Lithographed in Colors at the Surveyor General's Office, Calcutta, August 1876. Lithographed in Colors at the Surveyor General's Ortice, Calcutta. August 1876. I THE CHOLERA EPIDEMIC OF 1875 KiN ( BEING SECTION I OF THE ANNUAL REPORT OP THE SANITA^TCOMMISSIONER WITH THE GOVERNMENT OF INDIA FOE THATTEAR. ) BY / J. M. CUNINOJIAM, M.D., STJBGEON-MAJOB, BBKall, MEDICAL SEEVICB, SANITABY COMMISSIONEB WITH THE GOVEBNMENT OF INDIA. CALCUTTA: OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING 1876. NOTE. A few copies of this Report are issued in anticipation of the appearance of the full Report of the Sanitary Commissioner with the Government of India for 1875 3 of which it will form the first section. J. M. CUNINGHAM, m.d., Sanitary Commissioner with the Govt. of India. TABLE OF CONTENTS. Paba. p ฑ ge 1 Cholera among European Troops throughout India . . . . .1 2 Eemarkable absence of cholera in 1874, except in the Lower Provinces of Bengal, in Assam, and British Burma . . • • • • -1 3 Wide-spread epidemic in 1875 . . , . • • -2 4 Area occupied by the cholera of 1875 . . . • • .2 5 Areas of prevalence and exemption strikingly shewn on the map . • .3 6 These areas bear no relation to the great lines of communication . • .3 7 Even within the epidemic area the villages attacked comparatively few . . .3 8 The fact illustrated by statistics ..... . . 3 9 Probable objections to these statistics ... . . 4 10 Outbreaks in cantonments and jails . . . . • .4 11 Evidence afforded by the facts of these outbreaks . . • • .5 12 As regards meteorology, information imperfect . . . . .5 13 No evidence that the outbreak was in any case due to importation . . .5 ] 4 Facts at Jubbulpore examined . . . . . . .6 15 Evidence derived from experience of the attendants on sick , . . .6 16 In 56, out of the 67 outbreaks, no suspicion that the disease was communicated by the sick . 9 17 Attacks among attendants or others waiting on the sick . . . .9 18. Examination of the circumstances connected with these attacks . . .9 19. Escape of attendants not to be explained by disinfection . . . .10 20. Escape of attendants all the more remarkable, because they were often placed in circumstances favourable to disease . . . . . .10 21 In future the number of attendants will be shewn . . . . .11 22 . Other instances examined in which attacks are attributed to contagion . . .11 23 Sanitary defects. In no instance good reason to connect the outbreak with water polluted by cholera discharges . , . . . . .11 24 Movements generally attended with good results . . . . .12 25 Attempts at quarantine in certain places . . . . . .12 26 Places where no restrictions* were imposed as a rule suffered little . . .12 27 Only 9 stations where such measures were in force escaped . . . .13 28 Nor can their escape be attributed to quarantine. Cases of Banda, JSTagode and Chakrata . 13 29 Case of Fatehgarh . . . . . . # .13 30 Cases ฉf Subathu, Dagshai and Jutogh . . . . , .13 31 Cases of Dalhousie and Bakloh . . . . . f .14 32 Case of Bhagsu ฆ•••... 14 33 Merit claimed for quarantine in delaying the outbreak not supported by evidence. Case of Lucknow ... 24 34 No evidence adduced in favour of quarantine . 15 35 Evidence derived from the escape of most villages in the vicinity of cantonments . . 15 36 Objection to attempts at quarantine . jg 37 Quarantine condemned by all civilized countries . , \>j 38 Objects aimed at — the stoppage of persons sick of cholera, not attained in practice . .17 39 Affected localities to be avoided. Principle involved . . J7 40 Summary of the facts of the epidemic. .... 27 41 The evidence they afford as to its causes .... 18 REPORT THE CHOLERA EPIDEMIC OF 1875 Among the European troops throughout India in 1875 the cases of cholera numbered 288, of which 201 were in Bengal, 7 in cholera among European Troops Madras, and 80 in Bombay. The deaths from this throughout India. „„„„„ „„„„ toa ,'.. t> „! a :„ iv,r_7.._ J ka cause were 136 in Bengal, 4 in Madras, and 54 in Bombay, or a total of 194, — giving ratios of mortality of 3*66 for Bengal, -36 for Madras, and 5:30 for Bombay, or a total of 3*32 per 1,000 for the European army of India. The highest of these compares favourably with those of other epidemics. In Bengal, for example, in 1872, the loss from cholera was 10*66; in 1869, 1646; in 1867, 1384; and in 1861, 2373 per 1,000. These figures refer to the men only. Among the Native troops in Bengal* in 1875 there were 142 cases, of which 69 were fatal. Statistics shewing in detail the number attacked at each station and in each corps, both European and Native, the proportion of men, women, and children who suffered, and the extent of the disease among the prisoners, will be found in the usual tables. In this section I propose to summarise the evidence which has been furnished by Medical Officers in their special reports, and to consider how far it adds to our knowledge. But before turning 4o the instructive facts which these reports contain, the general history of the epidemic may be studied with advantage, and as the first step to this it is necessary to recapitulate very shortly the main events of the year previous. •'. ..-• '"I'll 1 /til* -W- -M-fc -a 2. In 1874 there was considerable prevalence of cholera in Lower Bengal. The fact is corroborated by the statistics of Calcutta, Remarkable absence of cholera ฆ. ? . -? - • * , - , .. ; in 1874, except in the Lower Pro- where the mortality from this cause exceeded that vinces of Bengal, in Assam, and Q f any year S] - nce ]_870. The returns for Assam, British Burma. i • i i i i i i , which have been received since last report was written, shew that over that part of the country also, cholera was prevalent. Out of a population of nearly 4 millions, 16,478 deaths were registered as due to it. In British Burma, also, there was some prevalence of the disease ; but with these exceptions cholera in 1874 was singularly dormant over the whole peninsula. The North-Western Provinces, with its 31 millions of people, returned only 6,396 deaths from it, and of these 4,952 were registered in the two districts of Gorakhpur and Basti, which adjoin the Behar Province of Bengal Proper. In Oudh, with more than 11 millions of inhabitants, the deaths from cholera were only 68 ; in the Punjab, with 17J millions, 78 ; in the Central Provinces, out of a population of 7-J millions, there were but 14, and of these 12 occurred in the district of Sumbulpore, which abuts on part of the lower portion of Bengal, and Jies not far from the endemic area. Among more than two millions of people in Berar, only 2 deaths from cholera appear in the returns, and of these, it was afterwards ascertained that one had been entered by mistake. In the whole of the Bombay Presidency, with 16 millions of people, only 37 deaths were recorded ; in Madras, with a population of 30 millions, the number was 313, and of these all but 70 occurred in the district of Ganjam, The returns of native troops and jails in the other presidencies are not received in this office. 2 which is continuous with the Bengal Province of Orissa. The Native States from which returns are received, shew the same remarkahle immunity from cholera in 1874, and the great facts of the year as regards the general population, the prevalence of cholera in Lower Bengal, Assam, and British Burma, and its remarkable dormancy in every other part of India, are borne out by the statistics of European troops, of Native troops, and of Jails. 3. Very different has been the history of cholera in 1875. Excepting British Burma, which returns only 761 deaths in Wide-spread epidemic in 1875. -ioHk a. a d c\aC\ *„ +V.^ • l 1875 instead of 960 as in the year previous, and of Assam, which returns 6,618 deaths in place of 16,478, there has generally been a marked increase in the disease. In the Lower Provinces it was more active, and, extending far beyond the limits of these provinces, it covered most part of the country and affected certain portions of it with great severity. The general results are shewn in the following statement. The mortality has been very heavy in many of the provinces, and it is all the more striking when compared with the immunity of the year previous, the figures for which have been placed in the statement side by side with those for 1875. The contrasts are very marked. In Oudh in the one year the cholera deaths were 68, in the other 23,321. In the Central Provinces there were 14 deaths in 1874 and 14,643 in 1875 ; in Berar 2 deaths in 1874 and 22,465 in 1875 ; in Madras 313 deaths in 1874 and 97,051 in 1875 ; in Bombay 37 deaths in the one year and 47,573 in the other. In endeavouring to understand the history of cholera, and to form any sound conclusions as to its cause or causes, the vast differences which characterise epidemic and non-epidemic years must be prominently borne in mind ; — are the causes to which epidemics have been ascribed in any decree sufficient to account for such differences ? STATEMENT OF DEATHS FEOM CHOLERA IN INDIA DURING 1875 AS COMPARED WITH 1874. Total deaths Total deaths Pbovince. Population. from cholera from cholera in 1875. in 1874. Bengal Proper and Assam ... 63,787,577 116,606 73,354 North-Western Provinces ... 30,769,056 41,106 6,396 Oudh... ... ... 11,174,785 23,321 68 Punjab ... ... 17,487,125 6,246 78 | Central Provinces... ... 7,427,608 14,643 14 Berar ... ... ... 2,184,945 22,465 2 British Burma ... ... 2,738,358 761 960 Madras and Mysore ... 30,360,211* 97,051 313 Bombay ' ... ... 16,228,774 47,573 37 Rajpootana, Hyderabad, and Central India ... ... not known. 14,649 4f * Population of Mysore not known. | f I n Western Malwa. 4. The distribution of the disease is more fully shewn in the statements Nos. I to X, which will be found in the occupied by the cholera of a p pen dix to this section marked A, and in which the number of deaths from cholera registered in every district are given by months. In No. XI similar information is given for Ceylon, but no further details have been received regarding the epide- mic in this island. The statistics shew that the prevalence of the disease in Bengal Proper was general, but most marked in the southern and eastern portions. In the North- Western Provinces the violence of the epidemic fell chiefly on the eastern districts. Some of those on the west also suffered severely. Of those bordering on the Jumna, Jhansi and Lalitpur almost entirely escaped. In Oudh the disease was very general and severe. In the Punjab the chief point worthy of notice is that the province suffered only in its lower part. The districts above Lahore except Sialkot 3 and Gurdaspur return only a very few isolated cases. As regards the Central Provinces, it is important to note that many of the districts escaped with little or no cholera. Jubbulpore returns only 11 deaths, Seoni only 3, Mandla only 47, Narsinghpur 93, Murwara 26, Damoh 0, Saugor 20, Balaghat 4, and Upper Godavari 20. As the population of each of these districts varies from 24,000 to nearly 400,000, the proportion of deaths in them due to cholera was thus very small. It was on Raipur and Bilaspur on the south-east, and on Nagpur and Wardha in the south, that the brunt of the epidemic in the Central Provinces fell: These four districts alone account for 11,100 deaths out of a total of 14,643 in the whole province. In Berar the disease was severe and widely diffused. The suddenness of its onset is remarkable. During the first four months of the year not a death from cholera was registered ; in May there were 249 and in June 3,625. In the Bombay Presidency the whole country was affected to a considerable extent, except Kanara in the south, where only 47 deaths were registered, and Sind in the north. Eor Upper Sind the return is blank, while Thar and Parkar and Karachi return in all only 49 deaths. The Madras statement so far corroborates the accuracy of this account, for South Kanara, which adjoins the Kanara of Bombay, was almost entirely free of the disease. Vizagapatam escaped entirely. In the Godavari and Kistna districts, also, there was little, but over the other parts of the Madras Presidency the people suffered much. The epidemic here, it will be observed, was in the main confined to the latter half of the year. 5. The area covered by epidemic cholera in 1875 is shewn in the map which accompanies this report. In such a map all ti^wฃiS?lSSrA < SS P " that cail be attempted is to indicate in a general way the areas of prevalence and exemption. The most striking facts which it illustrates are the very large area which the epidemic covered, its prevalence over nearly the whole of Southern India, its extension in the north-west, chiefly in those portions which lie near the Himalayas, several stations on which also suffered ; the escape of great part of the Central Provinces and of the Upper Punjab, the escape of the north-eastern part of Madras, and also of the south-western part, in which the neighbouring district of Bombay also shared. 6. These areas of prevalence, it is to be observed, are not the areas through which the great highways of traffic lead, These areas bear no relation to nor are t h e exem pt e d tracts those which are removed the great lines of communication. l . , from the great lines of communication. Over great part of the country in which cholera was most severe there are no railways, and the roads are often indifferent. Through part of the Central Provinces which escaped, one of the great trunk lines of railway, on which there is much and constant traffic, runs. In the Upper Provinces the extension of the disease was not alotfg the high road, but over an area where the means of communication are comparatively difficult and little used. 7. In looking at the map or at the statistics of the districts included in the epidemic, it must not be supposed that the Even within the epidemic area ... . , ,_ ฆ . ? -, *| - the villages attacked comparatively disease was universal, or that it afiected every por- tion of the population. The popular impressiou with regard to cholera seems to be that when once it attacks a district it spreads from village to village until all have more or less suffered. But this idea is altogether a mistake. In most of the districts where cholera prevailed the villages attacked were the exception, and even in those parts where it was most prevalent, and where it, beyond all question, attained the proportions of a very severe epidemic, many towns and villages escaped. Of this there is ample proof in the statement in the appendix marked B, in which the number of villages in each district is given, and also the number of them from which deaths from cholera were reported. This statement is a summary of the returns which have been received from Bengal, Oudh, the Punjab, the Central Provinces, and Berar. From the North- Western Provinces and British Burma the desired data have not been furnished. Exception may be taken to the statistics from Bengal, not only because the registration in that province is still very imperfect, but also because so much of it lies within the endemic area of cholera, but the details gathered from all the provinces agree in shewing how partial is the distribution of the disease. 4 8. To take a few examples. In Bengal Proper, the district of Burd wan re- turned 2,127 deaths from cholera in 1875 ; they were The fact illustrated by statistics. {mm 1Q g Qut of a of 5 igi vfllageB< The district of Nuddea suffered severely; 9,948 deaths from cholera were registered, but of 3,691 villages only 1,001 suffered. In Hazaribagh only 270 fatal cases were reported during the year, but they were spread over 8 months, and occurred in 38 out of a total of 6,703 villages. In Oudh the epidemic, as has been already stated, was very severe. In Gonda there were 3,806 deaths, but of 2,840 villages only 664 were attacked. In Bahraich 3,376 deaths were reported from 581 out of a total of 1,943 villages. In Hardoi 2,973 deaths were reported in 365 villages. The total number of villages in the district is 1,976. Yet in all three districts the disease was present for the greater part of the year. In the Punjab the fact of partial distribution is even more strikingly exhibited, as the epidemic in this part of the country was less violent. To take the three districts which suffered most the results are as follows :—: — \ I Number of Number of Total number Districts. deaths from villages of villages in cholera. attacked. the district. Gurdaspnr ... ... 1,482 164 2,179 iAmritsar ... ... 1,269 107 1,0*4 Kanffra ..'. ... 710 145 667 [_'_.._ ._ _.. . ' In the Central Provinces, again, Raipur returns 4,449 deaths from 401 out of a total of 3,071 villages, Bilaspur 2,525 deaths from 313 out of 2,210, and Nagpur 2,111 deaths from 325 out of a total of 1,637. Berar suffered more perhaps than any other province; but even in Akola, with its terrible mortality of 7,847 in 5 months, 272 villages escaped out of 980. In Buldana with 6,418 deaths 399 escaped out of 894. In Wun with 1,765 deaths only 293 villages were attacked out of 1,222. These instances are cited merely as illustrations. Nearly every line in the statement affords more or less striking evidence to the same effect. Nor are the phenomena to be explained on the supposition that the disease was confined to one portion of the district, and that the total number of villages attacked in each really represent those lying close to one another in a particular quarter, for the statement shews that it was widely diffused. In Burdwan, for example, 21 out of 28 of the circles into which the district is divided, for the purpose of mortuary registration, were affected ; in Nuddea 31 out of 33. In Noakholly all the 8 were attacked. In Amritsar, though 10 of the circles returned cases, only 107 villages were attacked out of 1,024. Similar results may be seen in the returns from Oudh, and indeed from every other part of the country. Further illustration of the same fact may also be found in the history of the villages within a radius of ten miles round military cantonments as shewn in Appendix C. 9. The Sanitary Commissioner of the Central Provinces, in forwarding the return for that province, observes that many Probable objections to these sta- o f c villages are mere hamlets consisting of a tistics. „ , ฆ?,.. , , mim o few houses, but this does not affect the compari- son. The question to be determined is how many different communities out of the total of each province were affected by the disease, and in this point of view it matters little whether these communities are generally large or small. It may be urged that the statistics under-state the facts hecause they refer only to those places from which deaths were reported, but with such a fatal disease as cholera any error due to this cause must be small. Or, again, it may be said that the registration is not to be depended upon, and that many deaths have been omitted. The registration is by no means perfect, but the contrast between 1875 and 1874, which has been already so fully discussed, is itself evidence that the returns are by no means so faulty as is supposed. The comparison of contiguous districts, whether in the same or adjoining provinces, tells a story which could not have been prearranged, and which bears within it most convincing proof of general accuracy. But the strongest grounds for believing that these returns, illustrating the 5 very partial distribution of cholera even within the limits of a severe epidemic, are substantially correct, is that it accords entirely with what is known of the disease, as it appears under the most intelligent medical observation. The distribution of cholera among villages as shewn in these returns is not in any degree more remarkable than its distribution in cantonments or jails, or towns, where the number of barracks or other dwellings attacked can be ascertained beyond all doubt. 10. The history of cholera among the people in the different provinces will be more fully recorded by their respective outbreak in cantonments and g an itary Commissioners. It will suffice here to discuss the details of the outbreaks in cantonments and jails, and as the facts regarding them came under the immediate observation of Medical Officers, their reports afford a mass of evidence of much more value than any that could be gathered from the general population of the country, among whom educated practitioners are as yet almost unknown. To save space as much as possible, and to avoid all needless additions to cholera literature, which has already become so voluminous, these reports are summarised as succinctly as possible in the " Notes on individual outbreaks " which form Appendix D of this Section. These notes have been prepared on nearly the same plan as those attached to the report of epidemic cholera in this country in 1872. They include every report which has reached me, and embrace every fact of the smallest importance which these reports contain. Here and there, indeed, they contain statements which seem to be of no importance, but which are reproduced because importance appears to be attached to them by the Medical Officers by whom they are made. All that can be attempted here is to summarise the facts. 11. The notes refer to 40 different stations scattered over a very large area. Commencing with Barrackpore and Eastern Bengal, Evidence afforded by the facts of pass on to Upper Bengal, to the North- Western these outbreaks. ti*ฃ i liS 1 iS , ซฎj.__it_jj. m T Provinces and Oudh, to Central India and the Low- er Punjab, beyond which, as has been already shewn, the epidemic did not extend in that direction. At these 40 places, 67 different communities suffered more or less from cholera. They consist of 37 European corps, 26 Native corps, 2 jails, the Thomason College at Roorkee and the Simla sanitarium. Unfortunately from many of the jails no reports have been received, and the record is therefore not so complete as it would otherwise have been. But the facts recorded are still very numerous ; they refer to 611 cases of cholera, which were treated in hospitals under the immediate care of many Medical Officers, of whom 66 furnish the reports. What, then, is the evidence derived from this large body of independent observers ? It may be conveniently summarised under the four heads which form the subjects of Sections II to V of tbe Notes. Ist, — The meteorology of the period when cholera was present ; 2nd, —The influence of contagion as exemplified either in the first appear- ance of the disease in each community or its subsequent spread ; 3rd, — The sanitary defects of the place ; and 4th, — The effect of movement from the locality attacked in checking the disease. The effect of other measures which were adopted to prevent its entrance will be separately considered. 12. On the first of these points, — the meteorology of the cholera time, — the as regards jneteoroiogy, informs information is scanty and imperfect. In many tion imperfect. of the reports it is not noticed at all, and in others the data are vague and unsatisfactory. This arises no doubt in great part from the want of proper instruments, but even in such a simple matter as the direction of the wind the statements are often indefinite and sometimes even contradictory. Generally heavy falls of rain and the unusual prevalence of east wind are noted, but this is not invariably the case. In some places the chief peculiarity was the stillness of the atmosphere. At Gwalior the prevailing wind is reported to have been from the south-west, and at Eerozepore it is said that there was a light wind from the west. Here the disease was confined to a few cases in the Cantonment. The district did not suffer. At Sirdarpore, again, the rain is described as unusually light, and the absence of electric phenomena is remarked. Much valuable information on meteorological conditions, in connec- 4 8. To take a few examples. In Bengal Proper, the district of Burdwan re- turned 2,127 deaths from cholera in 1875 ; they were The fact illustrated by Btatistics. reported frQm 19 g Qut o f a total of 5,191 Villages. The district of Nuddea suffered severely; 9,948 deaths from cholera were registered, but of 3,691 villages only 1,001 suffered. In Hazaribagh only 270 fatal cases were reported during the year, but they were spread over 8 months, and occurred in 38 out of a total of 6,703 villages. In Oudh the epidemic, as has been already stated, was very severe. In Gonda there were 3,806 deaths, but of 2,840 villages only 664 were attacked. In Bahraich 3,376 deaths were reported from 581 out of a total of 1,943 villages. In Hardoi 2,973 deaths were reported in 365 villages. The total number of villages in the district is 1,976. Yet in all three districts the disease was present for the greater part of the year. In the Punjab the fact of partial distribution is even more strikingly exhibited, as the epidemic in this part of the country was less violent. To take the three districts which suffered most the results are as follows :—: — Number of Number of Total number Districts. deaths from villages of villages in cholera. attacked. the district. Gurdfwpur ••• ••• 1.482 164 2,179 Amritsar ... ••• 1,269 107 1,024 Kangro ..'