Cholera: What can the State do to Prevent it ? ft*** ] t M. £UNINGHAM, M.D., SUROEON-GENERAL, INDIAN MEDICAL DEPARTMENT, AND SANITARY COMMISSIONER WITH THE GOVERNMENT OF INDIA. CALCUTTA : PRINTED BY THE SUPERINTENDENT OF GOVERNMENT PRINTING, INDIA. 1884. *o 643 6 43 20,124 3,418 40,985 27,575 330 9,140 II, 932 16,235 Berar . . . 2,630,018 2 22,465 2,683 842 34.306 223 I 3,404 3,573 27,897 Rajputana % t 1,203 283 60 2,393 918 ... 197 1,327 797 Central India . % t 2,555 *>929 926 8,047 2,734 299 581 1,562 1,740 Bombay . . 16,454,414 37 47,573 32,117 57,228 46,743 6,937 684 16,694 7.904 37>954 Hyderabad % f 10,891 5,582 7,414 6,696 6 ? 1,721 150 1,947 Madras . . 28,887,111 313 94,547 148,189 357,43° 47,167 13,296 613 9,446 23,604 36,284 Mysore . . 4,186,188 f 2,504 12,087 2,902 723 14 25 25 893 124 Coorg . . . 178,302 t t 210 f 49 — — 3 31 British Burma . 3,663,923 960 761 3,678 7,276 6,759 1,828 2,638 5.239 7>177 2,185 * Excluding Calcutta. + Statistics not available. % Population not known. 6 Facts in India. 7 This statement will serve to show the vast field o observation which India affords for the study of sue a disease, — vast not only in its area and in its popula tion, but vast also in the enormous number of cases for it may be estimated that the deaths represent onl one half of the attacks.. It will be observed that th disease appears year after year in nearly every part o the country, but that all the provinces have their year of epidemic prevalence as compared with years o marked abeyance. In Bengal, for example, the num ber of deaths has fluctuated between 39,643 in 188 and 196,590 in 1876. In the North-Western Province it has fluctuated between 6,464 in 1874 and 89,372 in 1882. In the other provinces the contrasts are even more striking : In the Punjab between 29 in 1877 an^ 26,135 i n 1^79 In the C. P. between 14 in 1874 and 40,985 in 1878 In Berar between 1 in 1880 and 34,306 in 1878 In Bombay between 37 in 1874 and 57,228 in 1877 and in Madras between 313 in 1874 and 357,430 in 1877. The statistics are no doubt imperfect, but of thei The statistics, though general accuracy as representing imperfect, are of great ° . ° value. the great facts respecting cholera distribution in India there can be no question There are many good grounds for coming to this conclusion. There can be no collusion among the very numerous and illiterate collecting agency, yet the records tell a consistent story from year to year and from district to district. The deaths registered on the border districts of one province often fit in and tally in a remarkable manner with the history of the disease as recorded by the deaths registered in the neighbouring districts of another province. More over, the general accuracy of the registration among the people from year to year is corroborated by th concurrent statistics of troops and prisoners scatterec over the general area of registration, and the facts re garding them are recorded with a care and accurac about which there can be no dispute. The statistic of cholera among the people of India, as represente( by the deaths registered under this head, must there fore be accepted as a most valuable contribution t our knowledge of the disease ; and before coming t any conclusions regarding it, these statistics must b carefully examined with a view to ascertain, if possible what these and other facts which have been collectec during the years the Sanitary Department of India ha been in existence really teach. But in order to arrive at any sound conclusions, it The statements in is necessary to take these facts the appendix show • j,m j« • • . i ? that there is a marked more m detail, district by district, [et'T s ,dSo c e n n td * nd f ° r this purpose the statements in the appendix have been prepared season. by the statistical officer, Dr. Stephen. These statements were compiled primarily with the object of studying the seasonal prevalence of cholera in different parts of India. It will be convenient, therefore, to examine what the main facts are on this point. First there is the endemic area, the area from which cholera is never absent. In Statement I, which includes the twenty 8 Facts in India. 9 districts which may be described as forming the cen tral portion of the endemic area, there are two periods of maximum prevalence, — one during the winter months November, December, and January ; and the othe during the spring months, March, April, and May During the months of July, August, and September the rainy season, there is comparatively little cholera. Within this area, during the twelve years 187 1-1882, 4^ per cent, of the cholera deaths occurred in the winter 38*7 in the spring, and only 3*7 in the rains. In th second statement, which embraces seven districts lyin to the south and south-west of the endemic area, th spring cholera is much the same as in the group in eluded in Statement I, the winter cholera is less, but th cholera of the monsoon or rainy