 125 8 12 192 192 862 Morshedabad ... 1,353,626 89 104 186 99 13 ... 1 1 9 1 1 35 539 Dinagepore ... ], 501,924 423 78 176 130 71 8 38 103 373 1,400 Maldah ... 676,426 9 14 1 1 5 1 2 11 1 7 52 Rajshabye ... 1,310,729 188 50 60 103 23 ... 1 1 ... 2 ... 1 429 Rungpore ... 2,149,972 57 4 18 18 62 27 69 73 93 195 402 967 1,985 Bogra ... 689,467 59 9 3 9 1 _ 23 104 Pubna ... 1,211,594 HO 23 24 147 92 13 10 1 ... 1 2 83 606 Purneah ... 1,714,795 •» 20 1 14 59 18 30 5 14 28 151 16 356 Chittagong ... 1,127,408 151 86 114 127 275 196 84 12 37 10 45 165 1,302 Noakbally ... 713,934 25 28 31 16 20 7 4 25 205 361 Tipperah ... 1,533,931 50 16 35 46 55 1 5 2 ... 5 133 517 865 Cachav ... 205,027 2 31 144 404 170 ... 4 6 3 ... 18 782 Sylhet ... 1,719,539 16 ... 36 204 148 25 14 1 1 . "" 2l 2 l 58 524 Duming ... 236,009 60 38 56 26 56 66 56 17 2 7 27 97 508 Nowgong ... 256,390 161 17 7 1 2 117 29 6 12 ••• 352 Seebsaugor ... 296,589 71 193 60 10 42 337 1862 9 " 3074 3 ' 074 Kamroop ... 561,681 589 215 79 95 341 312 176 86 56 45 '14 18 2,026 Luckimpore ... 121,267 4 1 ... 50 39 94 Jynteah Hills ... 141,838 1 2 ... 3 Balasore ... 770,232 35 53 189 278 250 346 60 21 10 14 1 5 1,262 Cottack ... 1,494,784 11 64 322 573 609 619 551 113 57 26 34 2,952 Pooree ... 769,674 2 57 82 177 111 486 203 33 41 3 q 6 1.207 Rajmehal ... W^C 2 1 _ 4 7 Deoghur ... ) (. 12 7 27 31 17 12 11 3 ... 120 • Purulea ••• 995,570 13 3 3 ... 63 139 56 3 4 ... 2 3 289 Hazareebaugh ... 771,875 15 14 24 38 15 1 2 1 1 ... HI Ranchee ... 1,237,123 1 ... 7 4 5 3 21 2 1 1 1 46 Chyebassa ... 415,023 131821... 124 4 27 Monghyr ... 1,812,986 28 30 92 395 253 99 27 2 3 1 930 Bhaugulpore ... 1,826,290 29 12 3 5 31 35 44 35 12 2 208 Gya - 1,949,750 2 3 3 50 240 494 550 369 54 11 14 2 1.792 Patna ... 1,559,638 10 1 12 23 42 319 333 315 52 18 222 I.H* Shahabad ... 1,723,974 30 ... 1 29 54 171 51 48 60 41 55 ... 540 Sarun ... 2,063,860 3 8 7 424 59 84 155 142 28 4 ... 518 Tirhoot ... 4,384,706 52 4 ... 5 69 188 83 308 400 297 65 19 1490 1 ' 490 Chumparun ... 1,440,815 2 51 65 36 83 191 75 503 _ Total '". ~^ol 141 Cholera Epidemic SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA Statistics— general TJ population. . 7 _ T Statement showing the deaths from Cholera registered in the different districts of the Northwestern Provinces during each month of 1872. Cholbba deaths registered in each month. =g — ; — la Population, . . I jf, Districts- Census of fe S S "= § 1871 U - ¦ . * 1 I I 1 1 1 I I g I I I 1 g I I .!__!_ Eastern Districts of the North-Western Provinces. Ghazeepore ... 1,454,000 15 11 26 26 94 169 92 132 36 4 ... 14 619 Benares ... 793,433 25 21 84 361 381 187 88 86 75 56 29 19 1,412 Mirzapore .. 1,087,200 5 4 71 372 474 273 205 172 32 8 2 ... 1,618 ArinAur ... 1,497,580 9 19 33 618 998 472 125 184 39 28 55 12 2,592 Jounpore ... 1,022,555 11 14 1,147 5,788 1,113 132 21 15 9 ... 1 ••• 8.20 l Goruckpore ... 2,044,821 60 528 1,297 698 47 39 66 119 94 56 3,004 Bustee ... 1,487.572 3 ... 92 2,670 3,987 2,458 153 10 1 132 625 9,537 Allahabad ... 1,382,826 ... 17 239 1,894 1,034 299 39 46 26 18 1 2 3,615 Futtepore ... 661,585 2 ... 5 6 119 151 65 57 73 38 7 1 524 Cawnpore ... 1,152,628 ... 2 ... 6 413 541 270 181 162 81 2 1 1,609 Futteghur 919,091 2 ... 4 1 31 111 329 1,321 540 195 4 ... 2,038 Districts of the N. W. Provinces, south of, or bordering on, the Jumna, Banda ... 696,443 ... 2 1 11 2 27 13 55 91 202 Hameerpore ... 