. ••• 710 145 667 In the Central Provinces, again, Raipur returns 4,449 deaths from 401 out of a total of 3,071 villages, Bilaspur 2,525 deaths from 313 out of 2,210, and Nagpur 2,111 deaths from 325 out of a total of 1,637. Berar suffered more perhaps than any other province; but even in Akola, with its terrible mortality of 7,847 in 5 months, 272 villages escaped out of 980. In Buldana with 6,418 deaths 399 escaped out of 894. In Wun with 1,765 deaths only 293 villages were attacked out of 1,222. These instances are cited merely as illustrations. Nearly every line in the statement affords more or less striking evidence to the same effect. Nor are the phenomena to be explained on the supposition that the disease was confined to one portion of the district, and that the total number of villages attacked in each really represent those lying close to one another in a particular quarter, for the statement shews that it was widely diffused. In Burdwan, for example, 21 out of 28 of the circles into which the district is divided, for the purpose of mortuary registration, were affected; in Nuddea 31 out of 33. In Noakholly all the 8 were attacked. In Amritsar, though 10 of the circles returned cases, only 107 villages were attacked out of 1,024. Similar results may be seen in the returns from Oudh, and indeed from every other part of the country. Purther illustration of the same fact may also be found in the history of the villages within a radius of ten miles round military cantonments as shewn in Appendix C. 9. The Sanitary Commissioner of the Central Provinces, in forwardiug the return for that province, observes that many Probable objections to these sta- o f villages are mere hamlets consisting of a tistics. _ , i j j_i • i ฑ ฃp j.i few houses, but this does not affect the compari- son. The question to be determined is how many different communities out of the total of each province were affected by the disease, and in this point of view it matters little whether these communities are generally large or small. It may be urged that the statistics under-state the facts because they refer only to those places from which deaths were reported, but with such a fatal disease as cholera any error due to this cause must be small. Or, again, it may be said that the registration is not to be depended upon, and that many deaths have been omitted. The registration is by no means perfect, but the contrast between 1875 and 1874, which has been already so fully discussed, is itself evidence that the returns are by no means so faulty as is supposed. The comparison of contiguous districts, whether in the same or adjoining provinces, tells a story which could not have been prearranged, and which bears within it most convincing proof of general accuracy. But the strongest grounds for believing that these returns, illustrating the 5 very partial distribution of cholera even within the limits of a severe epidemic, are substantially correct, is that it accords entirely with what is known of the disease, as it appears under the most intelligent medical observation. The distribution of cholera among villages as shewn in these returns is not in any degree more remarkable than its distribution in cantonments or jails, or towns, where the number of barracks or other dwellings attacked can be ascertained beyond all doubt. 10. The history of cholera among the people in the different provinces will be more fully recorded by their respective outbreak in cantonments and s an itary Commissioners. It will suffice here to jails. j. i-i,_. jซฑ_.:i_ if j_t i_i i • i m discuss the details of the outbreaks in cantonments and jails, and as the facts regarding them came under the immediate observation of Medical Officers, their reports afford a mass of evidence of much more value than any that could be gathered from the general population of the country, among whom educated practitioners are as yet almost unknown. To save space as much as possible, and to avoid all needless additions to cholera literature, which has already become so voluminous, these reports are summarised as succinctly as possible in the " Notes on individual outbreaks " which form Appendix D of this Section. These notes have been prepared on nearly the same plan as those attached to the report of epidemic cholera in this country in 1872. They include every report which has reached me, and embrace every fact of the smallest importance which these reports contain. Here and there, indeed, they contain statements which seem to be of no importance, but which are reproduced because importance appears to be attached to them by the Medical Officers by whom they are made. All that can be attempted here is to summarise the facts. 11. The notes refer to 40 different stations scattered over a very large area. Commencing with Barrackpore and Eastern Bengal, Evidence afforded by the facts of p ass on fa Upper Bengal, to the North- Western these outbreaks. _ J _r II & " Provinces and Oudh, to Central India and the Low- er Punjab, beyond which, ac has been already shewn, the epidemic did not extend in that direction. At these 40 places, 67 different communities suffered more or less from cholera. They consist of 37 European corps, 26 Native corps, 2 jails, the Thomason College at Roorkee and the Simla sanitarium. Unfortunately from many of the jails no reports have been received, and the record is therefore not so complete as it would otherwise have been. But the facts recorded are still very numerous ; they refer to 611 cases of cholera, which were treated in hospitals under the immediate care of many Medical Officers, of whom 66 furnish the reports. What, then, is the evidence derived from this large body of independent observers ? It may be conveniently summarised under the four heads which form the subjects of Sections II to V of the Notes. Ist, — The meteorology of the period when cholera was present ; 2nd, —The influence of contagion as exemplified either in the first appear- ance of the disease in each community or its subsequent spread ; 3rd, — The sanitary defects of the place ; and 4th, — The effect of movement from the locality attacked in checking the disease. The effect of other measures which were adopted to prevent its entrance will be separately considered. 12. On the first of these points, — the meteorology of the cholera time, — the as regard* meteorology, informs information is scanty and imperfect. In many tion imperfect. o f the reports it is not noticed at all. and in others of the reports it is not noticed at all, and in others the data are vague and unsatisfactory. This arises no doubt in great part from the want of proper instruments, but even in such a simple matter as the direction of the wind the statements are often indefinite and sometimes even contradictory. Generally heavy falls of rain and the unusual prevalence of east wind are noted, but this is not invariably the case. In some places the chief peculiarity was the stillness of the atmosphere. At Gwalior the prevailing wind is reported to have been from the south-west, and at Eerozepore it is said that there was a light wind from the west. Here the disease was confined to a few cases in the Cantonment. The district did not suffer. At Sirdarpore, again, the rain is described as unusually light, and the absence of electric phenomena is remarked. Much valuable information on meteorological conditions, in connec* 6 * tion with the prevalence of disease* can hardly be expected from Medical Officers who are provided with no special means of observation. What peculiar features characterise a cholera-epidemic year as contra-distinguished from a non-epidemic year, the Meteorological Department of India which has been recently organised may, it is hoped, in time be able to explain. 13. In regard to none of the 67 communities affected with cholera is there sufficient evidence to shew that the outbreak wSVl^caLdufto^Trtalfot was due to importation. At Agar the only person attacked had come two days previous from Oojein, where cholera was prevailing ; in other words, the causes of cholera to which he had been exposed at Oojein apparently did not produce their results until after his arrival at Agar, but there was no spread of the disease. The causes of cholera which existed at Oojein do not seem to have existed at Agar, and the seizure of the one man who was attacked to all appearance in consequence of his having been at Oojein was insufficient to produce any further case. This solitary instance, out of the total of 67, affords an illustration of how cholera may be imported and cause no outbreak. The remaining 66, on the other hand, are examples in which outbreaks occurred without any proof that they were due to importation. In many of the reports as extracted in the notes, it will be seen that the disease is ascribed to importation, merely because cholera was more or less prevalent in the vicinity. In the' 73rd Foot at Cawnpore, for example, it is attributed to indirect commut nication with cholera- stricken persons by means of the native servants. In the 35th Native Infantry, at the same station, it is explained by the fact that the first man attacked had only just returned from leave. In the l-18th Foot at Moradabad, the punka coolies are supposed to have been the medium of communication. In the Royal Artillery at Meerut, the barracks were under repair ; native workmen were thus about, and moreover some of the hospital establishment resided in a neighbouring village where cholera prevailed. At Dharmsala, travellers from Jawalamukhi and Mundi are credited with having introduced contagion. But in none of these or in any one of the 67 bodies concerned, except Jubbulpore, to which reference will be made hereafter, is there any attempt to prove by evidence that the resident in the locality who was first attacked had suffered in consequence of communication, either direct or indirect, with some individual, whether ill of cholera or in good health, who had come from an affected locality. The prevalence of cholera in the vicinity seems not unfrequently considered sufficient proof of importation, especially where, as is generally the case, communication, in spite of any attempts to the contrary, continued to a great extent unrestrained ; but however strongly an opinion founded on such grounds may be expressed, it is merely an opinion. In some instances the circumstances were adverse even to this theorer tical view. In Kasauli, for example, there had been no cases of cholera among the natives before the Europeans were attacked. Although the Europeans suffered severely, the bazar remained free of the disease throughout, and the only cases among natives were a few chiefly among the servants who were most exposed in camp. So far as is known, at Ferozepore there was no cholera among the natives when the disease attacked the European troops in the cantonment ; and at Meean Meer the natives did not suffer at all. 14. It has been already said that Jubbulpore forms an exception to the _ . __ Mk - general statement that at none of the places con- Facts at Jubbulpore examined. D . , ? ?. , . ./ . „ cerned is there any attempt to prove that cases ot cholera occurring in them had been due to importation. The matter is not mentioned in the report from Jubbulpore, but it was brought to my notice by the Sanitary Commissioner for the Central Provinces, and 1 enquired into the circumstances during my recent tour. As may be seen in the notes, the only one of the military attacked at this station was a sepoy of a Bombay regiment who was rejoining from leave. His illness commenced in the train; he arrived at Jubbulpore on the 27th August, and next day applied for relief at the hospital of the 16th Madras Native Infantry. He was placed in a separate building and then transferred to a tent close by. A few days afterwards cholera broke out in the village of Katinga, which is about 300 yards distant, and there were in all 10 cases reported in it. This village is on the banks of a small stream which passes by the hospital, and it was supposed that the outbreak 7 was due to the water having been polluted with the discharges of the sepoy, which the sweeper, instead of burying as he was ordered to do, may perhaps have thrown on the ground. But there is no evidence on any of the points required to substantiate the story. It is not known that the sweeper had thrown the discharges on the ground. The people do not drink from the stream, but from "jiriahs" or wells sunk near it. The water was very foul and the whole village very dirty, but it is not probable that any impurity, even if it had found its way into the stream, could have percolated into these wells. The facts so far as they are known may be regarded as favouring the idea that the outbreak in the village was in some way due to communication, but the most important particulars are too vague to be of much value in determining this matter. 15. On the subject of importation the evidence must often be more or less indefinite, but the question whether the disease J%?S^ฃsฃฃl3? iaDM s P reads from the sick to the health y admits of much more precise investigation, especially in these days when cholera patients under medical supervision are carefully isolated, and it is well known what persons come in contact with them. Assuming for the sake of illustration that cholera may be carried by human agency, there must always be difficulty in discovering how this has occurred, whether by direct communication with affected towns or villages, or indirectly by means of the native servants or supplies. But the probabilities of the outbreak having been due to the arrival of a person affected with cholera, a matter of fact, in regard to which, especially in this country, there must often be necessarily more or less conjecture, may be weighed to some extent, and estimated more nearly at their real value by considering what occurred in the case of attendants on the sick who came under medical observation, and in regard to whom all is known with comparative accuracy. The evidence under the one head will thus have a greater importance if taken in connection with that under the other, as it is in the following statement : — -r ? .j Number of hosloTh^S Numbe % of Pitalservants STATION. Corps or other community. the outbreak lln<ฃnฃon [p^S- *eate, 1. Barrackpore ... 10th Native Infantry .ซป no 2 none. 2. Cachar ... 3rd ditto ... no 3 none. 3. Baxa Dooar ... 38th ditto ... no 1 none. 4. Jalpaiguri ... 16th ditto ... no 3 none. 5. Dinapore ... C-llth Royal Artillery ... no 1 none. 6. Ditto ... 2nd Native Infantry no 1 none. 7. Chunar ... Detachment 109 th Foot no 3 none. 8. Ditto ... Detachment 13th Native Infantry no 1 none. 9. Gorakhpur ... Ist Native Infantry ... no .2 none. 10. Fyzabad ... 51st Foot ... no 24 none, 11. Ditto ... l-25th.Foot - no 2 1 12. Ditto ... Jail ... no 12 none. 13. Lucknow ... Royal Artillery ... no 24 none. 14. Ditto ... 13th Hussars ... no 17 1 15. Ditto ... 40th Foot • ... no 4 none. 16. Ditto ... 65th „ ... no iq none. 17. Ditto ... 19th Bengal Cavalry ... no 4 none. 18. Ditto ... 6th Native Infantry ... no 5 none. 19. Ditto ... 41st ditto ... no 4 none. 20. Sitapur ... 14th Foot ... no 1 none. 21. Cawnpore ... 73rd „ * ... no 6 none. 22. Ditto ... 35th Native Infantry ... no 5 none. 23. Allahabad ... Royal Artillery ... no 1 none. 8 , ? Number of hos. „ J? shew that ™J*J VheTat- Station. Corps or other community. the outbreak cholera tendants on wasduetQim- treatod _ the sick who Pฐ rtatlon? were attacked 24. Allahabad ... 1-s th Foot ... no 10 none. 25. Ditto ... 34tb Native Infantry ... no 16 none. 26. Bareilly ... Detachment Convalescents ... no 2 none. 27. Ditto ... 1 1 th Native Infantry ... no 1 none. 28. Moradabad ... 1-1 8th Foot ... no 6 2 29. Dehra Dun ... 2ndGoorkhas ... no 9 none. 30. Roorkee ... 55th Foot .. no 6 none. 31. Ditto ••• Thomason C. E. College. ... no 6 none. 32. Meerut .ซ. Royal Artillery ... no 15 1 33. Ditto ... 15th Hussars ... no 2 none. 34. Ditto ... 85th Regiment ... no 1 none. 35. Ditto ... Central Prison ... no 23 1 36. Delhi ... Royal Artillery ... no 3 none. 37. Ditto ... Wing 55th Foot ... no 5 none. 38. Ditto ... 4th Bengal Cavalry Detachment no 1 none. 39. Ditto ... 33rd Native Infantry ... no 1 none. 40. Muttra ... 10th Hussars ... no 8 2 41. Morar .., Royal Artillery ?, no 4 none. 42. Ditto ... 54th Foot ... no 26 none. 43. Gwalior ... Detachment 63rd Foot ... no 7 none. 44. Nowgong ... Ditto ditto ... no 5 none. 45. Ditto ... 3rd Bengal Cavalry ... no 4 none. 46. Ditto ... 20th M, N. I. ... no 11 none. 47. Jubbulpore ... 16th M. N. I. ... no 1 none. 48. Sehore ... Bhopal Battalion ... ... no 1 none. 49. Agar ... 2nd Regiment, C. I. Horse ... * 1 none. 50. Sirdarpore ... Malwa Bheel Corps ... no 21 none. 51. Guna ... Ist Regiment, C. I. Horse ... no 1 none none-52. Bhurtpore ... Det. Deolee Irregular Force ... no 1 none. 53. Umballa ... 11th Hussars ... no 1 none. 54. Ditto ... 4th Battalion, Rifle Brigade ... no 33 none. 55. Kasauli ... Convalescent Dep6t ... no 52 3 56. Simla ... Sanitarium ... no 58f none. 57. Ferozpore ... Royal Artillery ... no 2 none. 58. Ditto ... 2-12 th Foot ... no 6 none, 59. Sialkot ... 9th Lancers ... no 1 none. 60. Dharmsala ... Detachment 81st Regiment ... no 5 none. 61. Ditto ... Ist Goorkhas ... no 97 H 62. Kangra ... Detachment 81st Foot ... no 1 none. 63. Amritsar ... Ditto l-6th „ ... no 5 none. 64. Govindgarh ... Royal Artillery ... no 1 none. 65. On the march ... Detachment l-6th Foot ?. no 1 none. 66. Meean Meer ... 2-1 st Foot ... no 7 none. 67. Dera Ismail Khan 2nd Punjab Infant ... no 1 none. Total ... 611 * As already explained, this case was imported. No others followed. t Only those cases treated in hospital are entered here. The total number reported was 341, and no instance of con: tagion among them adduced. 9 > 16. In 59 of the 67 communities among whom cholera appeared* -^in 59 m 59 out of the 67 outbreaks no hospitals in which 391 cases of cholera were treated suspicion that the disease was com*- not one of those coming in contact with the sick municatedbythesick. suffered at all. In some of them the number of cases was small* but in others it was considerable. For example, in the 51st Foot at Fyzabad 24 cases occurred; in the 65th Foot at Lucknow 16 persons were attacked ; in the Malwa Bheel Corps there were 21 cases ; in the 4th Battalion, Rifle Brigade, Umballa, 33 cases ; and at Simla 58 cases treated in the cholera hospital ; yet in none of these or 54 of the other outbreaks did a single attendant suffer. In Bof the 67 communities certain of the hospital servants or of the friends who nursed the sick were attacked. The last column of the above statement shews that in all there were 22 such cases, and it will now be necessary to examine the facts recorded in regard to each of them somewhat in detail. 17. The first on the list is the Ist Battalion, 25th Regiment, which arrived at Fyzabad from England on the 25th November o tt e rwliMnTo\%h^k anta ฐ r 18 ?5. Two women were the only persons attacked. In regard to the first it is noted that there is a complete absence of any communication to account for the disease ; " not so the second, for here there is plain evidence of communication. The second woman came from a different block, accompanied her friend to hospital and stayed there for some time ministering to her. Twenty-four hours after being sent away she herself displayed the disease," In the 13th Hussars, at Lucknow, a man attacked on the 22rid September " had been attending his wife in one of the cholera tents from the 14th. The woman had been in a separate tent throughout, and had been moved into a clean tent when convalescent four days before her husband was attacked." In the l-18th Foot at Moradabad it is stated that a mother attending her child was herself seized. She, however, was ill previously with diarrhoea. The fifth case in this Regiment was the father of the other child seized. The child was attacked at midnight of the 4th September and sent to hospital at 6-30 of the sth. When the child was removed to hospital, the father was transferred to another quarter, and all communication between them ceased. He was attacked at 6-30 p.m. of the Bth. The quarter he occupied then was a building at the other end of which one of the first cases had occurred. The mother, it may be added, nursed the child throughout and did not suffer. A dresser attached to the Royal Artillery hospital at Meerut was attacked. In the Meerut central prison the second case was that of a hospital sweeper. In the 10th Hussars at Muttra, during the first outbreak, a hospital apprentice suffered from painless diarrhoea, and a sweeper was attacked. At Kasauliin three cases parents, after attending their children, were attacked, 2 in camp and lin the station. The report, of the Ist Goorkha Regiment at Dharmsala cites 11 instances in which hospital servants or friends coming in contact with cholera cases were themselves attacked, the details of which will be found in the notes on that station : 8 were attendants on the sick, 2 were doolie bearers, and 1 the hospital com pounder. 18. But small as the number is, the bare statement that 22 attendants on the sick suffered from cholera would convey a very JZ^^^tZSS™" erroneous impression of the facts, for there are other important circumstances connected with many of them that must be taken into consideration. Passing over the cases of the woman in the l-25th at Fyzabad, and of the man of the 13th Hussars who nursed his wife at Lucknow, there come the instances cited in the l-18th Foot at Moradabad. One of these is admitted by the Medical Officer to be more than doubtful, because the woman had been ill of diarrhoea previous to attendance on her child. In the other, the father is with his child for 6J hours; he is removed to another barrack, in the end of which a previous case of cholera had occurred, and has no further communication with the child. He had taken no food and had not slept for 3 days before he wag attacked. It is not stated if the sweeper in the Meerut jail had had any communication with the only other case which had occurred when he was seized. At Kasauli the cases of 3 parents attacked are complicated by their recent arrival in camp from the station where the 8 T ? . •. Number of hos- Station. Corps or other community. the outbreak SndantTon W nation? 11 "" treated - the Sick Who were attacked. 24. Allahabad ... l-sth Foot ... no 10 none. 25. Ditto ... 34th Native Infantry ... no 16 none. 26. Bareilly ... Detachment Convalescents ... no 2 none. 27. Ditto ... 11th Native Infantry ... no 1 none. 28. Moradabad ... 1-1 8th Foot ... no 6 2 29. Dehra Dun ... 2nd Goorkhas ... no 9 none. 30. Roorkee ... 55th Foot .. no 6 none. 31. Ditto ... Thomason C. E. College ... no 6 none. 32. Meerut ... Royal Artillery ... no 15 1 33. Ditto ... 15th Hussars ... no 2 none. 34. Ditto ... 85th Regiment ... no 1 none. 35. Ditto ... Central Prison ... no 23 1 36. Delhi ... Royal Artillery ... no 3 none. 37. Ditto ... "Wing 55th Foot ... no 5 none. 38. Ditto ... 4th Bengal Cavalry Detachment no 1 none. 39. Ditto ... 33rd Native Infantry .., no 1 none. 40. Muttra ?. 10th Hussars ... no 8 2 41. Morar .., Royal Artillery ?, no 4 none. 42. Ditto ... 54th Foot ... no 26 none. 43. Gwalior ... Detachment 63rd Foot ... no 7 none. 44. Nowgong ... Ditto ditto ... no 5 none. 45. Ditto ... 3rd Bengal Cavalry ?, no 4 none. 46. Ditto ... 20th M, N. I, ... no 11 none. 47. Jubbulpore ... 16th M. N. I. ... no 1 none. 48. Sehore ... Bhopal Battalion ... ... no 1 none. 49. Agar ... 2nd Regiment, C. I. Horse ... * 1 none, 50. Sirdarpore ... Malwa Bheel Corps ... no 21 none. 51. Guna ... Ist Regiment, C. I. Horse ... no 1 none. 52. Bhurtpore ... Det. Deolee Irregular Force ... no 1 none. 53. Umballa ... 11th Hussars ... no 1 none. 54. Ditto ?. 4th Battalion, Rifle Brigade ... no 33 none. 55. Kasauli ... Convalescent Depot ... no 52 3 56. Simla ... Sanitarium ... no 58f none. 57. Ferozpore ... Royal Artillery ... no 2 none. 58. Ditto ... 2-12 th Foot ... no 6 none, 59. Sialkot ... 9th Lancers ... no 1 none. 60. Dharmsala ... Detachment 81st Regiment ... no 5 none. 61. Ditto ... Ist Goorkhas ... no 97 11 G2. Kangra ... Detachment 81st Foot ... no 1 none. 63. Amritsar ... Ditto l-6th „ ... no 5 none. 64. Govindgarh ... Royal Artillery ... no 1 none. 65. On the march ... Detachment l-6th Foot ?. no 1 none. 66. Meean Meer ... 2- Ist Foot ... no 7 none. 67. Dera Ismail Khan 2nd Punjab Infant ... no 1 none. Total ... 611 * As already explained, this case was imported. No others followed. _ t Only those cases treated in hospital are entered here. The total number reported was 341, and no instance of eon? tagion among them adduced. 