season is much mor marked. In the third group the winter cholera almos disappears ; the spring cholera is comparatively unim portant, and the majority of deaths takes place in th monsoon. In the fourth group, again, the monsoon cholera has decidedly diminished, and the spring cho lera assumed much greater importance. It is not ne cessary to follow the details further here, because they are shown very clearly in the tabular statements, anc there the monthly ratios in different groups can be mor conveniently compared. It need only be remarkec by way of explanation that the districts of the Madra Presidency, of British Burma, and of Assam have been shown in Provincial Tables Nos. XII, XIII and XIV irrespective of season. They were added after th other tables had been prepared, as well as No. XV in which are included a few districts of other provinces presenting peculiarities of seasonal distribution. The great facts to be derived from a study of the first eleven statements are that in the same areas year after year cholera rises and falls with great regularity at the same season or seasons, and that these seasons of rise and fall differ much in different parts of the country. It will be seen from these same statements, and In the endemic area the fact is brought Out Still more there are marked dif- clearly from the detailed annual ferences between the J extent of cholera in figures from which these statements different districts. , ? ? were prepared, that certain dis- tricts suffer more or less severely from cholera yea after year and month after month. They form th groups shown in the first and second statements. I will be observed that while the average annual death I.te from cholera in the first is 18*08 per 10,000 o )pulation, and in the second i6'6o, the ratios in mdi dual districts vary enormously — some suffer very much more than others. For example, in the firs group, the annual death-rate varies from 49*51 in the district of Noakhally to 6*05 in Dinagepore; in the second group it varies from 35*27 in the district of Balasore to 6*44 in Rajmehal and Deogarh. Making every allowance for the admitted imperfection of the statistics, there can be no doubt that even within the endemic area some districts suffer with more persistent severity than others. This endemic area includes the delta of the Ganges, but it includes much more. It is 10 Facts in India. 11 usual to speak of and to show the endemic area in th map as if it were a well defined area, but, as a matte of fact, it is by no means well defined, and shades o gradually in all directions. Indeed, so gradual is th shading that it is impossible to say where the endemi area ceases. The districts which are not usually considered as The districts outside belonging to the endemic area ma t'Zf^tmoZZ be di vided into three great classes great classes. First, there are those which, a though they do not suffer continuously, yet suffe much more persistently and severely than others. T this class belong some of the eastern districts of th North-Western Provinces ; such, for example, as Be nares, Jaunpore, Gorakhpur, and Bustee, with mos of the districts of Oudh, as Sultanpore, Gondah, Ra Bareilly, and Sitapore. Secondly, there are thos which, as a rule, suffer little, but are subject at interval to violent epidemics. Such are many of the district of the Central Provinces and of the Punjab, whic may escape for months and even years without any deaths being registered from cholera, and then show a large mortality from this cause. Of this class Ferozepore is a good example. Its average annua cholera mortality for the twelve years was 3'2/j., bu this is practically made up of the results of two epide mics, one in 1872 and the other in 1879. In all the other years, the deaths from cholera are representec by a small fraction. A third class consists of district which are remarkably exempt from cholera at nearly al times, where in ordinary years cholera may be said t be practically unknown, and where even in epidemi years the number of cases is very small. Of this clas the districts of Montgomery, Mooltan, Muzaffargarh and Dera Ghazi Khan in the Punjab are strikin examples. These illustrations are all drawn from th Bengal Presidency, but others may be found in Madra and Bombay on referring to the particulars which are given in the statements. In all parts of the country there is a most marked „ , .... difference between the results of In all the divisions and also in the ende- different years. In some years the mic area there is a . . marked difference in disease is in abeyance, in others it different years. • .•-.„.