527,540 9 36 9 21 1 1 77 Jaloun ... 400,781 16 7 7 36 66 Etawah ... 671,247 1 1 ... 1 13 416 489 419 97 12 ... 1 1,450 Jhansie ... 311,773 Lulutpore ••• 214,593 2 Districts of the N. W, Provinces lying west of the line of 80° east longitude. Bareillv ... 1,506,547 14 4 2 11 7 9 30 75 330 717 270 30 1,499 Budaon ... 934,454 2 3 13 17 8 14 9 14 209 555 26 2 872 Shahiehanpore ... 945,705 3 3 5 8 9 12 66 1,318 1,214 1,449 306 10 4,403 Moradabad ... 1,118,943 6 6 7 21 21 11 12 59 403 569 14 2 1,131 Etah .- 700,688 4 7 12 17 192 87 20 1 ... 340 Mynpooree ... 753,971 2 ... 11 83 133 101 31 5 ... 366 AlWhur ... 1,057,939 1 ... 3 3 5 38 31 132 497 79 9 1 799 Booluudshahar ... 936,733 12 5 10 6 20 12 185 166 9 12 419 Ajrra ••• 1,097,425 1 3 ... 13 33 80 144 126 48 3 ... 1 452 Muttra • 892,542 11 3 23 55 47 56 100 91 25 4 ... 407 Meerut ... 1,271,454 14 6 2 26 88 13 127 222 19 1 1 510 Mozuffernugger ... 704,000 1 2 ... 2 5 8 15 9 2 3o Saharanpore ... 880,663 18 4 14 18 84 65 18 694 366 61 7 2 1,30 l Biinour ... 714,415 4 1 7 9 19 26 7 11 31 73 26 6 220 Deyrah ... 116,981 .. 1 1 54 175 11 8 200 Terai Pergunnahs ... 185,647 25 153 166 26 369 Kumaon ... 430,300 ... 2 4 20 2b Ghurwal ... 309,947 - Total ... 50,565 I c. Statement showing the deaths from cholera registered in the different districts of Oudh during each month of 1872. CHOLEUA DEATHS REGISTERED Ilf EACH MONTH. "3 Population, . , M , Districts. Census of S I S tj 2 5 im - i i d i 1 i I i * g g g 3 g ¦gg^fiSiiia^ . Pertabaurh ... 782,672 6 28 1,128 3,628 1,251 88 6,129 Eao ßareillv - 989 > 008 26 - 38 159 " 3 I'o7l 1 ' 071 167 43 31 ~ 35 20 2583 2 ' 583 SultanDore ... 996,456 184 20 447 1,114 460 116 14 5 4 2,364 FyS ... 1,025,718 2 3 ... 197 397 77 19 18 13 36 82 5 849 I&abunkee ... 1,102,165 33 ... 47 432 518 294 89 68 18 ... 37 ... 1,686 Luokuow ... 789,465 43 242 443 238 159 26 48 28 18 1 245 Oonao ... 945,955 2 253 689 344 865 165 100 18 ... 1,926 Cioudah ... 1,168,462 1 262 1,835 745 91 !77 215 289 24 6 3,545 Bamioh ... 774,640 141 531 406 294 196 127 816 191 54 8,256 Khoroe ... 746,340 115 5i 86 109 180 34 14 43d geetapore ... 932,959 73 176 11 |18 16 |124 160 17 ... 095 Hurdai ... 931,517 60 ! 375 702 974 581 ,'395 16 ... 3,103 Total ... 26,566 L 1 [Section I 142 NINTH ANNUAL REPOET OF THE D. Statistics— general population. Statement showing the deaths from Cholera registered in the different districts of the Punjab during each month of 1872. c Choleea deaths eegistebed in each month. a 'o « , Districts. .Sg . £ £ jj jj J I* ilitsiiii i i I i^ Goorgaon .. 690,522 ... 1 3 3 2 54 30 62 7 ... 162 Delhi ... 608,850 „ 1 29 119 4 53 12 1 219 Rhotuek ... 536,995 1 2 ... .. ... ... ... 3 Hissar ... 484,681 1 2 28 21 16 5 1 74 Sirsa .. 210,795 3 11 25 40 18 2 ... ~ ... 99 Kurnal ... 610,927 ... 1 ... 27 476 377 59 118 31 1,089 Umballa ... 1,008,952 1 1 ... 51 463 298 39 173 88 6 1 ... 1,121 Simla ... 34,173 5 5 Jullundur ... 783,020 2 1 1 1 14 149 196 43 ... 2 409 Loodiana ... 583,445 111 9 42 468 195 717 Hooshiarpore ... 938,890 ... 1 8 4 27 30 18 332 288 18 5 ... 724 Kangra ... 744,162 ... 4 1 4 JO 3 3 10 105 29 ... 174 Goordaspore ... 906,126 4 6 1 ... 15 7 79 208 444 99 863 Sealkote ... 994,458 1 2 27 38 188 27 283 Umritsur ... 832,750 1 1 1 3 5 44 39 94 Goojrat ... 616,347 1 1 1 ... 1 ... 2 27 35 ... • ... ... 68 Goojranwallah ... 550,576 1 1 7 ... 155 171 17 352 Lahore ... 775,551 1 2 1 ... 6 7 62 461 85 2 2 ... 629 Ferozepore ... 