9 > 16. In 59 of the 67 communities among whom cholera appeared, —in 59 m 59 out of the 67 outbreaks no hospitals m which 391 cases of cholera were treated suspicion that the disease was com*, not one oi those coming in contact with the sick municatedbythesick. suffered at all. In some of them the number of cases was small, hut in others it was considerable. For example, in the 51st Foot at Fyzabad 24 cases occurred; in the 65th Foot at Lucknow 16 persons were attacked ; in the Malwa Bheel Corps there were 21 cases ; in the 4th Battalion, Rifle Brigade, Umballa, 33 cases ; and at Simla 58 cases treated in the cholera hospital ; yet in none of these or 54 of the other outbreaks did a single attendant suffer. In Bof the 67 communities certain of the hospital servants or of the friends who nursed the sick were attacked. The last column of the above statement shews that in all there were 22 such cases, and it will now be necessary to examine the facts recorded in regard to each of them somewhat in detail. 17. The first on the list is the Ist Battalion, 25th Regiment, which arrived at Fyzabad from England on the 25th November ot^Tl^u^^t^:^^ ฐ T 1875. Two women were the only persons attacked. In regard to the first it is noted that there is a complete absence of any communication to account for the disease ; " not so the second, for here there is plain evidence of communication. The second woman came from a different block, accompanied her friend to hospital and stayed there for some time ministering to her. Twenty-four hours after being sent away she herself displayed the disease." In the 13th Hussars, at Lucknow, a man attacked on the 22nd September "had been attending his wife in one of the cholera tents from the 14th. The woman had been in a separate tent throughout, and had been moved into a clean tent when convalescent four days before her husband was attacked." In the l-18th Foot at Moradabad it is stated that a mother attending her child was herself seized. She, however, was ill previously with diarrhoea. The fifth case in this Regiment was the father of the other child seized. The child was attacked at midnight of the 4th September and sent to hospital at 6-30 of the sth. When the child was removed to hospital, the father was transferred to another quarter, and all communication between them ceased. He was attacked at 6-30 p.m. of the Bth. The quarter he occupied then was a building at the other end of which one of the first cases had occurred. The mother, it may be added, nursed the child throughout and did not suffer. A dresser attached to the Royal Artillery hospital at Meerut was attacked. In the Meerut central prison the second case was that of a hospital sweeper. In the 10th Hussars at Muttra, during the first outbreak, a hospital apprentice suffered from painless diarrhoea, and a sweeper was attacked. At Kasauli in three cases parents, after attending their children, were attacked, 2 in camp and lin the station. The report of the Ist Goorkha Regiment at Dharmsala cites 11 instances in which hospital servants or friends coming in contact with cholera cases were themselves attacked, the details of which will be found in the notes on that station : 8 were attendants on the sick, 2 were doolie bearers, and 1 the hospital com pounder. 18. But small as the number is, the bare statement that 22 attendants on the sick suffered from cholera would convey a very cOn^teTw?tllh^tSc O n^teTw?tl1h^tS? anceB erroneous impression of the facts, for there are other important circumstances connected with many of them that must be taken into consideration. Passing over the cases of the woman in the l-25th at Fyzabad, and of the man of the 13th Hussars who nursed his wife at Lucknow, there come the instances cited in the l-18th Foot at Moradabad. One of these is admitted by the Medical Officer to be more than doubtful, because the woman had been ill of diarrhoea previous to attendance on her child. In the other, the father is with his child for 6J hours; lie is removed to another barrack, in the end of which a previous case of cholera had occurred, and has no further communication with the child. He had taken no food and had not slept for 3 days before he was attacked. It is not stated if the sweeper in the Meerut jail had had any communication with the only other case which had occurred when he was seized. At Kasauli the cases of 3 parents attacked are complicated by their recent arrival in camp from the station where the 10 disease prevailed. At Dharmsala the 8 attendants, 2 doolie bearers and 1 compounder attacked, were from among a total of 127 persons who came in contact with the sick. The outbreak among the Goorkhas at Dharmsala was very severe. There were, in all, 97 attacks in a strength of 1,200, or in the proportion of 8 08 per cent. If the strength of attendants and the cases among them be separated, the results stand thus : — Attendants, strength 127; cases 11; percentage 8*66, All others, „ 1,073; „ 86; „ 8-01 The proportion of attacks among the attendants is thus almost the same as among those who did not come in contact with the sick. It is very remarkable that they are so nearly alike, for the attendants were treated on a different principle from any other part of the regiment. In the bazar and lines each hut, on a case occurring in it, was vacated and cleansed, but no such procedure was adopted with the building occupied by the attendants. The cases among them were attributed to contagion and the building was not vacated. If there is any virtue in the rules requiring the immediate evacuation of every building in which a case of cholera occurs, the attendants in this instance ought to have suffered far more than the regiment generally. That they did not suffer much more than the regiment appears to have been due to the fact that the movement into camp was so unsuccessful. Instead of moving away from the disease the site occupied by the camp seems to have been even more exposed to it than the lines. The evidence in support of personal contagion which is adduced from this outbreak at Dharmsala seems thus to tell very strongly against it. In not one of the communities in which an attendant on a cholera patient was himself attacked, is there evidence to make it even probable that the disease was contracted from the sick. The question of contagion can never be decided by individual cases. It is only by taking the statistics as a whole, and ascertaining whether the proportion of attacks among those who come in contact with the sick is decidedly greater than among those who have nothing to do with them, that any sound conclusions can be drawn. The facts of the outbreaks of 1875 afford no such evidence of contagion among the hospital and other attendants ; on the contrary, they testify strongly in quite the opposite direction. In none of the outbreaks is there any history of such attendants having suffered in any exceptional degree. In no instance is there the smallest ground for believing that the sick formed the centre from which others were affected. The first few cases occurred often almost simultaneously in different buildings, at considerable distances apart and occupied by persons who had no connection with one another. The other attacks have followed without any apparent relation to those which had gone before. 19. It may be urged that the escape of the attendants and hospital establishment is only what might be expected eSSedbySdSfe^ion! 1011 *ฐ be from tne use of disinfectants, which is now gene- rally had recourse to by those who come in con- tact with the sick, but this immunity is no new feature in the disease. It has been exemplified for years before disinfection was practised, not only in the Calcutta hospitals, but in other parts of the country. Writing in 1856, Dr. Kenneth Mackinnon quotes the experience of Dr. H. A. Bruce on this point. "In 1848,"* he says, " I had cholera in the Eusiliers (at Cawnpore) from May till September. During the whole of that time, I may say, the hospital was never free of some cases, and at times it was crowded with them. The whole establishment may be said to have lived in the wards ; the coolies for hours together never left the beds of the patients ; the Medical Officers did nothing but administer to their wants, and yet not one man, European, half-caste, or native, ever shewed the least symptoms of cholera. I took most particular care to have them mustered and looked at, but therewas not in that year even a case of bowel complaint among them." This quotaion is but an example of what has been observed again and again long before disinfection in cholera cases was ever thought of. * Indian Annals of Medical Science, No. Vll,page 140. 11 20 The singular escape of the hospital establishment and other attendants on the sick in 1875 is all the more remarkable Escape of attendants all the more because were o ft en exposed t.O depressing remarkable, because they were y J *, , , „.,]„„ often placed in circumstances fa- influences, such as the want oi rest ana reguidi vourable to disease. ra/in l o o^^ofrr on/I rvni^f oil whinh TปredisT)OSe to meals, anxiety and grief, all which predispose to disease, and in these days, when the dangers of personal contagion are so generally inculcated, they were no doubt in many instances also subject to the additional depression of fear, which has long been recognized as peculiarly favourable to the development of cholera. 21. The evidence as regards the attendants would be more satisfactory if the actual number of those who came in contact in future the number of attend- w ith the sick were known. The value of such ants -will be shewn. jซj.ซ:1ซ !,„„ 0 1- Q n^ VOV OQ r, ilinot.vn.fpH in f.Vlfl nnsfi of details has already been illustrated in the case of Dharmsala from which they were specially obtained. Unfortunately this information is not given in the reports of Medical Officers, but in future they will contain replies to the following questions :— How many individuals including Medical and other Officers, hospital assistants, orderlies and others, both European and natives, attended on the cases of cholera which occurred, and of these how many were attacked with cholera and on what dates ? Of the sweepers employed in collecting and removing cholera excreta (who should also be included in the above), how many were seized with cholera ? Were the circumstances connected with any of these attacks such as to lead to the conclusion that the persons in question were attacked because ot such attendance r 22 Other possible examples of contagion may now be examined. The first instance is that of the sirdar coolie employed 0 ! e a x ttrtu e ted To by the Royal Artillery at Lucknow "in removing infected clothing." He was attacked. The case contagion. is not cited by the Medical Officer as an example of contagion. On the contrary he writes : " This man was terribly afraid of cholera, and the fact of his having contracted the disease does not prove that it was communicated to him in the cholera hospital. None of the regular attendants on the sick were attacked." In the 11th Hussars at Muttra, the only man seized during the second outbreak in August, it is suggested, may have contracted the disease by having in his possession a waist-belt which had belonged to the man attacked on the 21st April. The quotation given in the notesฐ regarding the 54th Regiment at Morar narrates what are considered instances 0 of contagion. A father and daughter were attacked. Of 2 women and 7 children in a tent, 2 women and 2 children were attacked between 10 a.m. of the '29th August and 7 a.m. of the 30th, and there were six seizures in hospital tents. Again, a mother, having attended one of her children on the 30th August, is believed to have communicated the disease either directly or indirectly, by her husband to another of them, who was attacked on the 9th September. In the Gwalior Port cases Nos. 3 and 5 are ascribed to case No. 1, because they were for 10 hours in the same room where No. 1 was seized ; and case No. 6is also attributed to the same cause, as he had been located in the same barrack as men who had been in the same room as No. 1. At Kasauli, a man, admitted into hospital with diarrhoea on the 7th July, was attacked with cholera on the 9th, and the hospital sweeper s child also suffered from the disease. At Dharmsala, a water-carrier is believed to have contracted the disease from a previous case. At Meean Meer a man was attacked the morning after he had removed soiled bedding and clothing. Eor details of these cases reference must be had to the " notes ;" and from them it may be seen how far they deserve serious consideration. The cases brought forward in the 54th Regiment at Morar are opposed to all ordinary ideas of contagion. The father and daughter were attacked within a few hours of each other, so were the 4 persons in the tent. As for the 6 cases in hospital tents, there is no evidence of any of them having been in contact with the sick. Similar remarks apply to the 3 cases at Gwalior. At Dhurmsala the first case, and the watercarrier, who is believed to have contracted the disease from it, were attacked within a few hours of each other. 12 23. The fourth section of the " Note" includes the mention of any sanitary defects which have heen noted in the Medical go'TrSn^connec?^ ouISSS Officers' reports. To them reference must be made with water polluted by cholera dis- f or details. It will be observed that in many charges. ฆ, ? . . „ ปi . i i • „ „„.*.• places everything is said to have been in a satis- factory condition. In others there was a want of proper drainage, and in a few there was over-crowding. It is worthy of notice that, in regard to only two outbreaks, is it even suspected that the water may have been contaminated with cholera discharges and thereby caused the disease. The first is the case of Jubbulpore, which had been already mentioned, and in regard to which it has been shewn that there is no evidence either that the water had been so contaminated, or that it had been drunk by the people affected. The second case is that of Dharmsala, but here, although the Medical Officer suggests that this contamination of tlie water-supply may have taken place, he himself sets the idea aside as to all appearance an impossibility. 24. As a whole, the evidence is strongly in favour of the immediate evacuation of buildings or particular quarters in Movements generally attended w hick a case o f cholera may have occurred, and with good results. „ . . , / ? ซ.__*._ jj 7 1 ._i of moving into camp away from the affected local- ity. In many instances no case occurred among the parties thus removed into camp. There were none, for example, in the camp of the Detachment of the 109 th Foot at Chunar, of the jail at Fyzabad, of the 40th at Lucknow, of the 73rd at Cawnpore, of the l-sth and the 34th Native Infantry at Allahabad, of the 55th at Delhi, of the Royal Artillery at Morar, of the Detachment of the 63rd at Nowgong, or of the Detachment of the 81st at Dharmsala. In other instances, again, as in the 51st Regiment at Fyzabad, the 65th Foot at Lucknow, the l-18th Foot at Moradabad, the 55th at Roorkee, and the 63rd at Gwalior, the disease in camp was limited to one or two cases occurring generally within a short time after removal. The experience of the Thomason College at Roorkee, and the Royal Artillery at Meerut, was not quite so favourable, and still less so that of the 54th at Morar, the Rifle Brigade at Umballa, and the Ist Goorkhas at Dharmsala. At Kasauli, although 12 cases occurred in the camps, they were chiefly among new arrivals from the station in which the disease prevailed. But, even in those instances which were attended with least success, strong testimony is borne to the advantages of movement, not only as the best means of checking the disease, but also as a measure which is most beneficial in inspiring confidence, and raising the spirits of the troops and others among whom cholera may appear. In no instance are any ill effects of any consequence attributed to the exposure in camp. As a rule, the health of those in camp did not suffer at all, and in not a few instances it appeared to be benefited by the change. 25. Quarantine found no place in the Report of the Special Cholera Com- mission of 1861, or in the rules for the manage- Attempts at quarantine in pertain men t of troops in epidemic years which were based places. , . x * , ? \ -1, _ Mn j,,ซn.. j_ on their recommendations; but gradually, under the force of popular belief in the contagious character of the disease, endeavours have been made of late years to protect certain stations by isolating them as much as possible from the surrounding country. The experience of cantonments in this matter has been made the subject of special investigation and the main results may be briefly stated. The system varied much in different places. In many no restrictions whatever were imposed. In three of them pilgrims only were diverted, In others cordons were drawn round the station to prevent all persons ill from cholera from entering, and generally to stop communication with affected localities. In regard to only 6 — Nowgong, Nagode, Chakrata, Kasauli, Dagshai* and Subath — was any attempt made to carry out what may be called quarantine. At these places, natives desiring to enter were detained under observation for periods varying from 3 to 10 days, but, even in them, it was impossible to cut off all communication. Supplies came in, the post was delivered as usual, but in most of them the supplies and the letter bags were deposited at the barrier and brought on by persons from within. At some places, such as Mooltan, Jullunder, and Hyderabad in Sind, restrictions were imposed, although there was no cholera in the neighbourhood. They did not 13 suffer from cholera, but it would be absurd to attribute any immunity they enjoyed to these restrictions, when the population of the district as a whole enjoyed equal immunity without any supposed protection of the kind. 26. Leaving them out of account, the cantonments of the Bengal Presi. . dency which lie within the area of the epidemic Places where no restrictions were n inn* i jป •-i i •* j j 2. i imposed as a rule suffered little. ot 1870 may be divided into two great classes — those where no quarantine or other measures of the kind were attempted, and those where such Alipore. Allahabad, Dum-Dum. Dinapore. Barrackpore. Segowlie. ULiD iUVA Yr^ LVJ onouipucu, cinvx muao w..oi^ Bernampore. Oawnpore. . measures were more or less in force. In the first Dacca. Shahjahanpur. 4-\^ n n ~ n ,>ซ,ฑ~,.,^.,j xi_ ok 1 j Ba?SSy anpur# of these categories come the 25 places named in Bnagalpur. the margin. None of them suffered to any great extent. Some, as Segowlie and Solun, escaped al- Doranda. Landour. Hazaribagh. Iloorkee. Darjeeling. Delhi. Cachar. Agra. MleanMeer together. Iv others, such as Eerozepore, Meean Jalpaiguri. Ferozepore.' Meer, Delhi, Roorkee, and Bareilly, the outbreak Fort William. | I Solun, was limited to a few cases. Allahabad suffered most, but even here the cases among European troops were only 11 and among Native troops 16. 27. The facts regarding the cantonments in Madras and Bombay have only 9 stations where such mea- not been so fully ascertained as those for Bengal. sures were in force escaped, So far as they are known, they entirely accord with the experience gained on this side of India, but it will be more satisfactory to leave them out of account. Eor the purpose of illustrating the subject and of giving an opinion as to the benefit to be derived from the so-called quarantine, the statistics of Bengal afford ample evidence. Of 29 Bengal Cantonments which lay within the epidemic area of 1875, and where restrictions more or less stringent were imposed,* 20 * Ohunar. Meerut Benares. Muttra. Lucknow. Fatehgarh. Fyzabad, Uoaballa. Sitapur. Kasauli. Gorakpur. Dagshai. Moradabad. Subathu. Nowgong. Jutogh. Nag-ode, Kangra. Banda. Dalhousie. Morar. Bakloh- Dharmsaia. suffered from cholera. In these 20, therefore, it Fort, Gwalior. Chakrata. Go^nSarh. * s self-evident from the results that the restrictions Dehra Dun. did not succeed in keeping out cholera; the qua- Sialkot rantine was a failure. Many of them suffered much. 28. Nor can the escape of the 9f be in any degree attributed to the protection of quarantine. In order to form any sound to^uปStSef"a฿?8 e rfViSJฃ U N e^ opinion on this point, it is necessary to consider gode and Chakrata. t Banda. I the evidence as regards each in the light of former experience. During the period from 1864 to 1875 the troops at Banda enjoyed remarkable immunity from cholera. There were 2 cases in 1864, 1 in 1865, and 2 in 1869, or a total of 5 cases during Dagshai. Nagode. Subathu. Chakrata. Jutogh. Fatehgarh. ' Dalhousie. Bakloh. 11 years. At Nagode, during the same time, there has been but one case among the troops, and that was in 1873. Chakrata is in the hills. It has never suffered from cholera, except to the extent of 1 case in 1870, and 5 in 1872, of which 2 were fatal. At the neighbouring station of Landour, which occupies a similar elevation and was in much more close relations with affected localities, there were no restrictions and yet there was no cholera. If Landour without restrictions had suffered, and Chakrata with its attempt at quarantine had escaped, there would have been some ground for inferring that the protective measures may have been useful, but as both were equally free of the disease, the escape of Chakrata is no evidence that any benefit was derived from them. 29. Eatehgarh at first sight would seem to be a case in favour of quarantine, for the country in the neighbourhood suffered much in 1875, but, setting aside the necessarily imperfect Case of Fatehgarh. nature of the attempts to prevent intercourse, there is the evidence derived from the previous history of the cantonment, and this is very remarkable. The district is subject to cholera, but during the fifteen years from 1860 to 1874 without quarantine there have been in all only 18 cases among the European troops, — viz., lin 1860, 11 in 1861, 1 in 1866, and 5, among women and children, in 1872. Among Native troops, from 1866 (the earliest year for which they appear in Dr. Bryden's tables) to 1874 — a period of 9 years — there has been one case of cholera, and that was in the great epidemic of 1869. Little credit, therefore, can be taken for quarantine at Eatehgarh in 1875. 14 30. Dagshai, Subathu, and Jutogh are the next cases of exemption which claim notice, and, as they lie near one another in the cases of subathu, Dagshai, and Himalayas, they may be considered together. If the JutOgh. • 1 , J .' /,. V o XT T ii S n. ill neighbouring stations of Kasauli and Simla had not suffered in 1875, the exemption of these three places would require no notice. Hill stations rarely suffer from cholera. In 13 of the 33 years, from 1843 to 1875, cholera has appeared at Subathu, but generally in isolated cases. In 7of the 13 years it caused no deaths ; only three times can it be said to have been epidemic in all that time — in 1845, 1867, and 1869. During the 24 years, from 1852 to 1875, Dagshai has only twice suffered from an epidemic of cholera, but isolated cases have occurred in four of the other years. Jutogh has never suffered from the disease. Moreover, the quarantine here was merely nominal. Officers went back and forwards between Jutogh and Simla daily. As regards natives, the procedure adopted is thus described : " Natives wishing to enter, if seen by the sentries, were turned back and obliged to wait three days before being admitted. Eor this period they were permitted to reside in the village at the foot of the Jutogh Hill." At Kasauli in only three of the 33 years, from 1843 to 1875, has cholera appeared in any force. In six of the others one or two cases have been reported. To ascribe the protection from cholera which Dagshai, Subathu, and Jutogh enjoyed in 1875, to the restrictions imposed on human intercourse, is to ignore altogether their previous history and the immunity they enjoyed for years without any such restrictions. There is no connection established between the restrictions and the escape or non-escape of any of them from the disease. Kasauli with quarantine suffered heavily. Subathu, Dagshai, and Jutogh with it, escaped; but so did Solun, which lies in the midst of them, much more exposed to intercourse than any one of the three, and yet it attempted nothing of the kind. 31. Dalhousie and Bakloh alone remain to be considered among the places where it is supposed that measures of the nature 1 Case of Dalhousie and Bakloh. „ ? xx .liji j /> i t of quarantine prevented the entrance of cholera. But neither of them ever suffered from cholera without quarantine, and there is no evidence that the disease was kept out of either by any such measure in 1875. The restrictions adopted at Dalhousie in particular were not such as could have had much influence on the result, for they amounted merely to ordering all new arrivals to report themselves at the hospital for two days after coming up. It was quite impossible to enforce any such order. Ido not here refer to the measures taken with regard to the small isolated outburst of cholera in the outskirts of cantonment, but, before attributing any benefit to them, it must be remembered that the Chumba State, in which Dalhousie lies, has never suffered from an epidemic of cholera within the memory of those now living. 