• i u ofw ,_ n t l, pe p ~ v _ is epidemic, and between these ex- tremes there are many gradations. Even in the endemic districts, the difference between an epidemic and a non-epidemic year is very striking. In Nuddea for example, in 1871 only 528 deaths from cholera were registered, in 1882 the number was 1 1,020. In Backer gunge in 187 1 the number was 291, in 1877 it was 19,177. Similar results are to be seen in the districts outside the endemic area. In the Tirhoot and Dur bhanga districts combined there were 85 deaths from cholera in one year, and 23,025 in another. In Banda there were 7 deaths registered from cholera in 1874 and 2,337 in 1882. In the Jaunpore district the range was between 15 and 8,251 ; in Gorakhpur be tween 6\ and 8,314; in Rae Bareilly between 4 am 6,635 5 m Gonda between o and 6, 122.1 22. Or to take some examples from the Central Provinces and Berar, the 12 Facts in India. t 13 number of cholera deaths in Raipore one year was 17*076, in another year not one was recorded. In Wun there was a maximum of 4,891, in Bassim o 11,698, in Akola of 7,847, in Buldana of 7,414, in Khandeish of 6,224, and yet in all these districts in one or other year the cholera death register was blank In Montgomery in six out of the twelve years not a single death from cholera was registered. Of the smal total of 1 15 during the twelve years, 10 1 were registerec in the year 1879. Numerous examples of a like kinc will be found in the columns of the statements whicl show the maximum and minimum annual mortality during the twelve years included in them. It is not to be supposed from the above remarks that the periods o cholera abeyance and cholera prevalence occur simul taneously all over the country. The case is rather th reverse. In a year when one province is suffering another may be enjoying remarkable immunity. I does, however, usually happen that marked choler abeyance or cholera prevalence is observable ove large areas — areas which often include many districts. In some years, as notably in 1874, there was a marked abeyance of cholera over the greater part of India. In the endemic area and in the districts lying Isolated cases are around this area, cholera, as a rule, frequent in all parts. occurs rather j fl a j arge number of individual cases here and there than in epidemic outbursts. Outside the endemic area, in places indeed which are far removed from it and in which cholera is but seldom seen, there still occur isolated cases every now and then. The detailed statements furnish many instances of districts in which literally only one or two deaths from cholera have been reported during the whole year, and this may occur for several years together, with the variation that sometimes none are recorded at all. It is of the greatest importance to note these cases, because without a proper apprehension of them no just estimate can be formed of the facts. It is the fashion by some to regard them as no cases of cholera at all, but as evidences of the mac curacy of the returns, which have shown deaths dv to indigestion, or it may be to arsenical poisoning o some other cause, as having been due to cholera ; bu cases of a like isolated kind are constantly returnee from military and civil hospitals, where there can be no doubt whatever that, so far as the symptoms and in many cases so far as the post-mortem appearances are con cerned, death was really due to cholera. Such cases are sometimes the forerunners of an epidemic. In the Upper Provinces when they occur in the spring, they often seem to betoken the epidemic which follows in the rains. But in other years they seem to be isolatec attacks without any epidemic significance. By some they are described as " sporadic; " in Europe they would be called cases of " cholera nostras "; but in order to avoid all theorising as far as possible, it will be best for the present at least to speak of them simply as cases of cholera. It is further to be remarked as one of the impor- 14 tant points illustrated by the statements that the The districts which districts outside the endemic area which suffer to the greatest extent constant commumca- f rom cno lera are not those which tion with the endemic are nearest to the endemic area, area. or most closely connected with it by easy mean of communication. Nor is the reverse true that thos districts which escape are comparatively isolated anc removed from intercourse with the endemic area It has already been shown that some of the easter districts of the North-Western Provinces and Oud suffer with exceptional severity. Many of them are com paratively inaccessible, while others which lie eithe close beside them, and through which there is constan traffic by railway, escape with comparatively little loss In illustration of this, the following examples may be taken, in which the average annual cholera death-rate per 10,000 of population for the twelve years is se opposite each :—: — Districts away from the railway and comparatively difficult of Districts on the line of railway. access. Azamgarh . . ii'ij Allahabad . . • 73 Gorakhpur ' . 12"65 Futtchpur . . 5*06 Basti . . . 2260 Cawnpore . . .s*l; Gonda . . . 19*38 Etawah . . .3-6 Bahraich . . . 14*97 Unao . . , 7-04 Kheri . . . 