533,416 1 2 25 122 126 42 4 ... 322 Montgomery ... 359,437 2 ... 1 2 5 Mooltan ... 459,780 1 1 2 Mozuffurgurh ... 295,547 1 2 3 Dera Ghazee Khan ... 308,840 1 1 Dera Ismael Khan ... 394,864 1 6 15 ... ... 22 Jhung .. 348,027 ... 1 1 Shahpore ... 368,796 « 34 9 ... 43 Jhelum ... 500,988 2 6 15 252 6 281 Hazara ... 367,218 ... 1 ... 1 ... 1 50 14 1 ... 68 RawulPindee ... 699,647 3 2 30 107 6 148 Peshawur ... 500,443 1 ... 11 ... 2 1 310 76 ... 392 Kohat ... 145,419 94 228 29 351 Bunnoo ... 287,547 2 1 3 Total ... 8,727 E. Statement showing the deaths from Cholera registered in the different districts of the Central Provinces during each month of 1872. CnOLBBA DEATHS BEGISTEEED IN EACH MONTH. Population, _ , , .. Disteicts. Census of C „¦ c Total deaths 1868, £ .g ri | | of the y ear - Raipur ... 841,622 Bilaspiir ... 478,056 Sambalpur ... 268,296 ... Jabalpur ... 380,826 4 26 23 1 54 Seoni ... 421,650 Mandla ... 187,699 Narsingpur ... 336,796 1 11 12 13 13 ... 50 Murwara ... 218,391 Damoh ... 283,625 12 3 15 Sagar ... 498,642 Chindwarah ... 260,930 Baitool ... 258,230 Hoshangabad ... 399,430 31 11 1 1 5 27 30 47 153 Nimar ... 124,832 39 177 50 177 192 179 43 857 Bhandara ... 608,510 Nagpur ... 649,342 1 3 12 8 24 Balaghat ... 170,934 Wardah ... 343,269 205 62 267 Chanda ... 414,951 .. 7 7 Upper Godavery ... 54,684 ... Burhanpur ... 65,675 1 6 60 29 38 31 165 Total ... 1,592 Epidemic I SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. 143 Statistics— general T1 population, JC • Statement showing the deaths from Cholera registered in the different districts of Berar during each month of 1872. Cholera deaths registered in each month. Population Total Districts. according to . g* * j deaths of "' fIIS,I f{, I I """ Akolah ... ... 480,657 21 112 63 18 214 Buldanah ... ... 365,779 5 2 17 103 41 20 2 ... 190 Bassim ... ... 260,905 31 229 60 320 Oomrawuttee ... ... 496,379 2 35 148 40 85 ... 2 312 Ellichpur ... ... 237,799 2 6 8 Woon ... ... ... 343,426 2 226 244 47 2 13 534 Total ... 1,578 Statement of deaths from Cholera registered in the different districts of the Bombay Presidency during each month of 1872. o Cholera deaths registered in each month. 5 © Districts Estimated y . . 5 8 population. . * I J j J I I 4 ri . =5 • 1 1 I I 1 ?£ Il||| I £ & } J I I II i-5^S-l_f_'l 3 fa *a <3 *il_*_'«q_Ofc<-5i l _*_'«q_Ofc<-5 H Akyab ... ... 266,858 8 2 109 118 89 74 105 18 1 524 Ramree ... ... 144,251 8 3 .. 11 Sandoway ... ... 64,655 4 11 3 7 25 Rangoon ... ... 431,069 7 2 3 3 ... 1 13 ... 9 1 39 Bassein ... ... 316,982 4 ... 3 1 ... 8 Myanoung ... ... 444,750 2 2 11 15 Prome ... ... 274,872 ... Thayetmyo ... ... 144,131 ... 2 ... 9 ... .'.'. ... 2 ... ..' '" ""13 Amherst ... ... 236,437 1 ... 3 1 5 Tavoy ... ... 72,456 Mergui ... ... 46,184 Tounghoo ... ... 87,836 Shwegyeen ... ... 142,629 '.[[ "[ Z ... Total 640 Cholera ~j SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. £piaemic J 145 Statistics— T European Troops. . O • EUROPEAN TROOPS, 1872. TABLE showing the Distribution by Stations of the Cholera of the men, women, and children of the European Regiments composing the Army of India. 5 "Sj ° Number of Admissions into Hospital in each month, g 9 ° rS S *Ji : h h i !| f SJi t 1141 14 4 1 * II 11 ft I # &* I i i'k\s i i $1 1 li Pi 1 - i h Deolalie Depot, Bengal Troops ... 8 ... Poona and Bombay Depots, Bengal Troops ... 3 Troops on March, Bengal and North-Western Provinces ... 1 1 ... 