32. The case of Bhagsu also has been cited as a crucial illustration of the undoubted benefits of quarantine. The Officer Commanding at Dharmsala does not give an opinion Case of Bhagsu. to this effect ; on the contrary, he says that, with all the supplies required for the British troops in that part of the station which goes by the name of Bhagsu quarantine is an impossibility. But, when cholera appeared at Bhagsu on the 12th August, it was attributed to the fact that the quarantine had been taken off on the Bth. I enquired very carefully into the particulars during my late tour. As a matter of fact, the quarantine was not taken off. It was relaxed so far as to allow the men to go for a walk in the upper station. The quarantine was broken by a boy bringing in milk; he was seized with cholera on the road, and to this the outbreak is ascribed. But, long before cholera appeared in unmistakeable form, diarrhoea had been extremely prevalent among the men. In July and August, before the first case of cholera declared itself, there were 24 admissions into hospital from diarrhoea out of the small strength of 121 men. Some of these cases were very severe and attended with vomiting. One case nearly proved fatal. Besides the actual admissions from diarrhoea, many more received medicine for the same symptoms without being taken into hospital. This remarkable prevalence of diarrhoea at a place where the complaint is by no means common, can only be accounted for on the supposition that the causes which produce cholera were at work in a milder form for some weeks before cholera actually appeared. 15 33. But it is urged that quarantine is valuable if it only postpone the out- Merit claimed for quarantine in h ™ k ฐ{ $ h ฐ diseaBe a few days. No doubt delaying the outbreak not support- this would be a gain ; but is there the smallest c vied by evidence. Case of Lucknow. dence thftt any such benefifc accmed j n 1g75 ? The remark is made with reference to Lucknow, but the facts which have been recorded with regard to this station shew perhaps more clearly than any others in the whole list of replies how altogether useless the system is. Much stress has been laid on the results obtained in this cantonment, and it is therefore important to examine the facts somewhat in detail. It is argued that the epidemic was most virulent in the surrounding districts, and that, in consequence of the quarantine arrangements, the cantonment was comparatively free from its ravages ; and again it is said that, "bearing in mind the fearful mortality in Oudh, the comparative immunity from cholera in cantonments and its late appearance among the British troops, it is hardly possible to attribute these results to mere chance." No doubt the district of Lucknow suffered heavily ; yet of the 246 villages within 10 miles of the station, only 48 return deaths from cholera ; and, what is more remarkable, 26 of these return the date of the first case as later than the 20th April, the day on which the first case occurred in cantonments, leaving out of account the case in the 41st Native Infantry which was admitted into hospital so early in the year as the 11th February. But did the quarantine confer any immunity on the cantonment which it had not enjoyed equally in former years when nothing of the kind was attempted ? The statistics of cholera among the troops at Lucknow during April and May in each of the last 12 years are given in the following statement, from which it will be seen that during these months of 1875, the time when quarantine was in force, the cantonment of Lucknow suffered really more than it had done in any of the previous 11 years without quarantine, and yet several of them were years of great epidemic prevalence in the Lucknow district and in Oudh generally. The late appearance of cholera among the European troops in 1875 was merely the repetition of what has again and again occurred. Lucknow. Cases of Cholera. Ettbopeans. Natives. Yeae. Total. April. May. April. May. 34. In order to prove that quarantine or any measure of this nature is really productive of good, it is necessary to shew — no evidence adduced in favour of fl rs ฃ that, iudginff by former experience, a danger quarantine, i i -n ,i , r ,i • •ป & threatened ; and, secondly, that this danger was averted : but in no instance has any such proof been afforded. On the con- 16 trary, there is the general and very significant fact that, within the area in which cholera prevailed, those places mentioned in paragraph 26, where no such measures were tried, on the whole suffered much less than those where they were in force. It may be said that many of the places where the measures were not taken lie within or bordering on the endemic area, but cholera, even in the delta of the Ganges, is precisely the same disease as it is anywhere else. 35. In basing any opinion on the mere fact that a cantonment where re- Evidence derived from the escape strictions were imposed was not attacked, regard of most villages in the vicinity of must be had not only to the previous history of cantonments. ซซซV, ~l,>^ ฑ~ ,. T l,,'~U ซ++™f,™ I,™ 1 ~i ' J- each place to which attention has been already drawn, but also to the incidence of the disease in the neighbourhood. The partial distribution of cholera has been illustrated in a former paragraph by reference to the statistics of villages over whole districts. The same fact is borne out by the experience of the villages near cantonments. Taking an area of 10 miles round a few selected at random by way of example, the results are shewn in the following statement : — Number of Number of Number of Number of Cantonments. villages within these Cantonments. villages within these 10 miles. attacked. 10 miles. attacked. • Cawnpore ... ... 148 12 Meerut ... ... 236 24 Fyzabad ... ... 229 35 Koorkee ... ... 332 12 Sitapur ... ... 583 17 Muttra ... ... 163* 9 Shabjahanpur ... ... 373 19 Fatehgark ... ... 331 43 Morndabad ... ... 360 5 Agra ... ... 292 12 Bareilly ... ... 456 41 Uinballa ... ... 139 10 • Exclusive of about 15 or 20 villages, some of which are in the Agra district and some iv the Bhurtpore territory. Other examples may be found in Appendix C. The proportions differ considerably, but all attest the same truth, that the few are attacked and the many escape. 36. The objections to the restrictions are many and great. The quarantine can be a quarantine only in name. Any one who objection to attempts at quar- rea Uy desires to avoid it can enter cantonments either antine. , ? ••!<ป, i ii ซ . -i , by the aid of the darkness of night or the payment of a small bribe to the police ; moreover, it is quite impossible to keep the arrivals of each day separate, and those who are freed at the end of their term of detention may have come from direct contact with those who have just commenced it. If there is any' risk from intercourse with persons from affected localities, the unfortunates detained in quarantine are exposed to it and must often endure great hardships from want of proper shelter. The examination of railway trains and the forced separation from their friends of any persons found ill with symptoms resembling cholera are open to the most serious abuse. Even if carried out with the greatest care and consideration, any such measures must bear very hardly on the people. Entrusted, as they necessarily are in practice to the Native Police, it is not easy to estimate the amount of oppression to which they may give rise. They could be justified only by shewing that they are, beyond all question, beneficial ; but no such evidence has been adduced. At present, it appears to be left to the individual judgment of the officer who happens to command a station whether the people are to be subjected to grave inconvenience and loss or not; and, if so, to what extent. The system cannot be limited in its application to the cantonments. In many places the high road passes through the station, and any restrictions imposed affect the traffic of the country. The measures have been tried, and no single case can be cited in which the smallest good has been effected by them. The evil done, on the other hand, is patent, though the full extent of that evil can never be known. In addition to the interference with trade and traffic, and the hardships and annoyance to which the people must be more or less exposed, there are other grave objections to the system. It exposes the troops or others employed on the duty to fatigue and night-work at the time when such exposure is calculated to prove most hurtful. It fills the mind of the community with 17 needless fears, the depressing influences of which ought particularly to be avoided in time of cholera. If the authorities at many of the places where quarantine was enforced in 1875 had appealed to the history of these places for a series of years, they would have done more to quiet the public mind and inspire confidence than by placing sentries in the hope of keeping out the disease. The system, moreover, diverts the attention of the authorities from the real evils to be dealt with — the sanitary defects of the cantonments ; for, instead of endeavouring to discover what these defects are and what is the best means of rectifying them, they are taken up with the attempts to discover and arrest sources of contagion which, even if their existence be proved beyond all manner of doubt, can never be kept out by all the vigilance which can be exercised. Such endeavours, moreover, entirely mislead other countries, whicli are thus led to seek safety in quarantine and to involve themselves and those "who trade with them in all the miseries which quarantine entails, because, as will no doubt be asserted, the system has been adopted in India and has been found most beneficial, the real fact being that it has been productive only of evil. And what is perhaps most of ail to be regretted, it muse exercise the worst effect on the native mind and retard most seriously that progress in sanitary reform which the Government is so anxious to encourage. What can the natives think of our faith in pure air and pure water and good drainage and other improvements, the importance of which is so often urged on them, when they see that, when a great danger, such as a cholera-epidemic threatens the public health, we seek security not in these, but in the protection of military guards or of the police ? 37. It is not necessary, for the proper consideration of this question, to discuss whether cholera is a contagious disease, Quarantine condemned by aii or wne fcher it is spread by human intercourse. All civilized countries. ili- l^ i_i mui/i i__'_-'j.i -lj.-- m, * this has but little bearing on the matter. The only point to be determined is, can cholera be kept out of a cantonment by means of guards? The views above advocated on the subject of quarantine entirely agree with those of English and other authorities, who, even although they believe in human intercourse as the great means by which cholera is disseminated, are still convinced that quarantine is impracticable. The late Vienna Cholera Conference came to the conclusion that "land quarantines are inexeeutable and useless, and that on this account and on account of the serious damage they did to commercial interests they ought to be abolished."* Mr. Simon speaks of quarantine as "a mere irrational derangement of commerce ;''f and if quarantine at sea deserves this censure, what is to be said of any attempt at quarantine by land ? No doubt much of what was attempted was not quarantine, but merely medical inspection to detect sick persons; but the experience of 1875 proves that even this cannot be carried out in practice, and that it altogether fails to afford any protection. 38. It is argued that by means of guards persons ill of cholera may be objects aimed at the stoppage * to PP ed outside cantonments and that thus the of persons sick of cholera, not troops and others inside may be protected from the attained in practice. rlicmief* "Rnf. tho PvnpriAnr>A*nf 1 87n oVjottto fliof ai^r disease. But the experience of 1875 shews that sick persons are not stopped, except in instances so rare that they merely prove the rule. In none of the many cantonments in the Bengal Presidency, where restrictions were in force, is it stated that persons suffering from cholera or other sickness resembling cholera were stopped except at Lucknow and Nagode; but from Lucknow the information on this point is very vague. It is said that " many infected persons, especially from the Alumbagh side, were stopped by guards or sentries," but no record was kept of their number or of the dates on which they occurred. At Nagode no sick were stopped, but it is stated that a traveller, who, but for the cordon, would have gone on to cantonments, died of cholera outside. Among those detained under observation at other places in this presidency no mention is made even of any suspicious case having been detected. * Medical Officer of the Py Council Ueport, new series, No. V, page 210. f 0. P. cit., p. 6. 18 39. In the preceding remarks no reference has been made to the pre- caution which was generally adopted of placing Affected localities to be avoided. b azaars or towns and villages in which cholera Principle involved. , , j. /. i tjjij. was reported to exist out of bounds to the troops. This is quite in accordance with the rules which have been prescribed in G. O. C. C. No. 193, dated 3rd August 1870. To visit a locality where cholera exists, is to expose oneself to the causes producing the disease in that locality ; and all such localities should therefore be avoided. This principle, the importance of locality, is enforced by all the facts of the epidemic. 40. Stated shortly, these facts may be summarised in the following proposi- tions : cholera, which is always more or less pre- demlo maify ฐ f the facts of the epi " sent in the Lower Provinces of Bengal, was singu- larly dormant over other parts of the country in 1874; in 1875, on the other hand, it was not only very severe in these Lower Provinces, but extended widely over the peninsula, generally diminishing in violence as it neared the limits of the area which it covered ; widely as it extended, there were marked tracts of exemption, notably part of the Central Provinces and the Upper Punjab ; the areas of prevalence bear no relation to the facilities for communication, nor those of exemption to the want of such facilities; within the epidemic area the villages attacked nearly always formed but a small proportion of the whole, and even in those districts where the disease was most severe many of them escaped. In the 67 communities in which the disease appeared, and the facts regarding which have been reported by 66 Medical Officers, there is no evidence that the disease was due to importation; in these 67 communities the attendants on the sick did not suffer more than others ; removal from the affected locality was generally attended with excellent results in checking the disease, and all attempts to exclude cholera by means of guards and sentries and quarantine failed. 41. If results are to be taken as evidence of the causes which produce them, then it follows that the causes of cholera causes evidence they affordastoits which are always more or less prevalent in the Lower Provinces of Bengal were singularly dor- mant over other parts of the country in 1874 ; that in 1875 these causes were not only intensified in these Lower Provinces, but- extended widely over the peninsula, generally diminishing in force as they neared the limits of the area which the epidemic covered ; that these causes were not present in certain areas, notably in part of the Central Provinces and in the Upper Punjab; that the presence or absence of these causes was in no way dependent on the facilities or difficulties of communication; that even within the epidemic area these causes were in most parts localised in a small proportion of the villages of each district ; that even where the disease was most severe they left a large number of the villages unaffected by them ; that removal from the locality where these c xuses were at work was attended with great benefit in many instances, but that in others the benefit was doubtful, because apparently the movement had been made into another locality where these same causes existed; that these causes cannot be arrested by guards and cordons; and that attendance on the sick does not spread the, disease. The whole history of the epidemic in fact points to the danger of locality, to a cause or causes which, though spread over a large area, become in some way localised in certain quarters within that area. What these local cholera and other disease-causes are, must be the subject of further investigation, and their removal the aim of all practical sanitary action. APPENDIX A. STATISTICS OF CHOLERA AMONG THE GENERAL POPULATION OF INDIA IN 1875. Showing the Deaths from Cholera registered in the districts of Bengal Proper and Assam during each month of 1875. p ?. Number of cholkka deaths registered iK each mouth. Total Districts. ceusus of of the 1872. Jan. Feb. Mar. April. May. June. July. Aug. Sep. Oct. Nov. Dec year. 24-Pergunnahs ... 1,951,137 958 1,106 1,482 823 564 60 38 14 15 12l 586 1,342 7,109 Calcutta ... 447,601 130 73 268 268 119 66 32 35 55 150 358 172 1,726 Suburbs of Calcutta 258,910 175 170 460 270 87 65 52 36 56 177 310 241 2,099 Howrah ... 731,057 .220 277 345 156 93 24 38 30 56 102 297 255 1,893 Serampore ... 393,864 20 6 36 29 10 9 1 4 4 33 19 51 222 Hooghly ... 363,635 7 26 94 86 22 3 3 2 1 9 33 84 370 Nuddea ... 1,812,795 301 480 2,369 824 364 24 10 10 150 611 3,017 1,788 9,948 Jessore ซ• 2,075,021 626 286 078 84s 347 71 27 8 11 232 2,208 2,139 7,478 Burdwan ... 2,034,745 76 187 679 53e 112 21 68 45 3 9 109 282 2,127 Bankoora ... 526,772 ... 25 47 18 26 8 76 79 8 1 24 107 419 Beerbhoom ... 695,921 3 8 20 28 35 6 15 13 2 ... 3 49 182 Midnapore ... 2,540,963 917 1,902' 1,880 267 59 113 87 4,4 24 54 108 172 5,627 Dacca ... 1,852,993 399 202 248 664 474 134 35 25 67 403 2,068 1)908 6,617 Furreedpore ... 1,515,821 104 34 69 189 102 65 18 12 10 121 1,179 1 - 4 ฐo 3,303 Backergunge ... 1,874,201 110 132 170 164 33 85 35 21 13 94 540 1.605 3,002 MymensingU ... 2,349,917 471 155 114 412 572 213 7l 70 32 .129 923 !> 2l O 4,372 Darjeeling ... 94,712 5 4 ... 5 1 40 62 7 13 7 5 1 150 Jalpaiguri ... 418,665 ... 3 ... 35 242 314 129 59 130 204 145 62 1,353 ?Gioalpara ... 444,761 60 ... 4 23 542 162 163 107 214 522 403 88 2,288 Moorshedabad ... 1,353,626 32 12 54 78 61 46 89 14 5 32 101 203 72? Diuagepore ... 1,501,924 14 2 10 347 353 98 87 43 6 20 HI 177 1,268 Maldab. ... 676,426 46 23 1 164 123 67 156 130 49 116 685 1 52 1,712 Rajshahye ... 1,310,7^9 29 3j 184 394 113 7 5 46 43 26 203 161 1,247 Rungpore ... 2,149,972 190 92 294 833 1,085 382 ซ 285 70 65 540 1,166 662 5,664 Bogra — 689,467 28 2 5 155 845 218 19 31 4 12 50 390 m 1,883 Pubna ... 1,211,594 14 5 82 186 99 55 8 2 j 65 931 7 ฐ 5 2,153 Purneah •• 1,714,795 ... 2 213 578 507 80 53 15 75 407 477 73 2,480 Chittagong ... 1,127,402 32 l 9 81 75 102 37 29 63 2 1 58 140 218 875 Noakholly ... 713,934 74 2 1 133 164 122 39 18 15 3 51 508 1>066 2,204 Tipperah ... 1,533,931 70 102 292 185 170 31 52 2 2 33 539 7U 2 ป 222 •Cachar ... 205,027 15 g 16 13 56 46 3 1 ... 1 1 160 •Sylhet ... 1,719,539 302 64) 60 45 177 6 ... 2 ." ... 84 250 980 •Darrang ... 236,009 24 27 15 48 87 132 226 78 l 7 2 2 2 660 •Nowgong ... 256,390 52 2 2 ••• 30 17 16 13 57 85 9 ... *" 301 •Sibsagar ... 296,589 69 64l 231 101 15 65 38 3 12 188 777 *Kamrup ... 561,681 386 36 16 44 17l 280 177 69 5 X 62 25 1,430 ?Lakhimpur ... 121,267 .„ 15 7 ... ... 2 2 •Jaintia Hills f ... Balasore ... 770,232 2 6 192 585 397 313 244 226 85 82 136 287 203 2,776 Cuttack ... 1,494,784 2 4 161 6 153 233 231 608 567 215 320 466 582 687 4,102 Pooree ... 769,674 M J6 4l 41 4 4 6 440 302 uo 6 6 260 58 ฐ lป 9 06 Rajmehal") Deoghur ) '" I>2b 1 > 2b9 > 2^ 4 ... 23 21 63 206 191 178 153 100 47 19 1,005 Manbhoom ... 995,570 2 ... 46 70 35 21 41 7 2 19 10 1 254 Hazaribagh ... 771,875 ?. 22 6 2 29 4 125 54 28 ... - 270 Rancb.ee ... 1,237,123 x j 3 l 5 17 3 2 16 403 595 42 8 ... 15 1,472 Chybassa ... 410,821 5 2 3 3 3 9 30 33 17 15 26 26 172 Monghyr ... 1,812,986 ... j 28 79 424 788 445 257 184 203 152 32 2,539 Bhagalpur ... 1,826,290 1 j 1 66 60 98 166 377 414 449 82 3 X>7lB X > 718 Gya ... 1,949,750 1 _ 6 298 779 969 853 627 49 15 4 4 3,505 Patna ... 1,559,638 7 6 62 338 418 6 2 ซ 301 168 46 11ป 65 6 2,062 Shahabad ... 1,723,974 ... 4 2 8 167 241 411 237 .173 64 17 4 •" 1,346 Sarun ... 2,C63,860 1 4 ... 2 1 105 159 165 213 117 26 10 U 832 Tirhoot ... ?,188,382 2 84 1,106 1,272 280 56 38 22 9 •" 3,067 Chumpanin ... 1,440,815 1 38 126 183 96 56 21 ... "* 521 Durbhttnga ... 2,196,324 1,155 604 124 30 7 3 10 ... 17 1,950 Total ... 1116,6061 116,606 * Districts of Assam, f No Returns. 19 ( 20 ) STATEMENT 11. Showing the Deaths from Cholera registered in the Districts of the North- Western Provinces during each month of 1875. m Number of cholera deaths bkgistbred in each month. | & .. _. _________________ — ,, — _ — _ _ — . _____________________________ _——_-_, a? ฆ ป•> Districts. J| jj g g j I fr I _ * 1 j "a 1 * i_ jL___J____lJ____J_ JL_lJ_i_l. Eastern Districts. Ghazipur ... 1,345,401 126 158 154 85 67 58 13 14 ... 675 Benares ... 793,699 10 17 122 607 151 55 24 49 18 29 9 3 1,094 Mirzapnr ... 1,015,293 1 8 145 656 808 361 175 70 10 7 3 3 2,247 Azamgarh ... 1,531,410 ... 11 33 607 389 248 135 137 50 27 10 ... 1,647 Jaunpur ... 1,025,869 ... 40 277 704 115 56 52 96 70 30 1 ... 1,441 Gorakhpur ... 2,019,350 37 633 729 657 313 151 102 91 " 1 18 2,662 Basti ... 1,472,994 274 1,824 990 425 130 15 6 4 86 274 4,028 Allahabad ... 1,394,245 2 59 151 408 414 298 25 13 9 3 1 ... 1,388 Fatehpur .;. 663,815 ... 1 4 44 163 94 13 46 33 8 406 Cawnpore ... 1,155,439 5 3 10 175 191 209 179 141 137 103 8 ... 1,161 Fatebgarh ... 918,748 6 5 10 15 167 278 343 340 666 470 .22 1 2,323 Districts south of, or bordering on, the Jumna. Banda ... 697,611 ... 3 ... 122 495 500 45 1 ... .ซ 1.166 Hamirpur ... 529,137 ... 1 ... 11 232 549 131 59 127 73 1,183 Jalaun ... 404,384 4 45 60 43 312 35 499 Etawah ... 668,581 1 14 4 122 175 158 312 34 820 Jhansi ... 317,735 1 ••• 2 8 11 Lalitpur ... 212,628 ... 1 lซ • - 2 Districts lying west of the line 80ฐ east longitude. Bareilly ... 1,506,801 ... 5 3 6 3 13 411 241 .44 4 730 Budaun ... 934,348 ... 2 9 8 4 11 67 76 503 808 '210 43 1,741 Shahjabanpur ... 949,471 ... 6 23 2 19 17 127 596 246 27 1,063 Moradabad ... 1,122,131 2 4 3 5 5 6 6 173 445 123 21 1 794 Etah ... 703,485 1 .... 1 2 53 170 354 410 624 212 30 4 1,861 Mainpuri .. 765,783 1 30 427 619 229 395 68 2 ... 1,771 Aligarh ... 1,073,108 ... 118 33 216 457 1,037 570 41 6 2 2,372 Bulandshahr ... 936,593 2 1 ... 7 15 30 66 891 1,283 83 3 ... 2,381 Agra ... 1,094,184 1 ... 11 16 4 76 44 230 437 46 3 1 869 Muttra ... 887,355 2 2 3 9 80 183 158 93 139 14 .43 7 733 Meerut ... 1,273,914 1 12 141 443 949 20-7 1 1,574 Muzaffarnagar ... 690,082 19 4 26 186 304 31 561 Saharaapur ... 883,782 1 ... 2 3 21 54 35 129 212 46 .... 1 504 Bijnor ... 737,152 1 2 4 H 12 2 9 3 77 192 85 8 406 Debra ... 115,711 298 67 3 ... . 368 Tarai Pergunnahs ... 185,647 - 8 8 15 31 Kumaun ... 432,888 1 ... 4 1 6 12 Garhwal ' ... 310,282 3 6 103 361 92 18 ... ... 4 587 Total ... 41,106 ( 21 ) STATEMENT 111. Showing the Deaths from Cholera registered in the Districts of Ocjdh during each month ' . " ' 'of 1875. 2 Number of choleua deaths registered in each month. Districts. cฐฐ \6 ft ,tj 1 & ff j 4 I te I I Pavtabgarh ... 781,156 ... 43 140 351 152 75 10 ... 14 33 J 3 8 829 Uai Bareli ... 988,719 ... 2 4 37 152 319 210 146 61 70 197 375 1,573 Sultanpur ... 1,000,336 ... 3 367 1,362 396 342 71 9 8 3 31 210 2,805 Fyzabad ... 1,022,770 ... 5 83 991 274 187 31 38 5 23 163 224 2,034 BaraiianH ... 1,115,042 5 507 325 50 63 46 35 75 24 17 1,147 Lucknow ... 778,195 ... 1 36 429 216 81 65 128 230 49 8 8 1,251 Unao ... 944,793 6 701 501 115 119 6! 60 36 6 ... 1,605 Gonda ... 1,166,515 ... 2 79 1,447 918 481 211 303 105 96 61 70 3,,806 Bahiiiich ... 773,775 49 2,405 691 99 56 38 38 3,37 Kheri ... 739,283 7 10l 97 35 17 13 57 66 25 ... 458 Sitapur ... 930,224 48 226 328 67 7 ... 179 389 161 59 1,464 Hardoi ... 93!>,977 ... J ... ... 119 | 156 j 283 160 197 844 1,02.6 180 8 2,973 Total ... 23,321 STATEMENT IV. Showing the Deaths from, Cholera registered in the Districts of the Punjab during each month of 1875. ฐ Number of cholera deaths registered in each month. a 1 I ฉ งg4 I Districts. ฃ l g . >-' v v ซซ ' I ill I I 1 9" I I 1 I i | Gurgaoa ... 696,616 1 49 116 189 162 9 52(J Delhi ... 608,850 1 12 29 70 51 106 10 8 ... 287 Eohtak ... 630,959 1 17 72 130 6 1 3 9 ... 239. Hissar - .. 484,681 1 4 ... 4 49 16 67 1 ... 142 Sirsa ... 210,795 3 12 10 1 2 6 Karnal ... 610,927 25 12 32 3 "2 Umballa ... 1,008,860 ... 1 ... 