14*45 Lucknow . . . B#BB8 # 88 Several of these districts lie side by side, but those which suffer far the most are those which are the most inaccessible. Those which lie on the main line o traffic suffer much less. Or to take the case of the 15 Punjab districts already referred to as enjoying such a remarkable immunity from cholera, two of them, Montgomery and Mooltan, are traversed by the railway running from Amritsar and Lahore to Kurrachee, alon which there is constant traffic, and the result is as fo lows. All four districts lie on the line of railway am bear the same relation to the traffic of the country Yet the contrast is most marked. Amritsar am Lahore suffer considerably while Montgomery anc Mooltan almost entirely escape. Annual average cholera death-rate per 10,000 of population for the 12 years. Amritsar ...... 2*89 Lahore ...... 4/94 Montgomery ..... '24 Mooltan ...... # o6 The story which is told by these statistics con- The above facts re- cerning the general population o |oo a H n afion he are gen f e uir; the country is fully corroborated by borne out by the ex- c exact statistics of troops and perience of troops and t _?...,.. prisoners. prisoners. The distribution of cho lera among them follows the same general laws. So marked is the influence of season that great epidemics after several years' interval have frequently recurrec almost on the same day of the year, and what is perhaps the most noteworthy point of all, there are certain places which, as a rule, suffer severely when attacked and there are other places which suffer very little, anc yet to all appearance there is no reason except their 16 Facts in India, 17 geographical and physical position which satisfactoril accounts for the marked difference. Among canton ments that suffer much may be mentioned Allahabac Meean Meer, and Peshawur, while Mooltan, Sialkot and Nowshera suffer little, as may be seen by the fol lowing figures showing the average annual choler death-rate for the 10 years 1860-69: — Allahabad ...... 19*53 Meean Meer ..... 46*27 Peshawar ...... 2d"7z 2475 Mooltan 00 Sialkot ...... -8o Nowshera ...... -q-j •93 The frequent escape of the troops in hill stations even in times of widespread epidemic prevalence entirely accords with the general history of the disease among the ordinary population. There are other important facts which are not Even during epi- recorded in the statements, anc frTattSdXes not which cannot well be figured in suffer in all its parts. statistical tables. These now de serve attention. Among them the first to be notec (that even when cholera appears in epidemic violence wns and villages are not by any means all attack i. The popular belief regarding cholera is tha ice having been imported the disease is passed on from one person to another, and from one part of the country to another, until all is involved, but no idea could well be more unlike the truth. An epidemic o cholera is not a history of gradual spread from a centr b 18 Facts in India. or from many centres, but a history of outbreaks loca ised in a comparatively small number of the inhabitec towns and villages. As stated in the special repor on the cholera epidemic of 1879 in Northern India " The facts from year to year all bear out the sam conclusion, that the distribution of cholera is never un versal j that it frequently shows itself in only a few towns and villages ; that these are not confined to on corner of a district, but scattered at considerable inter vals, and that even within the area of a severe epidemic the proportion of villages attacked is generally sma compared with the proportion which escapes." T take a few illustrations at random. In 1882 the North Western Provinces suffered severely from cholera — 89,372 deaths from this cause were recorded. They were recorded in 668 out of 1,143 circles of registra tion, so that the disease was widely spread, but o 105,421 villages and towns in the province only 10,83$ suffered. Or to take a few of the districts in whicl the disease was most severe : In Lucknow, out of 947 towns and villages, 197 recorded deaths. In Bara Banki, out of 2,06 1 towns and villages, 283 record- Ed deaths. In Sultanpur, out of 2,460 towns and villages, 829 recorded deaths. In this last district nearly 5,000 persons died, or 5*05 per 1,000 of population, and the proportion o towns and villages attacked is unusually high. In the Central Provinces in 1878, a year of epidemic prevalence in that part of the country, the results for the Facts in India. 