1 Recruits, invalids, &c, &c Fort William ... 1,092 1 ... 1 2 IB 1 f 9 Dum-Dum ... 798 ... 1 ... 1 T3 1 I*B Barrackpore ... 615 1 ... 1 1-6 1 I*B Total ... 2,505 I ... j 1 ... | 1 ... 2 I ... 4 j T6; 3 T2 Hazareebaugh ... 1,126 ... ~~~. „, .„ ~ Z. ,„ ~ ~ ... Dinapore ... 1,114 1 1 2 I*B 2 IB Benares ... 655 3 1 4 61 3 4*6 Chuuar ... 71 ... Pyzabad ... 1,193 .- 13 49 62 520 39 327 Lucknow ... 3,187 4 ... 12 21 16 2 2 ... 57 17-9 37 H'6 Seetapore ... 792 I'uttehghur ... 273 3 2 5 18-3 4 14-7 Cawnpore - ... 1,107 22 8 30 271 20 18-1 Allahabad ... 1,378 13 5 49 1 59 42-8 38 27-6 Total ... 10,895 .„ 1 6 81 8_ 14 86 68 2 2 1 219 20*1 143 13-1 Shahjehanpore ... "" 476" ~ Z. ™ ~ Z ~ ~. 5 1 !T! ~ Z 6 la-6 4 8T Bareilly ... 937 H Moradabad ... 258 Roorkee ... 521 7 7 13"4 3 s*B Meerut ... 1,953 18 65 83 425 63 32"3 Delhi ... 743 Muttra ... 591 j _____ _____^ Total 5,479 1 ... 1 ... „. 2878 ...... ... 96 17_] 70 12-8 Agra ... 1,390 ~Z. ~ Z Z. 10 15 5 3 3 !7! Z. Z. 36 257^ 23 hFT Morar ... 1,386 1 1 I -7 Gwalior Citadel ... 421 ! Jhansi ... 500 I Nowgong ... 372 2 1 3 B'l 3 81 Saugor ... 499 Jubbulpore ... 724 J ... Total ... 5,301 _Jo[l6 6I 5 4 ¦ 40 75 26 4-[» Umballa ... 1,599 Z". Z. " 7. Z. Z. !T! 1 3^ Z. Z. Z. 4~1 2% 1 IT Phillour ... 70 5 6 11 1571 11 1571 Jullundur ... 1,028 6 6 2 14 13-6 12 11-7 Ferozepore ... 1,477 Mooltan ... 1,094 3 3 2-8 2 1-8 Dera Ishmail Khan ... 99 Sealkote ... 1,516 ... .. ... 1 3 4 26 4 2-6 Umritsur ••• 352 Fort Lahore ... 77 6 1 7 909 7 90-9 Meean Meer ... 1,358 1 179 5 185 136-2 123 90-6 Ravvul Pindee ... 1.775 1 ... 3 4 i 2-3 4 2o Campbellpore ... 182 Attock ... 204 3 3 147 3 147 Nowshera ... 741 Peshawur ... 1,703 80 2 ... 82 48-1 62 36-4 Cherat ... 943 1 1 I*l Troops on march, Punjab ... .. Recruits, invalids, &c, &c... .., Total ... 14,218 _^ 1j 3 ... 8 195 23 86 2 ... 318 22-4 229 16-1 Darjeeling ¦•¦ 87 KaueeKhet ••• 608 „ Chuckrata ... 1,136 3 2 5 4'-l 2 I*B Dugshaie ... 1,307 36 1 3 40 30-6 28 21-4 Subathoo ¦•• 1,184 ... 6 6 53 3 27 Jutogh ••¦ 125 Kangra ... 30 .., Dhurumsalla ... 80 Murree Hills ... 703 , Total ... 5,210 ... 1.. ... ... ... .. 161 89 3 3 61 ' 9_3 33 &-'6 Darjeeling Depot ... 159 ~Z. Z. Z. ... Z j Z. ~Z. Z. NyneeTal „ ... 372 Landour „ ... 283 Kussowlie „ ... 901 25 22 1 48 484 26 262 Dalhousie „ ... 510 Murree „ ... 805 ... 12 28 ... j 40 402 28 324 8,180 1 I ... ! 25 34 29 ... j ' 88 277 54 17-Q Bengal Presidency ... 46,799 2 7 44 24 59 382 201 91 G 1 817 175 559 IV9 M 1 146 NINTH ANNUAL REPORT OF THE [Section I Euro S ptanT C ro"ops. J— (continued.) J*L ° Number of Admissions into Hospital in each month. § » *© j§ g.g oil Is Ig I a g STATIONS - f|li *6 d i I*I j If -p£ I|| ly 4aa .& 1 1 1 1 fJ i 1 1° l&« lis Troops on march, Bombay Presidency ... ... ... Deolalie Depot, Bombay Troops ... 60 Poona Depot, Bombay Troops ... 67 Colaba Depot, Bombay Troops ... 36 Troops on march, Madras Presidency ... ... Poonamallee and Presidency Depots ... 300 Deolalie Depot, Madras Troops ... ... ... ... Poona and Bombay Depots, Madras Troops ... ... Nusseerabad ... 952 Neemuch ... 549 2 6 9 14 31 56-5 23 419 Indore ... HI 2 1 3 270 3 27-0 Mhow ... 2,078 6 13 ... 19 9'l 16 77 Deesa ... 1,350 .. Ahmedabad and Baroda ... 237 Kurrachee and Ghizree ... 1,122 Hyderabad ... 494 Aden ... 899 Total ... 7,792 6 15 2 6 10 14 53 6-8 42 5-4 Bombay ... 597 Asseerghur ... 141 ••¦ , Ahmednuggur ... 854 1 1 12 1 1-2 Poona and Kirkee ... 3,271 9 2 11 3-4 10 3*l Sattara .. 