3 2 109 99 64 60 11 ... ... 349 Simla ... 33,594 4 127 27 158 Jullundur ... 783,020 1 ... 11 12 32 7 63 Ludhiana ... 583,215 1 1 30 31 20 83 Hoshiarpur ... 938,890 2 5 84 97 98 ... ... 236 Kaugia ... . 743,758 ... 2 ... 1 1 11 122 288 197 81 7 ... 710 Giirdaspur ... 906,126 1 1 225 557 613 85 ... MB2 SSialkot ... 994,458 1 ... 74 216 3 . . 294 Amritsar ... 832,750 1 28 504 583 149 3 1 1 ป 269 Gujrat ... 616,347 1 1 ... 2 Gujranwdla ... 550,576 1 8 9 Lahore ... 775,551 1 ill 1 1 12 177 82 12 ... 288 Ferozepore ... 533,416 ... ... '. ... ' ... ; ... ; ... ... ... ... ... 1 ... 1 Montgomery ... 359,437 ... , ... '' •ป ; ... .ป 1 ...• 1 Mooltan ... 459,765 ... ... ... : ... I ... \ ... 1 ... 1 Musaffargarh ... 295,547 " ... : ..." | ... ... ... ..." Dera Ghazi Khan ... 309,978 j ... 1 I ... j ... , ... j 1 JX>ra Ismail Khan ... 394,864 ... ... ... ... 1 ••• 1 2 Jhang ... 348,027 Shahpur ..'. 368,796 jhelom ..'. 500,988 ... ... 1 ... '••• l HiSzara ... 367,218 ... ... ..' RawalPin.y ฆ '..-< -r X ฆฆ ฆฆ "y'1875." y'1875. ฐ Jv'UMBEE OF CHOLERA DEATHS REGISTEEED IN EACH MONTH. p • Districts. งw Ig sj v I il JliSI 111 $. I Partabgarh ... 784,156 ... 43 140 3pl 152 75 10 ... 14 33 3 8 8.89. liai Bareli ... 988,719 ... 2 4 37 152 319 210 146 61 70 197 375 1,573 Sultanpur ... 1,000,336 ... 3 367 1,362 396 342 71 9 8 3 31 210 2,805 Fyzabad ... 1,022,770 ... 5 83 991 274 187 31 38 5 23 163 254 2,034 Bara^anH ... 1,115,042 5 507 325 50 63 46 35 75 24 17 1,147 Liicknow ... 778,195 ..'. 1 36 429 216 81 65 128 230 49 8 8 1,20 i Unao ... 944,793 6 701 501 115 119 6.1 60 36 6 ... 1,605 Gonda ... 1,168,615 ... 2 79 1,447 918 481 241 303 105 96 61 70 3,,806 BahiMich ..'. 773,775 49 2,405 691 99 56 38 38 3,37 Kheri ... 739,283 7 151 97 35 17 13 57 56 25 ... 458 Sitapur ... 930,224 48 226 328 67 7 ... 179 389 161 59 1,464 Hardoi ... 930,977 ... J ... ... 119 156 j 283 160 197 844 1,02.6 180 8 2,973 Total ... 23,521 STATEMENT IV. Showing the Deaths from Cholera registered in the Districts of the Punjab during each month of 1875. ฐ NtJMBEE OB CHOLEBA DEATHS BEQISTERED IN EACH MONTH. I : ฆ : g> O3 V** Districts. clซc l ซ . ij . k' h ซ3r " ' fr * f' J | c | I ฐ l|. jfll. jt i i t:t-!i "I. !ฆฆ* Gurgaoa ... 696,616 1 49 116 189 162 9 526 Delhi ... 608,850 1 12 29 70 61 106 lO 8 ... 287 Kohtak ... 630,959 1 ... 17 72 130 6 1 3 9 ... 23a Hissar '.. 484,681 1 4 ... 4 49 16 67 1 ... 142 Sirsa ... 210,795 3 12 10 1 2 6 Karnal ... 610,927 25 12 32 3 72 Umballa ... 1,008,860 ... 1 ... 3 2 109 99 64 60 11 ... ... 349 Simla ... 33,594 4 127 27 ~ 158 Jullundur ... 783,020 1 ... 11 12 32 7 63 Ludhiana ... 583,215 1 I ... ... 30 31 20 83 Hoshiarpur ... 938,890 2 ... ... ... 5 34 97 98 ... ... 236 Kaugra ... . 743,758 ... 2 ... 1 1 11 122 288 197 81 7 ... 710 Giirdaspur ... 906,126 1 ... ... 1 225 557 613' 85 ... MB2 Sialkot ... 994,458 1 .„ 74 216 3 . . 2 94 Amritsar ... 832,750 1 28 504 583 I*9 3. 1 h%W. Gujiat ... 616,347. 1 ... 1 , Gujranwdla ... 550,576 1 ... 8 9 Lahore ... 775,551 , 1 ill 1 1 12 177 |82 12 ... 288 Ferozepore ... 533,41(3 \ ! ... i ... | ... j ... 1 ... 1 lldntgomery .;. 359,437 ' .... ! ... |ซ. j ... — 1 ... 1 2 Mooltan ... 459,765 ... ... ! ..." j ... j ... j ... 1 ... I ... * Muzaffargarh ... 295,547 " i ..." ' ... j ... ; ... [ ... ... : Dera Ghazi Khan „. 309,978 j ... 1 ... j ... ; ' x rปra Ismail Khan ... 394,864 ... ... ... ... 1 : ... ... ... 1 ... 2 Jhang ... 348,027 ... ... ... Shahpur ..". 368,796 ... jhelum ..'. 500,988 ... ?V ... ... 1 •ป' "... ... ... ... 1 Hazara ... ' 367,218 ... ... ..' ... BawalPindf ... 699,647 1 *] Peshawar ... 500,443 ... 1 1 2 Kohat ... 145,419 •'ฆ' EaTmii ... I 287,517 ] Total ... 6,246 ( 21 ) STATEMENT V. Showing the Deaths from Choleea registered in the districts of the Central Provinces during each month t>. , DISTBICTS. •^'g fc> S -g ฆS; I -| 4 ฅ i I J f ill f f f f I J I Bombay City ... 644,405 1 1 ... 31 67 132 279 177 45 56 38 21 848 Tanna ป• 847,424 3 182 1,679 1,545 1,653 492 234 93 88 5,9ซ!> Colaba ... 350,405 3 18 312 ;21 361 37 1 ... 1,453 Surat ... 607,087 1 315 288 76 89 124 53 19 965 Ahmedabad ... 829,637 1 251 577 68 164 17 1,078 Broach ... 350,322 ... 44 614 167 37 862 Panch Mahals ... 240,743 41 289 673 83 3 1,089 Kaira ... 782,733 95 838 942 150 14 4 , ... 40 21 2,104 Khandesh ... 1,028,642 26 809 1,660 2,825 870 22 12 6,224 Ahmednagar ... 773,938 65 456 1,297 ! 1,994 815 197 89 20 ... 4,933 jfasik ซ• 734,386 10 481 1,014 610 j 386 201 93 14 3 ... 2,812 Sholapur ... 662.986 ... ... ... 1 ... 94 12,453 731 210 33 3 H 3,536 Satara ... 1,116,050 53 ! 1,505 1,588 416 95 9 ... 3,666 Kaladgi ... 816,037 13 544 441 157 17-2 38 1,365 Belgaunr ... 938,750 49 281 445 1,460 451 50 2,736 Dharwar ... 988,037 216 1,056 539 477 2,288 Kanara ... 398,406 6 23 18 47 Katnagiri ... 1,019,136 8 3 1 13 238 246 162 178 51 900 Thar and Parkar .. 180,761 5 1 6 Poona ... 907,235 43 1,402 1,705 776 506 201 16 4,649 Shikarpur ... 776,227 Karachi ... 423,495 1 17 25 43 Hyderabad ... 721,947 Upper Siudh ... 89,985 Total ... 47,573 STATEMENT VIII. Showing the Deaths from Cholera registered in the Districts of the Madras Presidency during each mon/h of 1875. -^ Number of cholera deaths registered in bach month. ฉ J 2 j ; . -S _ "S^t^b ซ S3 S3 "H C } 1 1 j Mii 1 1 Hii 1 Ganjam ... 1,520,088 ... 11 4 1 ... 3 15 20 6 178 104 332 Vizagapatam ... 2,159,199 ; Godavery ... 389,712 „ 12 12 Kistna ... 282,358 -• , 5 6 22 40 Nellore ... 263,820 151 1,072 910 353 173 358 3,017 Madras ... 397,552 185 248 147 170 129 879 Chingleput — 938,184 ... 3 4 215 290 346 318 327 1,503 South Arcot ... 1,755,817 3 6 ... 3 3 216 2,338 2,338 906 695 659 1,167 8,384. Trichinopoly ... 1,200,408 1 ... 9 549 2,847 2,008 780 457 260 360 7,271 Tanjore ... 1,973,731 4 7 2 65 1,589 4,972 7,184 1,733 945 822 348 454 18,125 Madura ... 2,266,615 ... 1 113 412 915 2,804 4,074 3,303 11,622 Tinnevelly ... 1,693,959 9 30 59 227 541 1,341 1,150 1,085 2,073 6,515 Kurnool ... 959,610 40 447 262 118 19 ฃ86 Cuddapah ... 1,351,194 ... 31 763 1,513 1,394 492 245 213 4,651 Bellary ••• 1,668,006 9 569 657 672 345 134 2,386 North Arcot ••• 2,015,278 5 1,357 1745 937 624 1194 5,863 Salem ... 1,966,ป95 135 464 1,552 1,527 1,510 1,360 6,548 Coimbatore ... 1,763,274 60 383 427 1,239 2,741 4,680 3,400 12,930 Neilgherries ... 49,501 ... ... ... ... 3 ... 1 ... 8 12 South Kanara ... 918,362 8 _ 8 Malabar •ป 2,261,250 | 1 2 | 2 3 1 1 ... 26 146 579 1,227 1,575 3,563 Total ... 94,547 Mysore ••• I I "' I ••• I ... [ ... I ป• I ซ• ] ... I 178 [ 1,025 I 812 I 404 | 85 2,504 GRAND TOTAL ... 97,051 STATEMENT IX. Showing the Deaths from Cholera registered in the Districts of British Burmah during each month of i 875. ฐ Number of deaths from cholera registered in each month. Districts. JS ' ' fi 4 • J J |_ |||lll|fl|lj|lg /i< ya b .- 276,671 •ป ... 4 3 7 Thonkwa ป• 144,177 206 206 Sandoway ••• 54,725 Rangoon ... 431,069 .'.. ... ... 29 196 225 Bassein ... 322,689 • 4 3 ... 112 120 Henzada ... 476,612 65 55 Prome ... 274,872 ... ... 2 8 10 Thayetmyo ... 156,816 ... ... ... Ainherst - 266,057 1 25 18 23 39 3 ... .., ... 2 111 TaVoy •ป 71,827 ... ป •ป ... 25 25 Wergui ป• 47,192 Tounghoo - . 86,166 Shwegyeen ..'.' 129,485 2 2 Total ... 761 STATEMENT X. Showing the Deaths from Cholera registered in Rajpootana, Hyderabad, and Central India during each month o/* J 875. NUMBEK OF DEATHS FROM CHOI.EEA REGISTERED IN EACH MONTH. Native States. .2 ฃ jง c ฆ % J • . ฆ s 1• ' g I | rf ; . _ " , I J I 1 T | ' , , . ! : . Rajpo tana ... ... •ป 57 123 598 228 178 19 *1,203 Western Malwa ... 159 164 57 23 83 78 3 ... ... 567 BHghelkhuud ...' ... '.- 26 278 65 27 396 ]ndore ••• 55 Scat tered c ases oc curred till the end of the year- 66 Gunah ... ... ... 9 I 8 43 A few 70 'cases. Bundelkhund ... 8 54 179 310 100 76 9 736 IShopar J ...... 4 13 8 2 2 20 Lhopawar ... ... | ... ... ..'. 6 238 121 126 32 ... 523 Lingsugur ... ... .1 ... m 82 146 2 Hingoli ... ... ... I 4 3 ... ; ... 17 Momihabad ... ... ... ... ... ••> ••• ••• •ฆ• ••• ••• ••• ฆ•• . •*' Bolaram ... ... ••• * * 2 Hyderabad ... ... ..'. 3 19 1,434 2,912 2,144 142 3 37 6,CM Jal na ; ' ... ... 143 22 I 165 Au^aiigabcl ... ... ป• 540 22 3,62ป Total ... 14,649 * The total of the monthly statements furnished by the Superintendent General of Dispensaries. — In his min.ua! report the total is 2,776, but the monthly distribution of all these cannot be shewn. 24 25 STATEMENT XI. Showing the Deaths from Cholera registered in Ceylon dunng each month of 1875. 111I|it 1 1 I I I ฆ >^ a ฃ ••• 10 ... ... 10 Kalutara ... ••• ป. 3 2 5 Pabnapura ... ••• ••• 10 4 ... ... 14 Kurenegala ... 2 1 3 Pesalai and Venkuila 10 4 2 19 35 Navonia Velankulam ... 1 1 Combansanadecolum , ... 13 2 ... 13 28 Thenmarachi ... ... 2 2 Kalaer ... ... - 2 2 Madavalchiya ... 1 * w Matali District Iฐs 42 5 4 Badulea ... 2 ~ Total ... 1,817 9 26 APPENDIX B. Statement showing the proportion of villages attacked hy Cholera, in the Districts of certain Pro- vinces of the Bengal Presidency during the epidemic of 1875. 1 2 3 4 5 tw v i Number of those T\>fซi „„„!,„, „? Total number of Number of regis- , , 2 aUack . J"^ I"™* 1 "™*" 0 ' thoee in colaqn ? DISTEICM - toation circles e d by choleia in I tf attacked by cholera in each district. 1875 flisuaot. in 1875. BENGAL PROPER. Burdwan ... ... ... I 28 21 5,191 198 Bankoora ... ... ... 7 5 2,028 108 Beerbhoom ... ... ... 8 7 2,471 25 Hoogbly ... ... ... 6 3 961 32 Serampore ... — ... 7 2 803 34 24-Pergunnab.s ... ... ... 44 29 4,979 1,326 Nuddea ... ... ... 33 31 3,691 1,001 Jessore ... ... ... 33 24 4,247 1,352 Moorsbedabad " ... ... ... 34 13 3,753 128 Dinagepore ... ... ... 18 17 7,109 274 Maldah ... ... ... 10 9 2,100 382 Eajshahye ... ... ... 13 H 4,228 176 Eungpore ... ... 20 16 4,206 1,224 Bogra ... ... ~. ... 11 8 2,666 512 Pubna... ... ... 10 8 2,792 1,661 Jalpaiguri ... ... ... 6 6 158 117 Dacca... ... ... ... 15 12 5,016 1,275 Fureedpore ... ... ... 13 13 3,332 973 Backergunge ... ... ... 16 15 3,244 467 Mymensingh ... ... ... 19 13 7,601 889 Tipperah ... ... ... 14 12 6,150 577 Chittagong ... 14 10 1,062 161 Noakbolly 8 8 2,034 370 Patna... ... ... ... • 25 12 3,412 624 Gya ... ... ... - 14 12 6,530 345 Shah a b a d 18 U 5,110 244 Tirhoot ... ... ... 16 13 4,229 510 Saruu ... ... ~ ... 14 10 4,350 244 Chumparuu ~. 20 9 2,299 60 Mongbyr 15 H 245? 2 ' 4 5? 267 Bhagalpur ... 13 U 2 >?39 201 Purneah 14 13 4,179 299 Sonthal Pergunnahs .ซ. ... 5 5 9,872 198 Pooree 8 6 8,175 375 Balasore ... . *0 9 3,266 724 Hazaribagh 14 9 6,703 38 Rancbee ซ. 22 13 6,486 170 Cbybassa 34 19 3,208 108 Manbboom 19 10 6,368 60 OUDH. Lucknow ... 9 964 168 Unao ป 1X X' 739 X ' 739 460 Bua฿aitt I 2 12 2094 2 ' 094 262 Sitap.r 14 14 2,389 232 Hardoi ... 16 15 1,976 365 Statement showing the proportion of milages attacked by Cholera in the Districts of certain Provinces of the Bengal Presidency during the epidemic of 187 5. — (contd.) 1 2 3 4 6 Jfnmhpr nf roฆ Surgeon- Major O'Brien. No. 7 Battery, 23rd Brigade, Royal Artillery — ) 13th Hussars — Surgeon-Major J. N. Shipton. 40th Foot— Surgeon R. N. Mally. 65th Foot— Surgeon E. C. Ward. ] 9th Bengal Lancers — Surgeon-Major G. A. Watson. 6th Native Infantry — Surgeon-Major S. C. Amesbury. 41st Native Infantry — Surgeon H. P. Veld. Native population of cantonments, 18,932. The city of Lucknow, with a population of 273,220, returns 404 deaths from cholera during the year,— viz., February 1, March 3, April 143, May 38, July 3, August 56, September 140, October 14, and November 6. I. Details of outbreak. Royal Artillery. 13th Hussars. 40th Foot. 65th Regiment. ซg*3fป "fi^fe Cases. Cases. Cases. Cases. Cases. Cases. Cases. Deaths. Aug. 22nd, 1 Sept. 2nd, 1 Aug. 14th, 1 Aug. 6th, 1 April 20th, 1 April 9th, 1 Feb. 11th, 1 April 20th, 1 Sept. sth, 4 „ 10th, 1 Sept. 18th, 1 „ 10th, 1 „ 28th, 1 „ 20th, 1 April 20th, 1 Sept, 12th, 1 6th, i „ Hth, 1 „ 20th, 1 „ 15th, 4 May 3rd, 1 „ 22nd, 1 May 9th, 1 „ 16th, 1 7th, 3 „ 12th. 1 „ 25th, 1 Sept. 2nd, 1 „ Bth, 1 Au*. 25th, 1 June 16th, 1 „ 80th, 2 „ Bth, 1 „ 14th, 2 ? 7th, 1 Sept. sth, 1 Royal Artillery. — Twelve buildings furnished 16 cases, 8 others were from tents. On the 11th August there was a very suspicious case of diarrhoea not included in above. Diarrhoea was more than usually prevalent before the outbreak and among the men fo r some time after their removal to camp. \Uh Hussars.— One case occurred in a tent; the other 1 6 were from 7 different buildings. " Diarrhoea and malarious fevers were prevalent during the epidemic." " A very & - . . . mm m m t * , 1 n ii m Cs J ~\ IT. • 9T large number obtained astringent medicine from hospital or from the Troop Sergeants Major. ' & 40M Regiment. — Of the 4 cases, 2 occurred in family quarters, one in barracks and 1 in hospital. For some fortnight or three weeks before the 18th September a great deal of simple mild diarrhoea cases too trivial to be admitted into hospital was prevalent. QUh Regiment. — The disease was confined to the east side of the lines. No prevalence of diarrhoea. 19^ Bengal Cavalry. — At the time of the outbreak diarrhoea was more prevalent than usual. The cases of cholera were in three different troops. Uh Native Infantry. — The first three cases were " Dogras" from the detachment in the fort close by the city. No prevalence of diarrhoea. 41st Native Infantry. — Of the 4 cases which occurred at long intervals, 2 were among sepoys and 2 among followers. Diarrhoea did not prevail to any marked degree. 11. Meteorology. — Royal Artillery. — The wind during the epidemic was persistently easterly or north east. VUh Hussars. — During the whole time that cholera prevailed, the wind varied from east to south-east The rain-fall was excessive. It was observed that the most severe cases of cholera and the majority of the cases of diarrhoea occurred during or just after these falls of rain, accompanied by a fall of temperature. 4>Qt/i Regiment. — While the wind remained B in the east, cholera seemed to increase and also diarrhoea and low nervous prostration, but whenever it veered round to the west the disease began to decrease, and as it settled there cholera ultimately disappeared. 6 oik Regiment. — During the months of August and September there was a heavy rain-fall, and the prevailing wind was easterly. 35 X9IA Bengal Cavalry. — Up to 20th April westerly winds prevailed, but easterly winds during the remainder of that month and in May. 111. Contagion. — Royal Artillery. — No evidence of importation, nor could any cases be traced to intercourse with the sick. None of the attendants on sick attacked. The only instance favouring" the idea of contagion was that of the sirdar coolie employed at the cholera tents removing soiled clothing. (Date of his attack not mentioned, nor how long he had been employed on this duty.) 13^1 Hussars. — There is no evidence of the disease having been imported into the Cavalry lines. In 4 cases a second member of a family was attacked, but in 2 there appear to have been suspicious symptoms from the time of seizure of the first member. One of them, the man last attacked on the 22nd, had been attending his wife in one of the cholera tents from the 14th. None of the hospital attendants were attacked, or of the mehters employed in collecting and removing cholera excreta, although their work was almost continuous during the first part of the epidemic. 4S)th Regiment. — The first case could not be traced to communication with any previous case, or the subsequent ones to infection. No attendants attacked. 65^ Regiment. — No evidence of importation or contagion. None of the hospital attendants were attacked. 19tk Bengal Cavalry. — No suspicion of importation. No evidence of contagion. No attendants attacked. งth Native Infantry. — The men are believed to have contracted the disease by visiting the city, where cholera Was (no details given of such visits) . No evidence is adduced of personal communication. No attendants attacked. 41*^ Native Infantry. — No evidence of importation or contagion, nor were any attendants attacked. IV. Sanitary defects. — Royal Artillery. — The sanitary condition of the lines was satisfactory, and the conservancy arrangements carefully looked after. The water was boiled and filtered. The disease could not be connected with the water from any particular well. The drainage is fairly good. IStA Hussars. — The barracks are old and difficult to keep in repair, but were fairly watertight during the heavy rain in September. In the family quarters the ventilation is not so good as in the barracks, owing to the sub-division into rooms, and during the heavy rain the walls appeared to be damp. The night-soil from the syces' latrines was carried past the north end of the barracks in the morning at the breakfast hour, and the smell- was complained of. Orders were given to have it removed between 9 p.m. and 3 a.m. The drainage is surface and fairly good, but from the ground being level and the soil so impermeable, the whole surface is more or less under water for a considerable time after heavy rain. Around the hospital the drainage is not so good as round the barracks. In the male wards the roof ventilation is somewhat deficient. 4 The town of Cawnpore has a population of 98,476. Here the first death from chole ra according- to the mortuary returns, occurred on the 2nd April. In that month there were 45 deaths from this cause; in May 34; in June 14; in July 31 ; and in August 9 — or a total of 133 during the year. 73rd Foot. — The 6 cases came from 6 different buildings. No prevalence of diarrhoea. •&otk Regiment Native Infantry. — There was a case on the 18th July, not entered as cholera. A man returned from leave on the 16th; he came to hospital with rheumatism on the 16th, two days afterwards diarrhoea set in, and he died. 11. Meteorology. — The disease progressed in an easterly direction against the wind then prevailing. 111. Contagion. — 7 3rd Foปt. — The disease is ascribed to indirect communication by means of the native servants with people who had come to a festival on the banks of the Ganges, and among whom it is said many deaths occurred (The date of this festival and the number of deaths not stated.) First case could not be traced to communication nor the others to contagion. No attendants attacked. 3bth Regiment Native Infantry. — No evidence of communication, but the disease is ascribed to the man. who returned on the 16th July. No attendants attacked. V. Movement — Was made partly to unoccupied buildings and partly to camp about 4 \ miles distant. In no instance did fresh cases occur among the parties after being moved. ALLAHABAD. E Battery, 11th Brigade, Royal Artillery. No. 6 Battery, 23rd Brigade, Royal Artillery — Surgeon G. Shaw. Ist Battalion, sth Foot — Surgeon-Major Tippetts, and Surgeon-Major J. D. Sainter. 18th Bengal Cavalry. 34th Native Infautry — Surgeon- Major H. W. Spry. Native population of cantonments, 6,450. I. Details op outbreak. Royal Artillery. l-sth Foot. 34th Native Infantry. Naiive population of Cantonments. Case. Cases. Cases. Deaths May 3rd ... 1 May 17th ... 1 May 16th ... 3 May 4th ... 2 August 24th ... 1 „ 17th ... 1 „ 17th ... 2 „ 28th ... 2 „ 18th ... 2 „ 19th ... 1 „ 29th ... 1 „ 19th ... 6 „ 20th ... 2 Sept. 4th ... 1 „ 20th ... 3 „ 22nd ... 2 „ 13th ... 1 „ 25th ... 1 „ 29th ... 1 „ 14th ... 1 The population of the city of Allahabad is 145,864 ; among- them the deaths registered from cholera were in March 1, April 10, and May 7, or a total of 18 altogether. Royal Artillery. — The only case was an officer living 1 in the mess-house. 1 -hth Foot. — The case in May was a solitary case in cantonments. The 4 cases* in August occurred among the detachment in the fort. Diarrhoea had prevailed in the garrison of the fort prior to cholera appearing. In the September attack the 5 cases came from three different buildings in cantonments. งUh Native Infantry. — Of the 16 cases 5 were sepoysf and the rest followers : — 111. Contagion — Royal Artillery. — No communication traceable. No spread. Nona of the attendants attacked. \-*>th Foot. — No reason to suspect communication as the cause of the case in May. No attendants attacked. September outbreak. — First case could not be ascribed to communication. There was no connection in any way between the cases. No attendants attacked. Fort Jhlachmeut. — No communication or contagion traced. No attendants attacked. 34^ Native Infantry. — No evidence of communication. No attendants attacked. V. Movement. — 1-5^ Foot. — The inmates of affected barracks in the fort were placed under canvas within the walls. No case occurred in the tents. In the September outbreak, movements were made to camp near the Commissariat lines, and also to Deborah, 48 miles down the Jubbulpore line. No cases occurred in camp. 34M Native Infantry. — On the 20th May the regiment moved into camp at Dehree, about a mile north of the railway bridge over the Jumna. No cases occurred in camp. * From the Deputy Surgeon-General's remarks, it appears that there were 5 cases in this detachment, but only 4 are entered in the register. t Only 3 in the register. 38 ป BAREILLY. Detachment of European convalescents in camp — Surgeon- Major J. Hendley C-19th Brigade, Royal Artillery; 1-1 8 th Foot; 16th Bengal Cavalry; 11th Native Infantry ;— Surgeon-Major J. Duncan. Native population of cantonment 5,832. I. Details of outbreak. Detachment of Convalescents in camp. Hth Native Infantry, Native population of Cantonment. Case. Case. Deaths. March 31st ... ... 1 March 23rd ... 1 Nil. The city and forty villages within 10 miles of the cantonment suffered more or less from cholera. Besides the man attacked on the 31st March, there was another case among the convalescents, which commenced elsewhere, but proved fatal here on the 30th of that month. This man, Private Harnett, belonged to the 63rd Regiment, and marched with four of his comrades from Nowgong to Cawnpore. They left Nowgong about the 1 8th March. After leaving Banda, Harnett was attacked with vomiting and purging, which continued more or less till the party reached Cawnpore. (Date of leaving Banda not given.) The party remained in camp at Cawnpore two days, and on the 29th March started by the Oudh and Rohilcund Railway for Bareilly. During their stay at Cawnpore, Harnett had received no medical aid. On starting he seemed much fatigued, but it was not till after the train passed Lucknow that he became very ill. Then purging and vomiting set in, and as there was no convenience, the evacuations were passed out of the window. On the morning of the 30th March the party reached Bareilly, and Harnett was taken to hospital with pronounced cholera, and in nine hours he died. The other case occurred on the following day. The man belonged to the Royal Artillery at Saugor, and had not travelled in the same railway carriage as Harnett. There were several cases of diarrhoea in the detachment. 111. Contagion. — Detachment of convalescents. — No evidence of contagion. None of the attendants were attacked. \\ih Begiment Native Infantry. — There was no evidence of importation. No attendants were attacked. The medical officer remarks : "As only one man attacked out of about 700, in every respect similarly situated, the least improbable explanation of the origin of his illness is that the disease was imported by some of the visitors to the lines from dowu country." IV. Sanitahy defects. — llth Native Infantry. — The barracks over-crowded. MORADABAD. Detachment, 1-1 8 th Foot — Surgeon-Major T. Barnwell. Detachment, 16th Bengal Cavalry — ") q ivr ' T T v Head-Quarters and Right Wing, 45th Native Infantry— } JJ^Vv?, 0 * Jail 400- * J M. D., Civil Surgeon. Native population of cantonments, 1,045. I. Details of outbreak. l-18th Foot. Cases. Jail. Cases. September sth ... ... ... 3 August 26th ... ... 1 „ 7th ... ... ... 1 September 4th ... ... 1 Bth ... ... ... 1 „ 27th ... ... 1 13th ... ... ... 1 Total ... 6 Total ... 3 In the city of Moradabad cholera appeared on the Bth August. In that month there were 83 deaths from the disease, in September 244, and in the first five days of October 7 ; total 334, out of a population of 59,866. 1-18 M Foot. — Before the cholera appeared there were a few cases of diarrhoea among the men, but nothing unusual. On the morning of the sth three cases of cholera occurred, almost simultaneously, between 12 and lam Two were from the family barracks and one from the matron's quarters at the female hospital. Jail. — Only register received. 11. Meteorology. — \-\St/t Foot. — For several days previous to the occurrence of cholera, the mornings were cloudy, often overcast towards mid-day, evenings close and sultry; direction of wind east, varying but a few points. It is remarked that coming from this direction the wind blew from the city over cantonments. 