19 province as a whole and for some of the districts which suffered most are as follows ; and to them may be added a few illustrations from the Punjab in 1879, when the last severe epidemic occurred in this part of India : In the Central Provinces (1878), out of 27,306 towns and villages, 3,025 were attacked. In the Nimar district in the Central Provinces, out of 472 towns and villages, 124 were attacked. In Burhanpur district, out of 123 towns and villages, 24 were attacked. In Nagpur district, out of 1,699 towns and villages, 321 were attacked. In the Punjab (1879), out of 34,973 towns and villages, 3,753 were attacked. In Hissar district, out of 715 towns and villages, 334 were attacked. In Rohtak district, out of 498 towns and villages, 180 were attacked. In Kohat district, out of 469 towns and villages, 107 were attacked. In the districts of the Central Provinces above citec the disease was most severe. In Nimar the cho lera mortality equalled 10*08 and in Burhanpur 14*79 per 1,000. In the Punjab examples, the proportion o towns and villages attacked is much in excess of what is usual, but it is still much less than the proportion which escaped. The same story of exempted places is repeated year after year. And here again the experience of the troops and prisoners affords evidence of the general truth of the facts collected from among the people of the country, for the proportion of barracks Facts in India. 20 attacked in a cantonment or jail is, as a rule, but a small part of the whole. Another important fact is the relation between the Relation between the number of places attacked and the iTTiS t an nutfe intensity of the epidemic. This of places attacked. point was specially noticed in the report on the 1879 epidemic already referred to. It was then remarked that " so far as the evidence goe it would appear that the intensity of an epidemic i manifested not only by the death-rate, but also by the number of different places in which the disease show itself, although in many of these it may show itsel in only a very few cases." This peculiarity is to some extent illustrated in the examples above given. The subject is deserving of further investigation. If any general law of this kind can be established, it is cvi dent that it must have a very decided bearing on the question of the diffusion of cholera. That one epidemic is much more severe than Different epidemics another is a fact which cannot be differ much in severity, disputed, and the importance of which, in arriving at a just estimate of the epidemiology of cholera, cannot be over-estimated. Of this the experience of the Punjab in the great epidemics o 1867 and 1879 affords an excellent illustration. Bot these epidemics were ascribed to the pilgrims return ing from the Hurdwar fair. The epidemic of 1867 wa much more severe than the epidemic of 1879. Th total cholera mortality for the province in the one yea was 2*46 per 1,000, in the other it was only 1*49. Anc Farts in Tw/ii/i JL 1 1 1 ( o Ift I Nil 1(1. 21 not only was this true of the province as a whole, but it was true also of every one of the 32 districts except five. In point of relative severity the two epidemics were distributed very much in the same way — the districts which suffered most in the one year suffered most in the other, and those which suffered least in the one year suffered least in the other. The direction taken by epidemics is another matter Epidemics have a which requires careful considerageneral definite direc- . t^-UD ir> -j r tion. tion. In the Bengal Presidency, for example, the direction of an epidemic is always upwards. Such a thing as an epidemic moving downwards is absolutely unknown. The fact is of great importance, not only in itself, but also in regulating the movement of troops, and it was taken advan tage of after the Afghan war, when there was a fear according to the ordinary opinions entertained regarding cholera, that bodies of men who were suffering from cholera in and beyond Peshawar might be the means of producing an epidemic lower down. There was no ground for alarm, and this opinion was fully justified by what occurred. The troops moved down some of them suffered from cholera, but there was no downward movement of the epidemic. The direction of epidemics in the Upper Provinces is all the more worthy of notice, because the great drainage channels of the country into which much cholera matter must eventually find its way, run in the reverse direction to the epidemic. Were they the means of dissemi nating the disease, it should move downwards and no Facts in India. 22 upwards. In the Madras Presidency, as Dr. Bryden has shown, cholera invades not by the direct sea route, or from the neighbouring districts of Bengal, but by a very circuitous route through the Central Provinces. It has been already shown that places do not suffer Railways have had in proportion to their accessibility no influence on the . . . . . . . distribution of cholera, from the endemic area, and that in fact the extent of cholera in them seems in no way dependent on the facility or the difficulty of reaching them. And the same remark is true of the India of to-day as compared with the India of a hundred years ago. Railways have increased the number of travel lers enormously, they have placed the whole country within a few days' reach of the endemic area, am throughout the area beyond, .where epidemics chiefly attract attention, they