245 . Belgaum ... 1,384 Secunderabad ... 3,538 1 1 2 ... 4 Tl 1 -3 Kamptee ... 1,443 1 .. 1 '7 1 '7 Total .. H,473 1 1 ... 2 9 2 2 ... 17 I' 6 13 l'l i ! Bellary ... 1,157 Bangalore ... 2,563 Cannanore ... 938 Malliapoorum ... 130 Calicut ... H7 Trichinopoly ... 425 St. Thomas' Mount ... 616 Madras ... 919 Total ... 6,865 Rangoon ... 1,168 ¦•• ••• Tounsoo ¦•• 676 Thyetmyo ... 805 Port Blair .. H3 Total ... 2,762 I I Taraghur, Ajmere ... 43 1 1 233 1 23-3 Mount Aboo ... 167 Poorundhur ... 45 •»• Puchmurree, Madras Troops 149 Ramondroog ... 76 ••• Wellington ... 601 _Z_ _IL Z_ _H _HL _IL -111 -11. -H '" *" '" "' Total ... 1,081 1 1-9 1-9 Army of Brngal ... 46,799 2 7 44 24 59 382 201 91 6 1 817 175 559 119 i Army of Mapras ... 15,734 1 1 ... 1 2 ... 5 "8 2 "1 Army op Bombay .. 14,702 6 15 3 15 12 14 1 66 4"5 54 37 Army of India ... 77,235 3 14 59 28 74 J394 215 92 8 1 888 U« 615 79 I Cholera 1 sanitAlI y COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic- J 147 Statistics— TjT Native Troops. **• NATIVE TROOPS, 1872. Table showing the Distribution of the Cholera of the Native Regiments composing the Army of Bengal. . NUMBEK OB ADMISSIONS INTO HOSPITAL IN EACH MONTH. T()ta j Admis- Vera f, e — 3 ~u T admiss ion «J Jjl 111!! 1 J lij _n^ h - Trocos on march, Bengal and N. W. P. ... 2 4 2 1 JL "qA.q Looshaie Field Force ... ... f 2 4 97 2 10 ° 4-Q Fort William... ... ... 610 ... 3 % Vi Alipore ... ... ... 920 ... , 1 ... L Dum-Dum ... ... ••• 116 ••• ¦• ••• ••• " _ '"a-i, Barrackpore ... ... •• 786 ... 2 2 1 ... 5 Berharnpore ... — ••• 115 ••• ... ••¦ •• '" „ '"'j-l Dacca ... ... - 282 ••¦ ... 2 I J. B Cachar and out-posts ... ... 450 ••• ... 6 2 ••• ... Sylhet ... ... »• 105 ». ¦¦ „ - s>l Shillong ... ... ». 587 1 ... 1 1 ••• ••• % iv t Gowhatty ... - - 503 - ... 6 - ... \ lq . o Tezpore ... .. - 158 ... 2 1 ... ... 3 19 0 Nowgong ... »• ¦•• 85 - ... ... ¦•• ... ••• - •" " , "g.g Debrooghur ... ... »• 717 ••¦ ... 1 1 ... * * Buxa ••• ••• ••• 574 ••• •• ... " „ "g.4. Julpigoree ... ... ••• 319 ••• 1 l ••• 2 -(t Bhaugulpore ... ••• ••• 508 ••• ! ••• o 0.0 Dinapore ... ... »¦ 603 - 1 1 2 66 Segowlie ... •• ••• 274 •¦• ••• ¦«• " j "j.g Benares - ••• ••• 550 •• • • •¦¦ ••• ¦• ••• l „ 2 86 Chunar ... - - 70 - 1 - 1 ... * Goruckpore ... ••• ••• 599 •• ••• Fyzabad ... ••• ••¦ 606 ••• ••• •¦• " a "0.0 Lucknow ... - - 969 - 1 2 ... 2 2 1 » » A Seetapore ... ••• ••• 235 ¦•• — "' Futtehghur ... ••• •• 176 •¦ "' j "j.g Cawnpore ... ••• ••• 808 ••• 1 » 7.7 Allahabad ... - - 904 ••• 4 3 ... ' ' ' Nagode ... - ... 99 - •• 5 2 0 . 7 Shahjehanpore ... ... 242 ••• 5 — i 1i 1 "' Barielly ... »• - 933 ••• 1 Moradabad ... ... ¦•• 390 ¦•• "' Almorah ... ••¦ ••• 570 ••• ",' *"Ifl" 1fl «*.| Deyrah ... - »¦ 415 ••• 18.. A . -? Eoorkey ... ... - 732 ••• 4 - * §.§ Meerut ... •» - 857 ~ 1 X '" Delhi ... ••• ••• 598 ••• '" Agra •¦• ••• — 1,037 ••• "' Morar ... ••• ••• 1,494 ••• Jhansie ... ••• ••• 618 ••¦ Nowgong ... ••• ••• 228 •" "' Lullutpore ... ••• ••• 70 ••• "" Deolee ... ¦•¦ ••• 156 ••• "* Ulwur and Sambhur ... ... 151 ... — ••• •¦• Umballa ... - ... 903 - ! lfl Simla — ••¦ ••• 166 — '" Loodianah and Phillour ... ... 93 — ••• Jullundnr ... ... ¦•¦ 593 ••• L — '" •" '" Ferozepore ... «•> ••• 556 ••• '" Mooltan ... ... ••• 921 '" t Sealkote ... - ••¦ 969 - '" - 1M •*• Dhurmsalla ... ••• ¦•• 600 ••• Bukloh ... - ••• 537 - "' ••¦ Umritsur ... ••• ••• 260 "O" O , R io.« MeeanMeer ... ... - 1,267 - ... 