111. Contagion. — 1-18/^ Foot.. — No importation traced; it is believed that the disease may have been brought by the punka-coolies, but no actual case can be recorded of a punkacoolie taken ill at any of the quarters in which the cases occurred. It is said that one coolie employed at the kutcherry barrack was seized with purging and vomiting, went to his house in the city and died next day (no dates mentioned) . The fourth person attacked was 39 the mother of one of the children first seized. She was nursing- her child in the cholera tent. She had complained of feeling unwell, and suffered from diarrhoea ; but to this she paid no attention, as she was a sufferer from chronic dysentery and diarrhoea (the date of her beginning to feel worse and of the diarrhoea recurring is not stated). The fifth case was the father of the other child first seized. He was in attendance on the child till her removal to the tent, and then all communication ceased, and the man was not permitted to leave his quarters. He was complaining of feeling unwell the day before attack, and had diarrhoea ; he states that he ate little or no food nor slept for three days before he was seized. This man's child was seized at midnight of the 4th, and was sent to hospital at 6-30 of the sth September. The man himself was attacked at 6-30 p.m. of the Bth September. When his child was taken to hospital, the mother accompanied her and nursed her until her death, but did not suffer ; the father with his other children was removed to a separate building. In the quarters at the other end of this building one of the first cases had occurred on the sth September. None of the hospital attendants were attacked. V. Movement. — \-\Sth Foot. — On 9th September the families moved under canvas at the rifle range, half a mile from their quarters. On the 13th a woman was seized here. The camp was then moved to Saugor Tal, 3 miles south of cantonments on the Bareilly road. Here they remained till 24th, and returned all well. DEHRA DUN. Governor General's Body-Guard. 2nd Goorkha Regiment — Surgeon-Major F. F. Allen. Native population of cantonments, 231. I. Details of outbreak. 2nd Goorkha Regiment. Native population of Cantonments. Cases. Deaths. May 4th ... ... 2 May 20th ... ... ... 1 „ 16th ... ... 1 „ 30th ... ... ... 1 7 11T1ฃk )K^~H There was no prevalence of diarrhoea. 111. Contagion — No evidence that the disease was introduced by man, or that it spread by infection. No attendants were attacked. ROORKEE. Head- Quarters, 55th Foot — Surgeon T. Holmes, M.B. Head-Quarters and Nos. 1, 5, 6, 7, and 10 Companies, Sappers and Miners; 41st Company, Royal Engineers — Surgeon-Major A. Eteson. Native population of cantonments, 1,166. I. Details op outbreak. 65th Foot. Thomason C. E. College. May 14th ... ... 1 May 13th ... ... ... 2 June 7th ... ... 1 „ 18th ... ... ... 1 „ 17th ... ... 1 .i 21st ... ... ... 1 „ 18th ... ... 1 „ 22nd ... ... ... 2 „ 27th ... ... 1 July 4th ... ... 1 55^ Foot. — No diarrhoea prevalent. The cases were from four separate buildings. In three of them there was a history of unripe mangoes having been eaten. Thomason C. E. College. — Of the cases 3 were from barracks and 3 from camp. 11. Meteorology. — 55^ Foot. — A south-easterly wind prevailed during the most of the time. East winds had prevailed for several weeks previous to the outbreak, and a severe duststorm occurred on the 10th May. Atmosphere perfectly still during the whole of the 13th May and following night. No fogs. The only peculiarity noticed in the condition of the air was in the elastic force of vapour on the 12th and 13th May, the two days which preceded the outbreak — on the 12th *202 and on the 13th '270 ; the average for the last 20 days of May being -505. Thomason C. ~E. College. — The sustained prevalence of east winds all through the spring and hot months was very notorious. 40 111. Contagion. — bhth Foot. — No importation could be traced. Previous to the first case occurring" among the Europeans, no case had been reported either in Roorkee or the neighbouring- villages. As regards the immediate contagion of the disease, the soldier orderlies who attended their sick comrades, the doctors and apothecaries who performed the post-mortems, the hospital servants and mehters who were employed in collecting and removing the excreta, were all exempt from the disease. Thomason C. E. College. — The most rigid enquiry failed to connect the disease with importation. No attendants attacked. So far as is known, the three Europeans were the first cases in Roorkee or its vicinity, and these three were all seized almost at the same hour in buildings widely separated. IV. Sanitary defects. — hhth Foot. — The only insanitary condition observable was the practice of not keeping the fire-buckets, which are hung in the verandahs of the bungalows, filled with fresh water ; the fluid in these vessels was not changed as often as it might have been, especially in the family bungalows, in one of which two children and one woman contracted the disease. According to the statement of the occupants, the water had not been changed for weeks, and at the time of the occurrence of the disease in this bungalow the smell of the water was most objectionable, and the fluid filled with animalculae. Thomason C. E. College. — Imperfect drainage. Unsatisfactory condition of the latrines in use by the native students. Some over-crowding in the class-rooms ; and want of proper protection to the well. Some of these defects have been already remedied. V. Movements. — hhth Foot. — On the first appearance of the disease in a barrack, it was vacated; the men went into tents pitched in front of their bungalows and remained there for a period of 14 days. There was no second case among the inmates of any of the rooms where removal was at once adopted. On the 27th June the families went into camp, one mile from the station. One case was admitted from this camp. Thomason C. E. College. — On the 19th May the military class, nearly 40 strong, marched into camp at Peeronkullia, and next morning the college square was entirely vacated. The site was afterwards changed to a better place, one mile distant. On the 14th June the barracks were re-occupied. Three cases occurred in camp. MEERUT. A Battery, C Brigade, Royal Horse Artillery; E Battery, F Brigade, Royal Horse Artillery ; Head- Quarters, B and F Batteries, Bth Brigade, Royal Artillery — Surgeon- Major E. Y. Kellett. loth Hussars — Surgeon A. B. Robinson. Both Foot — Surgeon-Major William Skeen. 4th Bengal Cavalry. sth Native Infantry. Central Jail — Surgeon R. A. Holmes, M.D. Native population of cantonments, 26,139. I. Details op outbreak. Eoyel Art'llery. 15th Hussars. 85th Regiment. Jail-strength 1,333. Natiw fiS of Can ' Cases. Cases. Cases. Cases. Deaths. August 26th... 1 September 24th, 1 September 11th, 1 September 7th ... 2 September sth ... 1 28th... 1 October 7th, 1 „ Bth ... 1 „ 6th ... 3 September 3rd... 1 ป 9th ... 4 „ 7th ... 1 4th... 3 ? 10th ... 4 „ Bth ... 4 Bth ... 1 ป Hth ... 1 „ 9th ... 1 10th... 1 h 12th ... 1 ? 10th ... 1 11th... 2 ป 13th ... 3 „ 14th ... Si ," 13th... 2 m 14th ... 1 „ 16th ... ฃ 14th ... 2 ป 15th ... 2 „ 17th ... I 20th... 1 ป 10th ... 2 „ 18th ~ 7 • '*)f ll IP A /til ?ป X Total 15 2 ~ ป3 46 41 The city of Meerut, with a population of 51,991, returns the first death from cholera on the 14th August. In that month there were 4 deaths from cholera, in September 71, and in October 5, or a total of 80 in all. Boy al Artillery. — There was no diarrhoea. Of 32 buildings occupied, 10 were attacked; 2 cases occurred in hospital and 3 in tents. Ybth Hussurs,—- One of the cases was from the hospital and the other from the family quarters. Jail. — Diarrhoea not prevalent, but there was a persistent tendency to it among patients in hospital, so much so as to make it necessary to restrict the use of purgatives. 11. Meteorology. — Itoyal Artillery .—The disease appeared to advance against a strong east wind. Sbtk Regiment. — Heavy rain-fall and strong easterly winds day and night. Jail. — Direction of the wind easterly. 111. Contagion. — Royal Artillery. — It is stated that there had been cases in Kusseroo Khara, a village adjoining the grass-cutters' lines, but beyond cantonment limits. Many officers and mess-servants lived there, and it was ascertained that 2 dressers, a shop coolie, and a bheestie of the Royal Artillery hospital lived there surreptitiously. The first case in the Royal Artillery was in the hospital. Extensive public works were going on in the lines,and many of the work-people lived in Kusseroo Khara. No direct evidence of importation. No connection traced between the first and subsequent cases. No attendants were attacked, except a dresser who lived at Kusseroo Khara (date of attack not stated) . Ybth Hussars. — No importation traced or case suggesting contagion. No attendants attacked. &stik Regiment. — No communication could be traced. No attendants attacked. Jail. — First case could not be traced to importation. A sweeper attached to the hospital was the second case. It is not stated if he had been attending the first case. The medical officer suffered from " choleraic diarrhoea." IV. Sanitary defects. — Royal Artillery. — The syces' and grass-cutters' lines are badly constructed, in many instances 12 to 15 inches below the level of the ground. Roofs low. B&tk Regiment. — The ground around the hospital in which the only case occurred was water-logged owing to unusually heavy rain. V. Movements. — Royal Artillery. — When the first case occurred in hospital, the patients were placed under canvas in the compound. A-C, Royal Horse Artillery went into tents in the barrack square on the sth September, at a distance of 50 yards from their barrack bungalow. On the 15th September they marched to the cantonment camp at the far side of the parade ground, 1,000 yards clistant, and returned to barracks on the Ist October. JE-F Royal Horse Artillery to tents in barrack square on 11th September, and returned Ist October. B-Bt/t Royal Artillery occupants of one bungalow, to tents in barrack square on 12th September, and to cantonment camp on 13th, returned Ist October. F-Stk Royal Artillery, occupants of one bungalow, to Temperance Hall on Bth September. Those of another to guard-room on the 12th, the whole to cantonment camp on 13th September, returned Ist October. Two of the cases occurred in tents in the barrack square, and one in cantonment camp. Jail. — The inmates of the hospital were moved into" camp. Three cases occurred after removal. DELHI. No. 2 Battery, 23rd Brigade, Royal Artillery; Wing, 55th Foot — Surgeon-Major H. F. Paterson, M.D. Detachment, 4th Bengal Cavalry ; 33rd Native Infantry — Surgeon E. R. Johnson. Native population of cantonments, 3,973. I. Details of outbreak. Eoyal Artillery. 65tb Regiment. 4th Bengal Cavalry. 33rd Native Infantry. ฐ f Cases. Cases. Case. Case. Deaths. August 18th ... 1 August 14th ... 1 August 30th ... 1 September Bth 1 August 31st .. 1 November 13th ... 1 „ 19th ... 1 „ 215t... 1 September Bth ... 1 „ 24th... 1 September 9th 1* Total ... 3 6 1 1 2 * A Barrack Serjeant. 40 111. Contagion. — hhth Foot. — No importation could be traced. Previous to the first case occurring" among the Europeans, no case had been reported either in Roorkee or the neighbouring villages. As regards the immediate contagion of the disease, the soldier orderlies who attended their sick comrades, the doctors and apothecaries who performed the post-mortems, the hospital servants and mehters who were employed in collecting and removing the excreta, were all exempt from the disease. Thomason C. E. College. — The most rigid enquiry failed to connect the disease with importation. No attendants attacked. So far as is known, the three Europeans were the first cases in Roorkee or its vicinity, and these three were all seized almost at the same hour in buildings widely separated. IV. Sanitary defects. — hhth Foot. — The only insanitary condition observable was the practice of not keeping the fire-buckets, which are hung in the verandahs of the bungalows, filled with fresh water ; the fluid in these vessels was not changed as often as it might have been, especially in the family bungalows, in one of which two children and one woman contracted the disease. According to the statement of the occupants, the water had not been changed for weeks, and at the time of the occurrence of the disease in this bungalow the smell of the water was most objectionable, and the fluid filled with animalculse. Thomason C. E. College. — Imperfect drainage. Unsatisfactory condition of the latrines in use by the native students. Some over-crowding in the class-rooms ; and want of proper protection to the well. Some of these defects have been already remedied. V. Movements. — hhth Foot. — On the first appearance of the disease in a barrack, it was vacated; the men went into tents pitched in front of their bungalows and remained there for a period of 14 days. There was no second case among the inmates of any of the rooms where removal was at once adopted. On the 27th June the families went into camp, one mile from the station. One case was admitted from this camp. Thomason C. E. College. — On the 19th May the military class, nearly 40 strong, marched into camp at Peeronkullia, and next morning the college square was entirely vacated. The site was afterwards changed to a better place, one mile distant. On the 14th June the barracks were re-occupied. Three cases occurred in camp. MEERUT. A Battery, C Brigade, Royal Horse Artillery; E Battery, F Brigade, Royal Horse Artillery; Head- Quarters, B and F Batteries, Bth Brigade, Royal Artillery — Surgeon- Major E. Y. Kellett. 15th Hussars — Surgeon A. B. Robinson. 85th Foot — Surgeon-Major William Skeen. 4th Bengal Cavalry. sth Native Infantry. Central Jail — Surgeon R. A. Holmes, M.D. Native population of cantonments, 26,139. I. Details of outbreak. Royal Art'llery. 16th Hussars. 85th Regiment. Jail-strength 1,333. Native ฐ f Can " Cases. Cases. Cases. Cases. Deaths. August 26th... 1 September 24th, 1 September 11th, 1 September 7th ... 2 September sth ... 1 28th... 1 October 7th, 1 „ Bth ... 1 „ 6th ... 3 September 3rd... 1 ป 9th ... 4 „ 7th ... 1 4th... 3 „ 10th ... 4 „ Bth ... 4 Bth ... 1 „ Hth ... 1 „ 9th ... 1 „ 13th... 2 ? 14th ... 1 „ 16th ... ฃ 14th ... 2 ป 15th ... 2 „ 17th ... 1 20th... 1 ป 16th ... 2 „ 18th 7 20th ... 2 „ 19th ... 3 41 The city oฃ Meerut, with a population of 51,991, returns the first death from cholera on the 14th August. In that month there were 4 deaths from cholera, in September 71, and in October 5, or a total of 80 in all. Royal Artillery. — There was no diarrhoea. Of 32 buildings occupied, 10 were attacked; 2 cases occurred in hospital and 3 in tents. Ibt/i Hussars. — One of the cases was from the hospital and the other from the family quarters. Jail. — Diarrhoea not prevalent, but there was a persistent tendency to it among patients in hospital, so much so as to make it necessary to restrict the use of purgatives. 11. Meteobology. — Royal Artillery. —The disease appeared to advance against a strong east wind. Sstk Regiment. — Heavy rain-fall and strong easterly winds day and night. Jail. — Direction of the wind easterly. 111. Contagion. — Royal Artillery. — It is stated that there had been cases in Kusseroo Khara, a village adjoining the grass-cutters' lines, but beyond cantonment limits. Many officers and mess-servants lived there, and it was ascertained that 2 dressers, a shop coolie, and a bheestie of the Royal Artillery hospital lived there surreptitiously. The first case in the Royal Artillery was in the hospital. Extensive public works were going on in the lines,and many of the work-people lived in Kusseroo Khara. No direct evidence of importation. No connection traced between the first and subsequent cases. No attendants were attacked, except a dresser who lived at Kusseroo Khara (date of attack not stated) . \hth Bussars. — No importation traced or case suggesting contagion. No attendants attacked. S5tA Regiment. — No communication could be traced. No attendants attacked. Jail. — First case could not be traced to importation. A sweeper attached to the hospital was the second case. It is not stated if he had been attending the first case. The medical officer suffered from " choleraic diarrhoea." IV. Sanitary defects. — Royal Artillery. — The syces' and grass-cutters' lines are badly constructed, in many instances 12 to 15 inches below the level of the ground. Roofs low. 85tA Regiment. — The ground around the hospital in which the only case occurred was water-logged owing to unusually heavy rain, V. Movements. — Royal Artillery. — When the first case occurred in hospital, the patients were placed under canvas in the compound. A-C, Royal Horse Artillery went into tents in the barrack square on the sth September, at a distance of 50 yards from their barrack bungalow. On the 15th September they marched to the cantonment camp at the far side of the parade ground, 1,000 yards distant, and returned to barracks on the Ist October. E-F Royal Horse Artillery to tents in barrack square on 11th September, and returned Ist October. B-Bt/i Royal Artillery occupants of one bungalow, to tents in barrack square on 12th September, and to cantonment camp on 13th, returned Ist October. F-Stk Royal Artillery, occupants of one bungalow, to Temperance Hall on Bth September. Those of another to guard-room on the 12th, the whole to cantonment camp on 13th September, returned Ist October. Two of the cases occurred in tents in the barrack square, and one in cantonment camp. Jail. — The inmates of the hospital were moved into 1 camp. Three cases occurred after removal. DELHI. No. 2 Battery, 23rd Brigade, Royal Artillery; Wing, 55th Foot — Surgeon-Major H. F. Paterson, MJ). Detachment, 4th Bengal Cavalry ; 33rd Native Infantry — Surgeon E. R. Johnson. Native population of cantonments, 3,973. I. Details of outbreak. Royal Artillery. 55th Regiment. 4th Bengal Cavalry. 33rd Native Infantry. ฐ f Cases. Cases. Case. Case. Deaths. August 18th ... 1 August 14th ... 1 August 30th ... 1 September Bth 1 August 31st -. 1 November 13th ... 1 „ 19th ... 1 „ 215t... 1 September Bth ... 1 „ 24th... 1 September 9th 1* * A Barrack Serjeant. 42 In the city of Delhi, with a population of 111,015, there were between the Bth May and 24th November 44 deaths registered from cholera ; and in the suburbs, with a population of 48,402, between the 14th May and 26th September, there were 57. The monthly totals for the two taken together were — May ... ฆ Surgeon-Major A. Maclean. Head-Quarters and No. 1 Battery, 23rd Brigade — ) 43 54th Regiment — Surgeon-Major G. A. Davidge 6th Bengal Cavalry. 9th Native Infantry. 17th Native Infantry. Native population of cantonments, 4,638. I. Details of outbreak. Royal Artillery. 64th Regiment. Native population of Cantonments. Cases. Cases. Deaths. August 25th ... ... 1 August 23rd ... ?, 1 August 25th... ... 1 September 20th ... ... 1 „ 24th ... ... i „ 26th... ... 1 October 21st ... ... 1 „ 25th ... ... 2. „ 315t... ... 1 „ 22nd ... ... 1 „ 26th ... ... 1 September Ist... ... 1 „ 28th ... ... 1 „ 2nd... ... 1 „ 29th ... ... 2 „ 4th ... ... 1 „ 30th ... „. 2 „ 6th ... ... 1 Sept. 2nd ... ... 2 „ 10th ... ซ. 1 „ 3rd ... ... 3 „ 11th ... ... 1 „ 4th _ ... 2 „ 12th ... ... 1 „ 9th ... ... 1 „ 14th ... ... 2 „ 11th ~ ... 1 „ 17th... . ... 1 „ 14th ... ... 1 „ 18th ... ... 1 „ 19th ... ... 1* „ 19th... ... 1 „ 23rd ... ... 1 „ 20th... ... 1 „ 25th ... ... 1* October sth ... ... 1 October 10th ... ... 1* „ 11th ... ... 1* „ 17th ... ... 1* Total ... 4 26 17 * In camp. Royal Artillery. — The four cases were from three different barracks. There was no prevalence of diarrhoea. -* — , ฆ ?, -civ n -i *t i • j * i i • 1 -I • >i ฆฆ • , i 54M Regiment. — Ten blocks of buildings were attacked, including three hospitals — two for males and 1 for females : 20 blocks escaped. For some time previous diarrhoea had prevailed. 111. Contagion. — Royal Artillery. — No evidence of importation adduced. No attendants attacked. 54iA Regiment. — The Biswas Nullah which runs near the barracks may have been prejudicial to health on the cessation of the rains, as it most likely contained decaying vegetable and organic matter. The state of a native latrine near the regimental bazar was also reported to be unsatisfactory. V. Movement. — Royal Artillery. — The inmates of barracks in which cases occurred were moved into tents at from 200 to 400 yards from their quarters. No case occurred in tents. 54M Regiment. — The Right Wing moved into camp 4 miles from cantonments (date not stated); 4 cases occurred : further move of \\ miles made; one case followed. The headquarters sick, among whom the largest proportion of cases had occurred, moved to Mohunpore ; only one case followed, and in that suspicious symptoms had commenced before leaving Morar. FORT GWALIOR. No. 4 Battery, 23rd Brigade, R. A. ; Detachment, 63rd Foot; a few native guards- Surgeon- Major T. T. Gardner. I. Details of outbreak. Detachment, 63rd Regiment. Cases. August 9th ... ... ... ••ซ ... 1 11th „ ... ... ... ... 1 „ 23rd ... _ ... ... ... 2 „ 24th ... ... ... ... ... 1 99 J/Oh ll *•• ••• ••• ซaซ •t • X September 2nd ซ. ... ... ซ. ... 1 Total ... 7 Of 13 buildings occupied by the troops, 4 were attacked and 9 escaped. As soon as the first case appeared, diarrhoea and dysentery became very prevalent. 11. Meteorology. — The atmosphere was loaded with moisture and running with a fair amount of force from south-west. 111. Contagion. — First case not traced to communication. The man lived in the barrack nearest the city. "He was also seen either on the evening before, or on the evening but one before, the night he was taken ill, coming from the direction of a house in the fortress which is frequented daily by 6or 8 recognized women who reside in Gwalior at night." Cases 3, 5, and 6, it is believed, obtained the disease through the infecting influence of case No. 1, for cases Nos. 3 and 5 were in the same room as case 1 when taken ill, and until he was removed to hospital, a period of 10 hours ; while case No. 6, being removed from an infected barrack to another where were located those men who had been in the same room with case 1, thus came in contact with them. Case 7 is known to have had frequent communication for several days, previous to her illness, with a woman who was nursing her child and isolated on account of choleraic diarrhoea. Hospital attendants and mehters did not suffer from the disease, nor did any native in the fortress. IV. Sanltary defects. — There are 8 large tanks of stagnant water in the fortress, some of which in the early morning and evening give off unpleasant effluvia. V. Movement. — On 25th August the married people were moved into tents on the parade ground ; and 27 men from the barrack, where cases Nos. 3 and 5 had come from, moved into camp 6 miles from the Fort. The register returns no cases as having occurred in the camp, but one woman was seized in tents on the parade ground. Five of the 27 men moved into camp suffered from diarrhoea and dysentery, and one died from simple, continued fever, following diarrhoea. NOWGONG. G Battery, 11th Brigade, Royal Artillery. Detachment, 63rd Foot — Surgeon Hannah. 3rd Bengal Cavalry— Surgeon-Major J. J. Clarke. Detachment, 20th Madras Native Infantry — Surgeon J. Backhouse. Native population of cantonments, 6,318, 45 I. Details op outbueak. Detachment, 63rd Foot. 3rd Bengal Cavalry. gnth Madras Native Infantry. Native population of Cantonments. Cases. Cases. Cases. Deaths. August Bth ... 1 September Ist ... 1 August 10th „. 2 July 28th ... 1 15th ... 1 m 2nd ... 3 „ 21st ... 1 August 2nd ... 1 24th ... 1 „ 23rd ... 1 „ 4th ... 1 September 30th ... 1 „ 27th ... 1 „ 6th ... 3 October 3rd ... 1 „ 30th ... 1 „ 9th ... 1 September sth ... 1 „ 10th ... 1 „ Bth ... 1 „ 11th ... 1 „ 9th ... 2 „ 12th ... 1 17th ... 1 „ 14th ... 1 „ 10th ... 1 September Ist ...2 „ sth ... 1 11 42 Total ... 5 4 A 1 The first case in the bazar is attributed to a man having been to the to attend at the funeral of a man who died of cholera; he was himself attacked on return. (Exact information is wanting.) _._,._ an A children. 63rd Regiment.— There was some prevalence of diarrhoea among the women ana cnnaren. Three barracks attacked. ? . u een a 3rd Bengal Cavalry. -The first case on the border of cantonments is sa id to nave oeen a Goshain who'came from Chutterpore, where cholera was rife. He was attacked on the 27 h followers were attacked. Of these 10, 8 occurred July. Besides the 4 cases above noted, 6 followers in the first 30 hours. No prevalence of diarrhoea. 46 20t/i Madras Native Infantry. — Diarrhoea slightly prevalent. 11. Meteorology. — 3rd Bengal Cavalry. — During July the air was hot, muggy, and very still, until the 28th, when heavy rain fell. During August and September the air was cool and breezy, with occasional storms. 20M Madras Native Infantry. — During August the atmosphere appeared to be very low and still. 111. Contagion. — 63rd Regiment. — The first case could not be traced to importation. The Royal Artillery had not a single case, neither was there any among their followers, although their grass-cutters, out daily cutting grass, were doubtless in frequent communication with natives in the bazar and other affected localities. No hospital servants or attendants were attacked. 3rd Bengal Cavalry. — No importation traceable, nor could connection be traced between first and subsequent cases. Of the spread of disease from the Goshain, there is not a trace. In not a single instance did it spread, as it were, from individual to individual. No attendants were attacked. 20tA Madras Native Infantry. — No history of importation or evidence of contagion No attendants attacked. IV. Sanitary defects. — 63rd Regiment. — The soil is black cotton soil and becomes very swampy in the rains. The numerous small houses for the family barracks — one for every two families — are objected to on account of their bringing many natives constantly near the quarters, harbouring refuse and encouraging flies. The drainage from them also at times was offensive. '3rd Bengal Cavalry. — Lines over-crowded. The Dhorea Nullah, which divides the sudder bazar into two, is in an insanitary state. The conservancy of bazar defective. V. Movement. — 63rd Regiment. — Several parties from affected buildings were moved into tents at distances varying from 1,000 yards to 2 miles from barracks, and all with complete success. No further case occurred in any of them. JUBBULPORE. 1-1 lth Foot. Detachment, 3rd Madras Light Cavalry. 16th Madras Native Infantry — Surgeon-Major J. R. Theobald, Native population of cantonments, 16,221. I. Details of outbreak. 16th Madras Native Infantry. Natire population of Cantonments. ฆ Case. Deaths. August 28th ... ... 1 September Ist ... ... 1 3rd ... ... 1 % ?> " 111 • • • i * ป JL - ฆ - The sepoy attacked was a man of the 24th Bombay Native Infantry,* who had been on leave from Neemuch to Sialkot. He left Sialkot on the 24th August and arrived at Jubulpore on the 27th August ; his illness commenced in the train. 111. Contagion. — There was no evidence of contagion. No attendants were attacked. SEHORE. Bhopal Battalion— Surgeon- Major W. E. Allen, F.R.C.S. I. Details of Outbreak. — October 26th, 1 case.f The man was greatly fatigued by a double march he had made to the station. He was attacked 8 hours after arrival. In all, there were 4 cases in the station, and 3 deaths; 34 cases in the town, with 13 deaths. There was no unusual prevalence of diarrhoea. 11. Meteorology.— There was an unusual fall of rain on the 26th and 29th October, 26 days after the cessation of the regular rains. 111. Contagion. — Up to the 30th May, Sehore was quite free of cholera, when two travellers who had come along the Agra and Indore road, where the disease was, were attacked (date of their arrival not stated). On the 18th July a sowar, suffering from the disease, arrived from Bhopal and put up in the city : in his immediate neighbourhood there occurred, six days after a oroup of nine cases (it is not mentioned if they had had any communication with the sowar, or if people who had communication with them suffered) . No other evidence of spread by communication adduced. No attendants attacked. * The case is entered under the 16th Madras Native Infantry, as it was reported on by the Medical Officer of that regiment and treated in their hospital. t Eight other cases occurred in the Detachment at Indore between the 6th and 9th November, but no particulars of them are given. 47 2nd Regiment, Central India Horse — Surgeon R. Caldecott. I. Details of Outbreak. — May 17th, 1 case. The man had arrived two days previously from Oojein where cases of cholera had occurred. There was no prevalence of diarrhoea. 111. Contagion. — No futher cases occurred. No attendants attacked. SIRDARPORE. Malwa Bheel Corp — Surgeon-Major D. Campbell, M.D. I. Details op outbreak. — None of the sepoys were attacked, but among the followers cases occurred as follows : — Cases. Cases. June 22nd ... -. 1 August 14th ... ... 2 July 27th ... ... 1 „ 16th ... > ... 2 „ 30th ... ... 1 „ 19th ... ... 2 August sth ... ... 2 „ 22nd ... ... 1 „ 6th ... ... 1 „ 23rd ... ... 1 ;',' 10th ... ... 1 „ 28th ... ... 1 „ 12th ... ~ 4 „ 29th ... ... 1 ... ;" , Total ... 21 Cholera had prevailed, with more or less severity, in the towns and villages of the Bheel States, and more especially in the Jabbooa and Dhar territories, since the beginning of May, but the villages within 6or 8 miles of Sirdarpore had suffered very little. The bazar escaped entirely. Both before and during the outbreak diarrhoea was very prevalent among children, and they were the chief sufferers from cholera. 11. Meteorology. — The rains had been unusually light, and there had been a marked absence of electrical phenomena. 111. Contagion. — There was no evidence that the first case was due to importation or the subsequent ones to infection. No attendants attacked. IV. Sanitary defects. — The bed of the river, not having had a good flushing, was fouler than usual. GUNA. Ist Central India Horse — Surgeon A. Barclay. I. Details of outbreak. — 25th August, 1 case. No diarrhoea prevalent. 11. Meteorology. — Nothing remarkable. A light wind from north-east was blowing. No rain had fallen since the 20th August. 111. Contagion. — No evidence. There had been no cholera in the lines or regimental bazar or in the native city of Guna, and for six weeks none had been reported in the district. On the 24th a Seikh priest was attacked in the lines and removed to dispensary. He lived about-300 yards apart from the hut occupied by the first case. No communication had taken ulice between the two. No attendants were attacked. BHURTPORE. Detachment Deolee Irregular Force : strength 35 — Surgeon H. Compigne, M.D. I. Details of outbreak. — July 24th, 1 case. There was some increase of diarrhoea. The Superintendent-General of Dispensaries in Rajpootana returns 3 cases of cholera in the Bhurtpore State in April, 48 in May, 310 in June, in July 615, in August 404, in September 190, in October 20, and in November 1. The population of the State is not known, but it covers an area of 1,300 square miles. In the town of Bhurtpore 243 cases were reported, of which 106 were fatal! 11. Meteorology. — The rain-fall was late, but was of average quantity. 111. Contagion. — Cholera was on all sides, but there was no evidence that the first case was due to importation. One other case which occurred in the same compound may, it is said, be attributed to this cause (no history of this case is given). No evidence. No attendants were attacked. , UMBALLA. Head- Quarters and A & C Batteries, A Brigade, R. H. A. 11th Hussars — Surgeon-Major J. Beatty. 4th Battalion, Rifle Brigade — Surgeon-Major R. A. Allen, M.D. 15th Bengal Cavalry. 32nd Native Infantry. Native population of cantonments, 24,560. 48 I. Details of outbreak. 11th Hussars. Rifle Brigade. Native population of Cantonments. Case. Cases. . Deaths. September 23rd ... ... 1 August 3rd .„ ... 1 July 30th ... ... 1 „ 4th ... ... 1 August 2nd ... ... 1 „ ,6th ... ... 6 „ 3rd ... ~ 1 6th ... ~ 1 „ 6th .i. ... 1 7th ... ... 3 „ 12th ... ~ 1 „ Bth ! ... ... 2 „ 13th ... ... 1 „ 9th ... ... 1 ? 16th... ... 1 „ 10th ... ... 2 „ 17th ... ... 2 „ 11th ... ... 3 „ 18th... ... 2 „ 12th ... ซ. 1 „ 19th ... ... 2 „ 13th ซ. ... 4 „ 20th ... ... 1 „ 14th ... ... 2 „ 22nd... ... 2, „ 15th ... ~ 1 „ 24th ... ... 1 „ 16th ... ... 1 „ 25th _ ... 2 „ 19th ... ... 1 „ 27th... ... 1 „ 23rd ... ... 1 „ 29th ... ... 2 „ 29th ... ... 1 „ 31st ... ... 2 „ 30th ... ... 1 September Ist ... ... 3 2nd 4 3rd... ... 3 sth ... ... 2 M Ulli ... ... L jj XutQ ... ... -L 27th m. ... 2 ™"™ I 33 l attacked had been drinking., and lay on the wet grass near niffht when he woke up with pain and diarrhoea. Ine ฃ \ j., '„„> 4-i,r. /M-I+V.^Qcilr in f.Vip nn.ntonment. lltk Hussars. — The only man his barrack for great part of the night, when he wo*e up wซn pant "-ป"ซ-• *- regiment was particularly free from diarrhoea during the outbreak m the can^ment. & Rifle Briiade.-Otti* 33 cases 22 occurred m barracks and 11 in the camps beven at another resident m the same house. ann \ na - Vซrv heaw ฆThe monsoon was late in commencing. Very heavy 11. Meteorology. — Wth Hussars. — ' am S e a flritr-On the evenins of the 29th, shortly after the first case of cholera was reported fnZ Rifle ฿riฃfc 7bZ?, there was for about twohours a terrific down-pour. Agam, 49 on August Ist and 2nd heavy rain fell. The 3rd was fine ; late that night the first case occurred in barracks, The 4th was fine. The early morning of the sth was very wet, and during the night and early morning of the 6th it rained incessantly. This was the worst night as regards cholera. IIL Contagion. — i\th ffustars. — The case could not be traced to communication. None of the attendants were attacked. Rifle Brigade. — The first case could not be traced to communication ; some of the barrack^ in which most of the cases occurred are near the public road, but others equally near escaped. None of the hospital attendants or others coming in immediate contact with the sick suffered, and their number was between 40 and 50. IV. Sanitary defects. — Rifle Brigade. — Drainage is imperfect. V. Movement.— Rifle Brigade. — -Out of 560 men about 300 were moved to tents in cantonments — to the rest-house and to, camps at Khojepore, Jundlee, Khurdan and Boh. The and Khurdan moves were not successful. The heavy rain rendered all movement difficult. The families did not move. Grass huts were erected in camp and proved a great comfort to the men. Of the 11 men attacked in camps, 7 had come from barracks which had furnished eases. KASAULI. Convalescent DepSt — Surgeon-Major C. C. "Dempster, M.D. ; Surgeon W. Elgee. Strength on 2nd July, 538 men, 84 women, and 199 children, — total 821. Native population of cantonments, 1,400. ... I. Details of outbreak. Convalescent Dcpdt. Native population of Cantonments. Cases. Deaths. July 3rd ... ... 4 July 9th ... ... ... 3 „ 4th ... ... 8 „ 10th... ... ... 1 „ sth ... ... 3 „ 11th... ... ... 1 „ 7th ... ... 5 „ 12th... ... ... 1 ? 9th ... ... 2 „ 13th... ... ... 1 „ 10th ... ... 1 „ 14th... ... ... 1 „ 11th ... ... 3 „ 15th ... ... ... 1 „ 12th ... ... 4 „ 16th... ... ... 3 „ 13th ... ... 8 „ 17th... ... ... 2 „ 14th ... ... 2 „ 18th... ... ... 3 „ 17th ... ... 1 „ 19th... ... ... 1 „ 20th ... 1 „ 20th... . ... ... 3 „ 21st ... ... 1 „ 25th ... ... ... 1 „ 24th ... ... 1 „ 30th... ... ... 1 „ 27th ... ... 1 „ 29th ... ••• 3 „ 30th ... 3 August 3rd ... •ซ 1 Total ... .52 Total ... 23 The attack was very sudden and severe. On the night of the 3rd of July* and following day, 12 cases occurred in four different barracks, and from among nine different regiments. There had been no prevalence of diarrhoea. Eleven barracks were attacked. No. 1 6, Family Quarter, which suffered most immediately, overhangs the plains. From this barrack there were 14 admissions on the 3rd, 4th, sth, and 7th July. In the bazar there were no cases whatever. The deaths returned among natives were nearly all of servants, who were greatly over- worked and much exposed to the weather. One officer was attacked and died; three other Europeans residing in Kasauli were seized : one on the 3rd July, one on the 29th July, and the other on the Ist August. Also a Eurasian on the 16th July. 11. Meteorology. — The prevailing wind was easterly, very light, and sometimes variable. Immediately antecedent to, and coincident with, the first appearance of the disease, the weather was unpleasantly warm, foggy and damp, with occasional showers. 111. Contagion. — The first case could not be traced to importation. So far as is known, none had occurred in the bazar or among the civil community. Nor could any connection be established between the earlier cases and those which occurred subsequently. None of the attendants were attacked, except one man who nursed his child. This child was one cf those first seized. The father attended him in hospital till the 13th July. On that date * Within a few hours of the time when the severe outbreak of 1872. commenced at the station. 50 he went out to camp and was attacked in the afternoon. Another man was admitted into hospital on the 7th July suffering from diarrhoea. There was no communication between him and the cholera patients, and he was attacked with cholera on the 9th. " These are the only two cases in which it might possibly be said that the disease could be traced to communication/ In the camp hospital, also, none of the attendants suffered. The child of one of the sweepers there was attacked. In two cases in camp parents attending their children were attacked. The question of possible contagion is complicated by residence within the affected locality of Kasauli. IV. Sanitary defects. — The site of No. 16, Family Barrack, is said to have been formerly occupied by a bazar, and the ground in the ravine immediately below it has been, it is said, defiled by latrines and slaughter-houses. In earth taken from the spot the Chemical Examiner found over 9 per cent, of organic matter, but it was all of vegetable origin. The flooring of the barrack gave evidence of damp. V. Movement. — Between the 7th July and 26th August, 215 men, 61 women, and 121 children moved into camp at Gurkhul, a ridge which stretches almost parallel to the Kasauli ridge, but further from the plains. The tents were provided with boarded floors, and charcoal was issued for drying tents, clothes, &c. Twelve cases occurred in camp, but they were chiefly among those who had recently left barracks. SIMLA. Population. Europeans and Eurasians ... ... ... 1,434 ) Natives ... ... ... ... 13,414 I. Details op outbreak. — The first case occurred on the 26th June and the last on the 28th August. Between these dates there were 341 seizures reported, and, of these, 184 were fatal. The daily incidence of the disease was as follows :—: — Oases. Cases. June 26th ... ... ... 1 July 22nd ... ... 24 „ 27ih ... ... 1 „ 23rd ... ... 10 „ 28th ... ... 3 „ 24th ... ... 14 „ 30th ... ... 1 „ 26th ... ... 5 July Ist ... 9 26th ... ... 8 „ 2nd ... ' ... 3 „ 27th ... ... 19 ? 3rd ... ... 3 „ 28th ... ... 8 „ 4th ... ... 3 „ 29th ... ... 6 „, sth ... ... 3 „ 30th ... ... 19 „ 6th ... ... 8 „ 31st ... ... 23 „ 7th ... ... 8 August Ist .ซ ... 19 „ Bth ... ... 4 „ 2nd ... ... 13 „ 9th ... ... 6 „ 3rd M . ~ 10 „ 10th ... ... 9 „ 4th ... ... T „ 11th- ... 5 sth ... ... 2 „ 12th ... ... 3 „ 6th ... ... 2 „ 13th ... ... 5 „ 7th .- ... & „ 14th ... ... 3 „ Bth ... ... 5 „ 15th ... ... 3 „ 9th ... ... 4 „ 16th ... ... 9 , ; 10th ... ... 1 „ 17th ... 5 „ Hth ... -. 1 „ 18th ... ... 12 „ 18th ... ... 1 „ 19th ... ... 9 ? 21st ... ... 1 „ 20th ... ... 7 „ 22nd ... ... 3 „ 21st ~ ... 6 „ 25th ... ... 1 Total ... 341 Of the 341 cases, 25 were in Europeans and Eurasians, and 316 in Natives. Of the total, ao-ain, 308 were adults and 33 children. Of the natives, the hill-men suffered by far the most severely. Of the 316 attacks among them, 198 were in hill-men. The proportion of the different classes is not known, but the population is by no means composed chiefly of hill-men, 51 but includes a large number from the plains, thus — According to locality the disease was distributed Cases. In the Main Bazar ... ... ... ... 89 „ Lukkur Bazar ... ... ... ... ... 14 „ Boileau Gunge ... ... ... ... ... 7 „ Chota Simla ~. ~. ... . ... ... 2 „ Khyutoo ... ... ... ... ... ... 6 „ Detachment of Goorkha ฿egiment.., ... ... ... 4 n Jail ... ••ฆ •-• ••• ... ... 2 In private compounds ... ... ... ... „, 217 Total ... ... 341 Some portions of the community were remarkably exempt. For example, in the establishments attached to the Viceroy's household, which embraced 620 persons, there was not a single case. During the time of the outbreak diarrhoea was very prevalent. For weeks before cholera appeared, the public health at Simla had been bad, and very many deaths from fever had occurred among the people. 11. Meteorology. — The rainfall in July and August was heavy. In the one month 25-64 inches were registered, and in the other 27*88. The total for the year was 91*39, which is much above the average. 111. Contagion. — The first case could not be traced to importation. At one time it was supposed that the disease might have been brought up by a party of 7 jampanies, returning from Kalka via Kukurhuttee, in which small village there were 8 cases between the 14th June and 3rd July, but these men are said to have arrived on the evening of the 26th. As has been already said, the first case at Simla occurred on that day. Enquiry also failed to attach the cases at Kukurhuttee to importation. There had been no case at Kalka, and, as shewn elsewhere, the outbreak at Kasauli did not commence till the 3rd July. In the whole course of the disease at Simla no fact has been recorded tending to shew that it was spread by contagion. After the 24th July no attempt was made to remove the sick from their homes against the wishes of their friends. Numerous cases were thus treated in + heir own houses, but none of the four Medical Officers under whose care they were treated could point to a single instance in which the disease appeared to have been spread by this means. Not one of the hospital attendants, who were in constant contact with the sick, suffered. Cholera at Chiawag, a place 14 miles distant from Simla, is ascribed to its constant and direct communication with the Lukkur Bazar. The first case occurred in the Lukkur Bazar on the 7th July, and cholera commenced at Chiawag on the 10th. Twenty-one persons were seized there, of whom 15 died. (It is not stated whether any of them had been to the Lukkur Bazar, nor are any details of supposed communication of the disease recorded.) IV. Sanitary defects. — These were many and great. The water-supply, drawn as it is from many independent and unprotected sources, is scanty and open to all kinds of contamination ; the conservancy both of bazars and private houses is defective. The houses in which the natives and even some of the Europeans live are over-crowded, ill-ventilated and damp during the rains. Many of the huts occupied by native servants in particular are not fit to live in. The sanitary condition of the settlement has been reported on by a special committee, and recommendations have been made for dealing with all these evils. V. Movement. — In a community like that of Simla no general movement could be attempted. From the commencement of the outbreak to the 24th July, an effort was made to isolate all those attacked by removing them to a hospital specially set apart for their reception. But this system created great alarm among the people, and no doubt led to concealment. Patients were sent to hospital often only when there was no hope left. Of 5S admitted, 47 died, or 81 per cent. Of the 47, 17 arrived either actually dead or moribund.* * What was said on this very important point in last Annual Report may be here quoted — " Paea. 36. — The proper mode of dealing with epidemic cholera among the people is a matter of very great importance, and the recent experience of Simla in this particular is valuable. When the disease first appeared, a cholera hospital was established, and endeavours were made to remove to it every person that was attacked. This procedure was based on the idea that cholera is contagious, that the disease is spread by discharges, and that, therefore, the public safety would be best consulted by isolating all who are seized. But it altogether failed in practice. The people feared cholera, but they feared the cholera hospital still more. It was but natural that they should dread the removal of their friends or members of their family to a hospital to be tended by strangers, especially when there was so little hope of ever seeing them again. The consequence was that every effort was made to conceal the disease, and hence, instead of diminishing the sources of supposed contagion, they were only increased. After a time, an altogether different system was adopted. The settlement was divided into districts, each district was provided with a supply of medicines and a hospital assistant. People were encouraged to apply for remedies at the first onset of any premonitory symptoms, and the cholera hospital was reserved for those who had no friends to look after them. When it was known that those attacked would not be carried off to the cholera hospital against the wishes of their friends, applications for medicine were numerous, and in this way many cases were checked in their early stage. The sick were attended in their own houses, and measures were adopted for disinfection so far as they could be carried out. There is not the smallest ground to believe that treating the sick in this way in the least degree spread the disease. The four Medical Officers at Simla who have been brought in immediate contact with cases since the new system came into play, have all recorded that in the whole of their experience during this outbreak they have never seen any ill-effects from the sick being treated in their own houses, and that in their opinion it has not in a single instance spread the disease. The sick have, in fact, not acted as sources of contagion from which others have become affected. On the other hand, there can be no question of the advantage to those attacked in being left at their homes. Not only did they meet with care and comfort there which they could have had nowhere else, but they were also spared the fatigue and other depressing influences of removal to hospital which are so full of danger to a cholera patient. As the attempt to remove cholera patients from their homes, which failed at Simla, has been tried elsewhere with the same want of success and the same distress to the people, it is most important that these facts should be known, not only throughout India, but also in other countries where belief in the contagion of cholera has gained much ground, both with the profession and the public, and where compulsory measures of isolation have been advocated in order, as it is called, to ' stamp out ' the disease, and that it may be seen how needless is the social misery which any such system most inevitably entail." 52 FEROZEPORE. E Battery, Bth Brigade, Royal Artillery. No. 5 Battery, 13th Brigade, Royal Artillery — Surgeon-Major F. Howard, M.D. 2- 12 th Foot — Surgeon-Major J. W. Lougheed. Detachment, 11th Bengal Lancers. 40th Native Infantry. Native population of cantonments, 14,345. I. Details of outbreak. Royal Artillery. 2-12 th Regiment. Native popnlation of Cantonments. Cases. Cases. Deaths. November 6th ... 1 August 23rd ... 1 November Ist *.. 1 „ 14th ... 1 „ 24th ... 1 „ 21st - 1 26th ... 1 „ 23rd ... 1 October 6th ... 1 „ 25th ... 1 „ 27th ... 1 December Ist ... 2 28th ... 1 Total ... 2 ... 6 ... 6 In the city among a population of 20,592, no death from cholera was registered during the year. Royal Artillery. — No prevalence of diarrhoea. Of the three barracks, two furnished cases ; only one case occurred among the followers, and that was on the 31st October. At the time there was no cholera in the sudder bazar, jail, or the civil community. 2-12^ Foot.- — Of the six cases four occurred among the detachment in the Fort, and the other two in cantonments ; but of these one had just returned from the Fort. Before the man was attacked on the 23rd, there had, so far as known, been no case of cholera in any section of the community of Ferozepore. 11. Meteorology. — 2-12^/5 Foot. — A light westerly breeze was blowing. The rainfall in July, August, and September was unusually heavy. 111. Contagion. — Royal Artillery. — The first case could not be traced to communication. There was no evidence of contagion. None of the attendants were attacked. 2-\2tk Foot. — No communication was traced. No attendants were attacked. IV. Sanitary defects. — Royal Artillery. — To the east side of the lines, at a distance of nearly half a mile, there is some low ground, where the water lies for some days after a heavy fall of rain. * V. Movements. — Royal Artillery. — The occupants of the barracks affected were placed under canvas, and no more seizures took place among them. 2-l2t/i Foot.- — The men moved into camp about 900 yards from the Fort on the 25th August. No case occurred after they had been in camp 24 hours. SIALKOT. D Battery, A Brigade, Royal Horse Artillery. 9th Lancers — Surgeon-Major R. Lewer. l-6th Foot. 17th Bengal Cavalry. 15th Native Infantry. Native population of cantonment, 13,400. I. Details of outbreak. — 9tA Lancers. — July 24th, 1 case. In the city, among a population of 25,337, only two deaths from cholera were registered, one on the 11th, and the other on the 22nd October. 111. Contagion. — No mention is made of any communication with a previous case. No attendants were attacked. DHARMSALA. Detachment, Blst Foot (at Bhagsu) — Surgeon J. Riddick. Ist Goorkha Regiment — Surgeon-Major C. F. Oldham. Native population of cantonments, 1,930. ' 53 I. Details of outbreak. Detachment, 81st Foot. lst Goorkha Regim ent. Native population of Cantonments. Strength — lal men. B Cases. Cases. DeathB - August 12th ... ... 1 July 2nd ..._ ... 2 July 3rd ... ป• 1 „ 14th ... ... 2 „ 3rd ... ... 1 „ 4th ... ... 1 „ 15th ... ... 1 „ 4th ... ... 2 „ sth ... ... 1 „ 16th ... ... 1 „ 5th... ... 5 ป 7th... ... 6 6th ... ... 5 „ Bth ... ... 2 7th ... ... 12 „ 9th ... ... 