19 6 25§ 1»« Jhelum ... - - 1,538 •• 1 2 3 ... ••• b 6 * KawulPindee ... - 1,658 •» 1 - - L ° Tullagunge ... ••• ••• 415 Attock ... ••• — 156 ••• Hazara ... ••• ••¦ 457 •«• Murree ... ••• ••• 100 Nowshera and out-posts ... ... 752 "¦ Q Peshawur and out-posts ... ... 3,4,9s 44 1 ... 45 l--y Troops on march, Punjab ... ... I^[ 1 Total ... 36,658~ 3 4 104 12 19 8154214 48 3 4 276 7-6 Murdan ... ••• ••¦ 680 Abbottabad ... ••• ••• 1,317 1 J '? Kohat ... .» - 2,222 44 46 1 91 41-0 Bunnoo ... - — 1,621 Dera Ghazee Khun ... •¦• 1,381 ••• Dera Ismael Khan ... - 1,571 1 1 Raiaupore ... ••• ¦•• 548 Total — ~9,340_~7_~ ¦- \ rL _ 44 47 J 1 ¦¦ I ... 93 10-Q Augur ... ... .« 290 - | - Goonah ... ... ... 329 1 1 30 Sirdarpore ... ... ... 452 Kherwarra ... ... ... 438 Erinpoora ... ... ... 795 Ajmere ... ... ••• 633 Deolee ... ••¦ ... 725 - # " Sehore ... ... ... 814 7 _-_ _- '_ 8b Total ... 4,476 1 ... 7 _- j^_ 1-8 Grand Total ... 50.474 3 ! 4 104 12 20 19228661 I 49 ! 3 4 377 75 * Fifty-three eases admitted into the General Hospitals of the Looshaie Field Force in March appear also in the Regiraenta 1 Returns. The number of admissions here given corresponds very nearly with the number shown in the annual returns ot the Regiments employed. ln» current record is frequently deficient when regiments are broken up into small bodies, and their sick distributed in Oeueral iiospi.als. t The strength represented in the returns is approximately 3,400. % A child of the Regiment died on 23rd May, and a doolie bearer on 11th October. § One fatal case occurred at Fort Lahore. % Man of .tesluwur Mountain battery returning from Looshaie Expedition, seized at Lahore. [ Section I 148 NINTH ANNUAL REPORT OF THE statistics- K — (continued). Native Troops. v ' Numbek ob Deaths in each month. Average _ Death . length T()tal rateper Stations. of th e g, J J Jj Deaths i 0 00 of month of £ g . 3 I | 1 S strength. August. §||lsgi.§|,|ig Troops on the march, Bengal and North-Western Provinces * ••• 2 1 5 Looshaie Field Force, with General Hospitals ... ... 3 1 80 2 86 20"3 Fort William ... ... 610 2 ... ... 2 3"3 Alipore ... ... - 920 1 1 11 Dum-Uum ... ... ••¦ 116 •• Barrackpore ... ... •¦• 786 1 — 1 VA Berhampore ... ••• ••• H5 •• ••• ••• Dacca ... ... ... 282 ... 1 1 35 Cachar and out-posts ... ••• 450 4 l 5 n l Svllipt ... 105 Son, ::: ::: ... i ... i ... :: 2 ™ Gowhatty ... ... - 503 3 3 6 0 Tezpore ... ... ¦¦• 158 Nowgong ... ... ••• 85 •• ... ... Debrooghur ... ... ... 717 1 1 2 8 Buxa ... ... ... 574 Julpigoree ... ... ••• 31 9 1 1 31 Bhauijulpore ... ... ¦•• °08 •• •• ... • •• Dinapore 603 1 1 2 B'B Segowlie ... ... - 274 » ... ... Benares ... ... ••• 550 -I 1 18 Chunar ... ... ••¦ 70 ¦ Goruckpore ... • ... ••• 599 Fv7abad .. ••• 606 LSnot ::: i ... 2 2 i 6 c* Seetapore ... ... ••• 235 .. Futtehghur ... ... - 176 ¦• - •¦• ••• Oawnpore ... ... - 808 1 ... ... 1 JJ Allahabad ... ... ... 904 3 1 ... 4 44 SeLnpore' Z Z 242 ZZZZZZ Z 1 Z Z Z Z ~8 1M Barei'lly ... ... — 93 3 Moradabad ... ... ••• 390 • OSS? ::: SS ::: ::: ::: ::: ::: »: "i "a ::: ::: "i :» "io ¦« Roorkee Z Z ... 732 2 2 87 Meerut ... ... ••• B °7 Delhi ... ... ... 698 Agra ... ... .- 1.037 Morar ... ... •• I» 4M Jhansie ... ••• ••• 618 Nowgong ... ••• ••• B Lullutpore ... ••• ••• 70 Deolee ... ... — 1§ 6 Ulwur and Sambhur ... ••¦ 151 Umballa ... ... ••• 903 ••¦ " Simla ... ... - 166 Loodianah and Phillour ... 93 •• ••• Jullundur ... ... - 693 1 1 17 Ferozepore ... ••• ••• 556 Mooltan ... ••• ••• 921 Sealkote ... ... •• 9U9 Dhmmsalla ... ••• ••¦ 600 Bukloh ... ... ••• 537 Uairitsur ... ••¦ ••• 260 ••• ••• ••¦ ¦•¦ MeeanMeer.:: 1,267 •¦ 10 2 12 96 Jhelum ... 1.538 »¦ 1 1 2 13 Kawul Pindee ••• ••• I|6oB Tullagunge •¦• •¦¦ 415 Attock ... ... - 156 Hazara ... ••• ••• 45 7 Murree ... •¦• ••• 100 Nowshera and out-posts ... 752 ••• ••• ••• ¦¦• ••• Peshawur and out-posts ... ... 3,498 28 1 ... 29* 83 Troops on march, Punjab ••• ' "* "' Total ... 36i6M" "T "T IT 710 5 426 628 3 3 182 6*o Murdan ... ... ¦¦• 680 •• ••• "• Abbottabad ... ... ... 1,317 1 - ••¦ ••• J ' Kohat ... 2,222 27 32 59 26 5 Bunnoo ... ... ... 1.621 Dera Ghazee Khan ... ... 1,381 •• ••; Dera Ishmael Khan ... ... 1,571 l x Rajanpore .. ••¦ ••• 548 | •¦• ••• '.__'.'!_ J'L_ '" Total ... ... ... 1 - 27 33 61 6-5 j Augur ... .•¦ ••¦ 290 Goouah ... ¦•• ••• 329 Birdarpore ... ••• - 402 "; [[ Kherwarra ... •¦¦ •¦• f™ Erinpoora ... ••• •¦• ',° ' Ajmere ... •¦• ••• * . g^ 168 - Bi4 ::: ::: :;; ::: z z i"i ::: ;¦/. z z "\ *-9 Sehore ... ¦•• ••• O1 Total ... 4,476 ¦¦ <* 8 * 4 Geani. Total ... 50,47^ "T "T ¥" 710 6 75439 j 28 3 3 247 4-9 * A man of the Guides died at Peshawur on 18th October, while on command, lie is not included in this total. Cholera IsiNITAKYl siNITAKY COMMISSIONER WITH THE GOVERNMENT OF INDIA. Epidemic J 149 Statistics - T. Jails. "" JAILS, 1872. TABLE showing the Distribution of the Cholera of the Jails of the Bengal^ residency. .__ == Rates per Number of Admissions fkom Cholera, in each month, g «g 1000. Average 7 " «j g jj « || , Stations. strength of J } t?lJaa~"S»f=l August. || $ d , & ||l| |- £Q |.| | PjesJfcneyKatJves ... " 1.U6 .« ... ... ... ••• *« ~ 1 J ;;; ;;; » >J Baraset ... »¦ 303 1 ... £ ||| x Jessoro ... ... 630 Kislmaghur ... ... 32G • "" •" " 2 Moorshedabad ... ••• 214 1 ¦• Ilowrah ... ••¦ 37 ... Scramporo ... ••• 30 ••• «« •"'„ 2 googhly 405 l ... 1 ... ... .« ¦» ¦•¦ ;;; 2 _ Burdvvan ... ••• l y Uancoorali ... ••• 2 jjp ¦•• '^ "' '" ||| Pnrulea ... ••• 19 3 ••• "j "' "\ Ranecgungo ... - l» •• "2 '" '" \" 2 Sooreo - ••• 2™ 2 ™ Rajmehal and Pakour ... 169 Deogur and Sub-Divisions.. 100 • ¦ «•• '"« 1 Maldab ... - 68 ¦¦• 1 1 1 Dinageporo ... ••¦ 418 •¦ •« •¦ - \' m 5 2 Kajshahyo ... .- 650 6 i 1 ... Kungporo ... - 204 ! »• Bograh ... ••• »j •• •» 2 Mymcnsnigli ... ... ov* ¦ ••• — ••• — 14 3 Pubnali ... - 131 8 1 !. ' ... Furroedporo ... - 871 ¦¦• ••¦ - ••• ••• "j '- "j i ls & l 0 Baokergunge ... •¦• <>'» ° Noacolly ... - 1«* - "| ,"' , 1 ... CLittagong ... - 244 1 Ssr 11 ::: :- S ::: ::: "i ::: i i"i M ™"i ::: ::: 4 " ° 3 Naga Hills ... ... J ;|| "] ... Gowalpavnb ... •» W* Gowhatty ... - »» •" \" 4 ... ""4 2 Beebsaugor ... - lj™ Nowgong ... •¦• «^ •: ••• # ;; '"' c 1 Tezpore ••• ••• l °^ "i 11 Debroogurh ... - j£ ••• •« j 2 >n Midnapore ... - M?° * ... 1 1 Ualasoro ... - 1^ L '" *" "J ... 2 2 Cuttaok ... .« 2^ l - l 2 2 1 Poorce ... .» o °s •- "* Monghyr ... ••• *>* • ¦¦ ¦•• ••• "4 "g '" ir, ... Bhaugulporo Central ... 800 2 8 ... 4 : Bhaugulpore District ... 330 4 I ... 6 1 ••• ••• ¦•• Purneah — ••' 3 f? a', "1 '" " ,[', 25 19 Julpigorea ... ... |/ -1 1 ¦•• ••• __^^__ Darjeeling _ __.^ . --^ -^ |-^ -fi- Jq--& y-5 (i 'i«.V 71 JQ(i 15 Chyobassa ... - | 102 ... j 1 j- j ••• j- j •'• 2 Kunchee ... ••• 208 1 •• ¦•¦ 1 ; , J j Hazareebaugh, Central ... j 729 1 J j 1 __ Hazareebaugh District ... 