5 Bth ... ... 8 „ 10th ... ... 2 9th ... ... 12 „ Hth ... ... 6 10th ... ... 14 „ 12th ... ... 3 11th ... ... 7 „ l 3th ••• ••• l 12th ... ... 7 ป l 4th ••• ••• l 13th ... ... 2 „ 15th ... ... 1 15th ... ... 2 ? 16th ... ... 2 16th ... ... 2 ป 17th ... ... 2 17th ... ... 4 „ 18th ... - 2 18th ... ... 5 ป 20th ... ... 1 21st ... ... 1 ป 21st ... ... 1 25th ... ... '2 ป 27th ... ... 1 . August 9th ... ... 1 August 9th ... ... 1 „ 29th ... ... 1 September 14th ... ... 1 September 14th ... ... 1 ป l 6fch ฆ•• >~ l 15th ... ... 1 Total ... 5 • 97 42 81*ฃ Regiment. — Before and during the outbreak, diarrhoea was very prevalent. In all 42 cases were treated in hospital, and many more received medicine without being admitted into hospital. None of the cases were attended with collapse or cramps, but there was vomiting in some, and one nearly proved fatal. -The Medical Officer himself was very ill from diarrhoea with vomiting, and did not get well till he went into camp with the men. He seems to have been, attacked about the end of June and got worse from 3rd July. The admissions from diarrhoea were, — in May 1, in June 4, in July 16, and in August 8, before the Ist case of cholera declared itself on the 12th of that month. All three barracks furnished cases of cholera. Ist Goorkha Regiment. — In the bazar, cases occurred in 12 houses. In the lines people were attacked in 34 huts, and 200 were free from the disease. There was no prevalence of diarrhoea previous to the outbreak. Jail. — In the end of June and beginning of July a very suspicious outbreak of diarrhoea occurred in the jail ; a man admitted into hospital on the 28th June, died on the Ist July ; another admitted on the 29th June, died on the 3rd July. On the 4th July a death was reported from cholera. On the Bth and the 9th July other deaths were reported from diarrhoea. This statement is taken from the report of the Medical Officer of the Ist Goorkhas. No report or register has been received from the jail. 11. Meteorology. — 8 1st Regiment. — The wind generally from the south. Rainfall unusually heavy. 111. Contagion. — 81st Regiment. — The first man attacked had eaten pork, and also, it is said, drank milk brought up by a boy who was taken ill of cholera on the road when bringing it. Two men of the detachment are reported to have drunk of this milk ; one was attacked and the other felt no ill effects (details are not given as to where the milk came from, in what sort of vessel it was brought, when it was drunk, &c). No other communication could be traced. Subsequent cases could not be connected with contagion. No attendants were attacked. Ist Goorkhas. — The disease is believed to have been imported, but it could not be traced. There had "been cholera at Mundi and Jawala Mukhi, and the roads from each pass through cantonments. The following are cited as instances of contagion : — The second case was that of a water-carrier who supplied water to the first case. The two were attacked within a few hours of each other. The first commenced at 4p.m. on the 2nd July, the other was ill all that night. The third case lived near the water-carrier. No evidence of communication between them. Eight of the attendants on the sick, out of about 100, were attacked. " The sick orderlies were not allowed to go to the lines, but were lodged in a separate barrack near the hospital."" 52 FEROZEPORE. E Battery, Bth Brigade, Royal Artillery. No. 5 Battery, 13th Brigade, Royal Artillery — Surgeon-Major F. Howard, M.D. 2- 12 th Foot — Surgeon-Major J. W. Lougheed. Detachment, 11th Bengal Lancers. 40th Native Infantry. Native population of cantonments, 14,34,5. I. Details of outbreak. Royal Artillery. 2-12 th Regiment. Native population of Cantonments. Cases. Cases. Deaths. November 6th ... 1 August 23rd ... 1 November Ist ... 1 „ 14th ... 1 „ 24th ... 1 „ 21st - 1 26th ... ] „ 23rd ... 1 October 6th ... 1 „ 25th ... 1 „ 27th ... 1 December Ist ... 2 28th ... 1 Total ... 2 ... 6 ... 6 In the city among a population of 20,592, no death from cholera was registered during the year. Uoyal Artillery. — No prevalence of diarrhoea. Of the three barracks, two furnished cases ; only one case occurred among the followers, and that was on the 31st October. At the time there was no cholera in the sudder bazar, jail, or the civil community. 2-I2tk Foot. — Of the six cases four occurred among the detachment in the Fort, and the other two in cantonments; but of these one had just returned from the Fort. Before the man was attacked on the 23rd, there had, so far as known, been no case of cholera in any section of the community of Ferozepore. 11. Meteorology. — 2-12^ Foot. — A light westerly breeze was blowing. The rainfall in July, August, and September was unusually heavy. 111. Contagion. — Royal Artillery. — The first case could not be traced to communication. There was no evidence of contagion. None of the attendants were attacked. 2-\2t/i Foot. — No communication was traced. No attendants were attacked. IV. Sanitary defects. — Royal Artillery. — To the east side of the lines, at a distance of nearly half a mile, there is some low ground, where the water lies for some days after a heavy fall of rain. V. Movements. — Royal Artillery. — The occupants of the barracks affected were placed under canvas, and no more seizures took place among them. Z-l2t/i Foot. — The men moved into camp about 900 yards from the Fort on the 25th August. No case occurred after they had been in camp 24 hours. SIALKOT. D Battery, A Brigade, Royal Horse Artillery. 9th Lancers — Surgeon-Major 11. Lewer. l-6th Foot. 17th Bengal Cavalry. 15th Native Infantry. Native population of cantonment, 13,400. I. Details of outbreak. — 9tA Lancers. — July 24th, 1 case. In the city, among a population of 25,337, only two deaths from cholera were registered, one on the 11th, and the other on the 22nd October. 111. Contagion. — No mention is made of any communication with a previous case. No attendants were attacked. DHARMSALA. Detachment, Blst Foot (at Bhagsu) — Surgeon J. Riddick. Ist Goorkha Regiment — Surgeon-Major C. F. Oldham. Native population of cantonments, 1,930. I 53 I. Details of outbreak. Detachment, 81st Foot. Strength -121 men. Native population of Cantonments. Ist Goorkha Regiment. I I . — Cases. Cases. Deaths. August 12th ... ... 1 July 2nd ... ... 2 July 3rd ... ป• 1 „ 14th ... ... 2 „ 3rd ... ... 1 „ 4th ... ... 1 „ 15th ... ... 1 „ 4th ... ... 2 „ sth ... ... 1 „ 16th ... ... 1 „ sth ... ... 5 ป 7th ••• ••• 6 „ 6th ... ... 5 •• Bth ••• ••ฆ 2 11th ... ... 7 m 13th ••• ••• 1 12th ... ... 7 h 14th ••• ••• X 13th ... ... 2 ป 15th ... ... 1 15th ... ... 2 ป 16th ... ... 2 16th ... ... 2 ii l^th ... ... 2 17th ... ... 4 ,i 18th ... - 2 18th ... ... 5 ป 20th ... ... 1 Augusjt 9th ... ... 1 August 9th ... ~ 1 29th ... ... 1 September 14th ... ... 1 September 14th ... ... 1 ป 16th ... ... 1 Total ... 5 • 97 42 B\st Regiment. — Before and during- the outbreak, diarrhoea was very prevalent. In all 42 cases were treated in hospital, and many more received medicine without being admitted into hospital. None of the cases were attended with collapse or cramps, but there was vomiting 1 in some, and one nearly proved fatal. -The Medical Officer himself was very ill from diarrhoea with vomiting, and did not get well till he went into camp with the men. He seems to have been attacked about the end of June and got worse from 3rd July. The admissions from diarrhoea were, — in May 1, in June 4, in July 16, and in August 8, before the Ist case of cholera declared itself on the 12th of that month. All three barracks furnished cases of cholera. Ist Goorkha Regiment. — In the bazar, cases occurred in 12 houses. In the lines people were attacked in 34 huts, and 200 were free from the disease. There was no prevalence of diarrhoea previous to the outbreak. Jail. — In the end of June and beginning of July a very suspicious outbreak of diarrhoea occurred in the jail ; a man admitted into hospital on the 28th June, died on the Ist July ; another admitted on the 29th June, died on the 3rd July. On the 4th July a death was reported from cholera. On the Bth and the 9th July other deaths were reported from diarrhoea. This statement is taken from the report of the Medical Officer of the Ist Goorkhas. No report or register has been received from the jail. 11. Meteorology. — 8 1st Regiment. — The wind generally from the south. Rainfall unusually heavy. 111. Contagion. — %\st Regiment. — The first man attacked had eaten pork, and also, it is said, drank milk brought up by a boy who was taken ill of cholera on the road when bringing it. Two men of the detachment are reported to have drunk of this milk ; one was attacked and the other felt no ill effects (details are not given as to where the milk came from, in what sort of vessel it was brought, when it was drunk, &c). No other communication could be traced. Subsequent cases could not be connected with contagion. No attendants were attacked. Ist Goorkhas. — The disease is believed to have been imported, but it could not be traced. There had been cholera at Mundi and Jawala Mukhi, and the roads from each pass through cantonments. The following are cited as instances of contagion : — The second case was that of a water-carrier who supplied water to the first case. The two were attacked within a few hours of each other. The first commenced at 4p. if. on the 2nd July, the other was ill all that night. The third case lived near the water-carrier. No evidence of communication between them. Eight of the attendants on the sick, out of about 100, were attacked. " The sick orderlies were not allowed to go to the lines, but were lodg-ed in a separate barrack near the hospital." 54 They occupied the same barrack throughout, and this was not vacated until the outbreak was over, when it was leeped and disinfected. All sick attendants, whether sepoys or not, were under the same rules, and none were allowed to visit the lines while attending in hospital. When they left, their clothes, &c, were disinfected. Two of the doolie-bearers were attacked. The hospital compounder was attacked. The attendants and doolie-bearers and compounder were attacked on the following dates :— Case 3. On July sth ... ... „. ... 1 6th ... ... ... ... 1 M Bth ... ... ... ... 4 „ 10th ... ... ... ... 1 12th ... ... ... ... 1 15th ... ... ... ... 1 17th ... ... ... ... 1 On September 14th ... ... ... ... 1 The number of attendants and hospital establishment taken together was 127. The Commanding Officer, the only officer attacked, is supposed to have contracted the disease during his visits to the hospital. He was seized on 11th July. Of 7 sweepers employed in removing excreta not one was attacked. The other attendants carefully "avoided the excreta, and of these 8, as has been already mentioned, were seized. IV. Sanitary defects. — Slst Foot. — Quarters are required for the native servants. Ist Goorkhas. — State of the lines was very bad ; huts over-crowded together. New lines are in course of construction. Water-supply open to contamination. A watercourse which passes through the lines flows past the jail, where, as already stated, there had been cases of cholera some days before, and a portion of the drainage of the jail is liable in heavy rain to be washed into it. It does not, however, seem possible that this drainage can make its way into the springs [from which the regiment is supplied] , as they are above the flood-level and are at a distance of from 300 to 400 yards from the jail. V. Movement. — Slst Foot.~- -The men marched to camp 'there were no families at Bhagsu), 38 on the 15th August and the remainder on the 16th. The camping ground was 3 miles distant and 1,000 feet higher than the barracks. One man was attacked on the road, but no other case followed. They returned on the 6th September. Ist Gooikhas. — On the Bth July 280 men, without their families, were moved into camp half a mile from the lines and within cantonment boundaries; 10 cases followed here from the 9th to the 1 2th. On the 1 3th July the camp moved to Chaitru Hill ; here 8 cases occurred between the 14th and 25th. The Chaitru Hill is somewhat lower than the Goorkha lines. KANGRA FORT. Detachment, 81st Foot— Surgeon R. W. O'Donnell Detachment, Ist Goorkha Regiment. Native population of fort, 51. I. Details of outbreak. — Slst Foot. — July 14th, 1 case ; mild diarrhoea was prevalent among the men of the 81st Foot. 111. Contagion. — Two persons in neighbouring bazar are said to have been attacked between the sth and the 12th July, but no communication could be traced with those or any other case. No attendants were atl acked. V. Movement. — The men of the affected barrack moved into tents inside the fort on the 15th and returned to it on the 24th. No further case. AMRITSAR AND GOVINDGARH. Detachment, l-6th Foot— Surgeon R. Smith; ) Cantonment. Detachment, 25th Native Infantry ; j 3-23 rd Royal Artillery — Surgeon W. P. Smith; Fort of Govindgarh. Native population of cantonment, 230. I. Details of outbreak. Detachment, l-6th Foot. Royal Artillery, Fort. Detachment, l-6th Foot, on the march to Amritsar. Cases. Case. Case. September 14th 1 September 9th 1 November 11th 1 20th 3 21st 1 Total ... 5 1 1 registered 756 deaths from cholera. The In the city with a population of 136,609, were first case occurred on 26th July, and the last on 31st October. The monthly totals during 55 the outbreak were for July 27, August 404, September 280, October 45. The maximum of 32 deaths on any one day was reached on the 3rd September. For the last 7 days of the outbreak there was only one death on each day. Detachment, \-งth Foot. — The first 4 cases occurred in hospital and the fifth in a tent to which the sick had been moved. Some prevalence of diarrhoea. R. A., fort. — Cholera had been prevalent in the city of Amritsar, which is close by the tort, from the 26th July. Diarrhoea not prevalent in the Battery. 111. Contagion. l-6tA Foot.—' No communication could be traced. No hospital attendants attacked. Royal Artillery. — No connection could b8 traced between this case and any previous case. No attendants attacked. IV. Sanitary defects. — l~Qtk Foot.— A large quantity of rain was lying on the ground, and the ground was thoroughly soaked. V. Movement. — l-6tA Foot. — When the case occurred in a tent, the camp was removed further from the hospital and no others were attacked. Royal Artillery. — Men placed under canvas. No further cases. (In connection with this outbreak may be mentioned the case of a man of the l-6th Foot marching with a detachment of his regiment from Dalhousie to Amritsar, under the medical charge of Surgeon R. Exham. He was attacked on the 11th November. It was the only case, and no diarrhoea was prevalent. No communication could be traced. No attendants attacked.) MEEAN MEER. A-F Royal Horse Artillery. D-Bth Royal Artillery. Head-Quarters and 2- 13 th Royal Artillery. 2- Ist Foot — Surgeon-Major H. Kelsall. 11th Bengal Lancers. 25 th Native Infantry. 26th Native Infantry. Native population of cantonments, 8,462. I. Details op outbreak. 2-lst Foot. Cases. October 20th ... 1 „ 23rd ... 3 „ 24th ... 3 Total ... 7 Among the native population of cantonment no cases were known. In Lahore City, which is about 5 miles from Meean Meer and has a population of 85,346, there were 37 deaths from cholera registered between the 27th August and 3rd November, — August 2 deaths, September 10, October 23, and November 2. In the Lahore Lunatic Asylum 27 cases, with 19 deaths, occurred between the Ist September and 9th October, out of a strength of 260. There were also cases in the Central Prison, but from this no report has been received, %-lst Foot.-~ No prevalence of diarrhoea. 111. Contagion. — The first case could not be traced to importation. There were no cases among the natives. No attendants attacked. Case No. 7 went into the quarters of No. 4, and removed soiled bedding and clothes, and was attacked next morning. IV. Sanitary defects. — 2- vat Foot. — Two of the men attacked worked in a barrack where for some time previously a bad smell had been noticed as emanating from the brick floor. This building has since been abandoned. , V. Movement. — Some of the married people went into camp to westward, half a mile from the quarter-guard, on the 24th October, and returned on the 7th November. No cases occurred in camp.* DERA ISMAIL KHAN. No. 3, Horse Light Field Battery. Punjab Frontier Field Force Detachment, 92nd Foot. „ 3rd Cavalry. yy 2nd Infantry. ft 2nd Seikh Infantry. ป Native population of cantonments, 4,211. I. Details of outbreak. — 2nd Punjab Infantry. — May 9th, 1 fatal. No prevalence of diarrhoea. 111. Contagion. — No evidence of communication. Careful enquiry was instituted, but no other case could be heard of in the city, jail, bazar, other regiments, or any other place in the district. No attendants attacked. • Ih the Centra! Prison at Lahore about 5 miles from Meau Meer there were 26 cases of cholera. No detailed report has been received, but in his remarks appended to the Register Dr. Stephen observes '* None of the attendants on the sick were attacked." Govt. Central Press,- No 1 S. C.,— 440-76.-100. 54 They occupied the same barrack throughout, and this was not vacated until the outbreak was over, when it was leeped and disinfected. All sick attendants, whether sepoys or not, were under the same rules, and none were allowed to visit the lines while attending in hospital. When they left, their clothes, &c, were disinfected. Two of the doolie-bearers were attacked. The hospital compounder was attacked. The attendants and doolie-bearers and compounder were attacked on the following dates :— Cases. On July sth ... ... ... ... 1 6th ... ... ... ... 1 „ Bth ... ... ... ... 4 10th ... ... ... ... 1 12th ... ... ... ... 1 M 15th ... ... ... ... 1 17th ... ... ... ... 1 On September 14th ... ... ... ... 1 Total ... ... ซ. 11 The number of attendants and hospital establishment taken together was 127. The Commanding Officer, the only officer attacked, is supposed to have contracted the disease during his visits to the hospital. He was seized on 11th July. Of 7 sweepers employed in removing excreta not one was attacked. The other attendants carefully avoided the excreta, and of these 8, as has been already mentioned, were seized. IV. Sanitary defects. — 81*i5 Foot. — Quarters are required for the native servants. Ist Goorkhas. — State of the lines was very bad ; huts over-crowded together. New lines are in course of construction. Water-supply open to contamination. A watercourse which passes through the lines flows past the jail, where, as already stated, there had been cases of cholera some days before, and a portion of the drainage of the jail is liable in heavy rain to be washed into it. It does not, however, seem possible that this drainage can make its way into the springs [from which the regiment is supplied] , as they are above the flood-level and are at a distance of from 300 to 400 yards from the jail. V. Movement. — 81*/! Foot.-— The men marched to camp 'there were no families at Bhagsu), 38 on the 15th August and the remainder on the 16th. The camping ground was 3 miles distant and 1,000 feet higher than the barracks. One man was attacked on the road, but no other case followed. They returned on the 6th September. \st Gooikhas. — On the Bth July 280 men, without their families, were moved into camp half a mile from the lines and within cantonment boundaries; 10 cases followed here from the 9th to the 1 2th. On the 1 3th July the camp moved to Chaitru Hill ; here 8 cases occurred between the 14th and 25th. The Chaitru Hill is somewhat lower than the Goorkha lines. KANGRA FORT. ? Detachment, 81st Foot— Surgeon R. W. O'Donnell." Detachment, Ist Goorkha Regiment. Native population of fort, 51. I. Details op outbreak. — Slst Foot. — July 14th, 1 case ; mild diarrhoea was prevalent among the men of the 81st Foot. 111. Contagion. — Two persons in neighbouring bazar are said to have been attacked between the sth and the 12th July, but no communication could be traced with those or any other case. No attendants were attacked. V. Movement. — The men of the affected barrack moved into tents inside the fort on the 1 5th and returned to it on the 24th. No further case. AMRITSAR AND GOVINDGARH. Detachment, l-6th Foot — Surgeon R. Smith; \ n , nyn , _. . . / „,,, v ? T ซBซ B , ' > Cantonment. Detachment, 25th Native Intantry ; ) 3-23 rd Royal Artillery — Surgeon W. P. Smith ; Fort of Govindgarh Native population of cantonment, 230. I. Details op outbreak. Detachment, 1-flth Foot. Royal Artillery, Fort. Detachment, l-6th Foot, on the march to Amritsar. Cases. Case. Case. September 14th 1 September 9th 1 November 11th 1 20th 3 21st 1 Total ... 5 1 1 population registered 756 deaths from cholera. The In the city with a of 136,609, were first case occurred on 26th July, and the last on 31st October. The monthly totals during 55 the outbreak were for July 27, August 404, September 280, October 45. The maximum of 32 deaths on any one day was reached on the 3rd September. For the last 7 days of the outbreak there was only one death on each day. Detachment, \-งth Foot. — The first 4 cases occurred in hospital and the fifth in a tent to which the sick had been moved. Some prevalence of diarrhoea. R. A ., fort. — Cholera had been prevalent in the city of Amritsar, which is close by the fort, from the 26th July. Diarrhoea not prevalent in the Battery. 111. Contagion. 1-QtJi Foot.— No communication could be traced. No hospital attendants attacked. Royal Artillery. — No connection could be traced between this case and any previous case. No attendants attacked. IV. Sanitary defects. — l-6tk Foot.-~A. large quantity of rain was lying on the ground, and the ground was thoroughly soaked. V. Movement. — 1-66 A Foot. — When the case occurred in a tent, the camp was removed further from the hospital and no others were attacked. Royal Artillery. — Men placed under canvas. No further cases. (In connection with this outbreak may be mentioned the case of a man of the l-6th Foot marching with a detachment of his regiment from Dalhousie to Amritsar, under the medical charge of Surgeon R. Exham. He was attacked on the 11th November. It was the only case, and no diarrhoea was prevalent. No communication could be traced. No attendants attacked.) MEEAN MEER. A-F Royal Horse Artillery. D-Bth Royal Artillery. Head-Quarters and 2- 13 th Royal Artillery. 2- Ist Foot — Surgeon-Major H. Kelsall. 11th Bengal Lancers. 25th Native Infantry. 26th Native Infantry. Native population of cantonments, 8,462. I. Details op outbreak. 2-lst Foot. Cases. October 20th ... 1 „ 23rd ... 3 „ 24th ... 3 Total ... 7 Among the native population of cantonment no cases were known. In Lahore City, which is about 5 miles from Meean Meer and has a population of 85,346, there were 37 deaths from cholera registered between the 27th August and 3rd November, — August 2 deaths, September 10, October 23, and November 2. In the Lahore Lunatic Asylum 27 cases, with 19 deaths, occurred between the Ist September and 9th October, out of a strength of 260. There were also cases in the Central Prison, but from this no report has been received. 2-l*ฃ Foot.-— No prevalence of diarrhoea. 111. Contagion. — The first case could not be traced to importation. There were no cases among the natives. No attendants attacked. Case No. 7 went into the quarters of No. 4, and removed soiled bedding and clothes, and was attacked next morning. IV. Sanitary defects. — 2- lH Foot. — Two of the men attacked worked in a barrack where for some time previously a bad smell had been noticed as emanating from the brick floor. This building has since been abandoned. , V. Movement. — Some of the married people went into camp to westward, half a mile from the quarter-guard, on the 24th October, and returned on the 7th November. No cases occurred in camp.* DERA ISMAIL KHAN. No. 3, Horse Light Field Battery. Punjab Frontier Field Force Detachment, 92nd Foot. „ a 3rd Cavalry. >y 2nd Infantry. a 2nd Seikh Infantry. n Native population of cantonments, 4,211. I. Details of outbreak. — 2nd Punjab Infantry. — May 9th, 1 fatal. No prevalence of diarrhoea. 111. Contagion. — No evidence of communication. Careful enquiry was instituted, but no other case could be heard of in the city, jail, bazar, other regiments, or any other place in the district. No attendants attacked. * In the Central Prison at Lahore about 5 miles from Meau Meer there were 26 cases of cholera. No detailed report has been received, but in his remarks appended to the Register Dr. Stephen observed '? None of the attendants on the sick were attacked." Govt. Central Press,- No I S. C.,— 4-XO-76.-100, •^> tuAA^ /L * ji YU'6 iyOLA^ Lj^a**J\Jlxsvv^ฃ- l&dL &r. ON THE CHOLERA EPIDEMIC OF 1875 ฆ ( BEING SECTION I OF THE ANNUAL REPORT OP THE SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA FOR THAT YEAR.) J. M. CTJNJNGHAM, M.D., SUBGEON-MAJOB, BENGAL MEDICAL SEETICB, SANITAEY COMMISSIONER WITH THE GOVEBNMENT OF INDIA. OFFICE OF THE SUPERINTENDENT OF GOVERNMENT PRINTING.