133 • .» ¦» •» •« • 7 I 1 ptfah ::: ::: gj "• - :: j -£3J 3 J - ;;; E :.. ,1 i* Debrco convict ••• ''* • Avrah ... * l i "2" 2 _ x ... 3 2 Clmmparum ... - -°' »¦ " "j 73 74 39 Mozufferpore ... - «g n 3 14 8 Chuprah ... ••• f?* ••• | ... 1 Ghazeepore ... •• -'^ ••¦ "• "q | ... q 5 Benares, Central ... M^ - 3 I #>> 3 1 Benares District ... »v ••• ! "4" 4 3 7 4 Mirzapore ... - j J»J ••• j ;;; ;;; ;;; 8 [" x 9 7 Azimgurk ... -• •« | Jounporo ... - 8g " ;" | Gonuckpore ... ¦•• *™\ Bustee *ij ;;; ;¦; ;;; Barraltoh ... - »** - |"' 7 62 5 ... 67 19 Fyzabad ... - Lg ; Sultanporo ... •• "- L g 2 1 Boy Barreilly ... - gB4 - Pertabgwrh .» ¦•¦ "\ '" ... ,„ Hurdul .» ••¦ •" Kheree ... - J™ ••• j | ... Lucknow, Central ... li oß4 ••• | I 3 3 Lueknow District ... | I|l° (J ••¦ I ' Beetapore ... ••• 8^ Nawubgunge ... ... 222 ; •«• "¦ 4 " 2 Oonao •• ••¦ 264 ¦•• I " Humeerpore ... •¦• 241 ... | Oraie ••• •¦• 182 ! , "j '"{ 2 2 Futtehgurh, Central ... 935 j ••• "' 3 3 Futtehgurh District ... oiJl I -5 ••' "• x 1 Cawnpore ... ••• 8»7 L 1 ¦•• Futtehpore ... ••• °°~ ; Bandah ... - f*g \", Allahabad, Central ... 1.078 •¦ •• •¦ 7 5 A]]a]M^"_ - •...JS -; ::: y i '^^^j «* ~^" ""^ : i]1 ' w ~* 1 NINTH ANNUAL REPORT OF THE SANITARY COMMISSIONER C Section I 150 staMsties- Jj — [con tinned. ) NUMBKB OF ADMISSIONb FROM CHOLERA IN EACH MONTH. g J inn,! >EB , >> v ¦ Average " 2 j Stations. strength of |> « £ ~ § August. j? § „• tf 1 S i 1 II 4 Iliitii#il l i i i 1 i 1 Sumbulporo ... ... 95 Kaepore ... ••• 247 Belasporo ... ••• 77 Mundla ... ... 42 Seoneo ... ... H6 Chindwarrah ... ... 47 Baitool ... ... 73 ... ». Nursingpore ... .. 139 Hosuugabad ... ... 109 ... Nimar ... ... 101 2 1 ... 2 5 4 Sehore ... ... 69 Nagpore ... ... CB2 „ Bandhara ... ••¦ 60 ••• Wurdah ... ... 47 Chandah ... ... 103 Sironcha ... ... 14 2,021 2 1 ... 2 5 4 2-5 2-0 Jubbulporo ... ... 742 1 I ... 1 Dumoh ... ... 48 j Saugor ... ... 134 Lullutporo ... ... 117 Jliansie ... ... 269 ; ... - Ajmere ... ... 323 Muttra ... ... 205 Agra, Central ... ... 1,352 Agra Dis-rict ... ... 293 1 1 3,483 1 ... 1 2 ... -G ... Etah ... ... 250 None. Etawah ... ... 238 Mynpoorio ... ... 452 Allygurh ... ... 458 Boohindsliuhur ... 141 5 5 3 Sliahjehanpore ... ... 254 1 11 Bareilly, Central ... 994 Buveilly District « (ill Budaon ... ... 298 Saliarunpore ... ... 350 Bijnour ... ... 244 Deyrah ... ... 50 2 1 2 5 4 Almorah ... ... 187 Jloozufformiggiir ... 112 Mooradabad ... ... 305 Mecrut, Central ... 838 18 18 10 Meeiut District ... 424 6,296 3 6I 20 29 j 18 4-6 29 Delhi ... ... 301 j None. ... Goorgaon ... ... 173 Rohtuck ... ... 232 Hiasar ... ... | 265 ... j Sirsa ... ... i 2(16 ... Kurnaul ... ... j 237 .. I j Umballa ... ... 675 ... j 10 5 15 6 „ Roopar ... I 497 ... 11 4 15 C | Loodianah " ... ... 328 ... ! j 7 7 Julhiudur ... ... 373 2 2 2 Feiozepore ... ... 403 Umritsur ... ... 685 ... j Lahore, Central ... 2,271 47 47 22 Lahore, Female ... 153 Sea.koto ... .. 509 Dhurmsalla ... ... 152 Coordaspore ... ... 3-19 ... Goojramvulla ... ... [ 516 1 ... 1 1 Goojrat ... ... j 275 Shahpore ... ... I 248 ... .Thclmn ... ... 290 Montgomery ... ... <>G5 Mooltan ... ... 813 Jhuny ... ¦¦• : 308 I Dera Ghaze Khan ... | 405 j Dera Ismail Khan ... 380 I ... j Kohat ... - 199 | ... I 3 3 3 Buunoo ... ••• HI j .«• Rawulpindee ... ... 1,085 I reshaivur ... ... 706 1 1 1 13,971 10 73 7 1 91 41 6-5 ! B'9 I I i Bengal Presidency ... 03,681 4 4! 22 22 43 19 80 223 41 G9 12 20 SGO 248 8-8 3"9 U. 8. U. P.— No. 5 S. C— 2o-9-73— 250