have placed one place in eas^ communication with another, when formerly the passage from one to the other was often tedious and difficult. Have railways and good roads and steamers which now traverse the country and ply from port to port increased the frequency of epidemics or rendered them more rapid in their progress ? Have they changed their direction from what it used to be The answer must be emphatically, No. The direction of epidemics is in no way altered, nor has thei frequency been increased. Moreover they do no move more quickly than they did a hundred year ago, when there were no railways and no steamers, anc very few roads. Mention has already been made of places where There are certain cholera is little known, but there ar places where cholera places in India in which it may b is practically unknown, . , , t . „ although thare is con- said that cholera is practically un stant intercourse be- , - . . . , tween them and cho- known. One of these is the con lera-stricken areas. sett l ement on the Andaman Islands, which has been occupied ever since 185^ The communication with Calcutta is constant, mos of the supplies have been drawn from the heart of th endemic area of cholera, and yet to all intents am purposes it may be said that cholera is unknown in the place. The escape may be ascribed to quaran tine, but the so-called quarantine has been littl more than a name, and the immunity dates back ove years before any, even nominal, quarantine was in existence, to a time before the idea had taken an hold in India that cholera could be imported by huma intercourse, or that if it were, quarantine could d anything to prevent it. Other places having an analo gous history of remarkable exemption might be men tioned. The hill station of Mussoorie, for example although it is only seven miles from the plains wher cholera is frequent, and draws all its supplies from th plains, has suffered less from cholera over a long serie of years than most towns in Europe. Other example of a like kind might be given. In India, experience has shown that all attempts to Quarantine has failed keep out cholera by means of quaranto prevent cholera, and . , . - ? . done much harm. tine have entirely railed. Quarantine has been tried again and again to pro- 23 Facts in India. 24 tect a cantonment, and not a single instance can be cited in proof of its success. No doubt there have been cases in which such quarantine has been attempted and the cantonment has escaped, but there are abundant instances of escape when there was no quarantine. In no instance is there evidence to lead to the conclusion that the cantonment or other community concerned was protected. by the quarantine. On the other hand, the mischief which has been done by such endeavours has beyond all question been very great. Such a system is impossible without leading to oppression and hardship to the people, and exposing them to all the evils which specially arise in a country like this, where the police is so venal and the population so submissive. The arguments against quarantine as applied to any tract of country are still stronger than when applied to the case of a cantonment. The feeling of the people undoubtedly is that they would rather face all the dangers of cholera than be subjected to quarantine interference, and any one who knows the circumstances can fully sympathise with them in this feeling. So satisfied has the Government been of the futility of quarantine to do any good and its power to do evil, that quarantine in India has been altogether prohibited. Occasionally, though rarely, cordons have been drawn by the local authorities around villages suffering from cholera, in the hope that the disease might be arrested by this means, but in the case of such cordons there are all the difficulties and dangers of quarantine, and besides all these there is the inhumanity Facts in India. 25 of attempting to keep people within the spot where the cause of the disease is at work, and where therefore there is the greatest reason to fear an attack. In India, so far as all experience goes, to impose quarantine or cordons in order to keep out cholera is a proceeding no more logical or effectual than it would be to post a line of sentries to stop the monsoon. As quarantine or cordons, or both combined, have isolation of the sick been powerless to arrest the proand disinfection have <• • » ¦ • • 1 ,• c proved powerless to g ress of an epidemic, so isolation of arrest an outbreak. t h e sick and disinfection have been equally powerless to arrest an outbreak once it has commenced. Among troops and prisoners these measures are tried, and very properly tried, but so little confidence is reposed in them that, when a single case occurs, removal from the affected room or building is compulsory. If a third case occur among any body of troops, then they are immediately removed into camp. 1 Experience has fully proved the wisdom of these rules. Frequently, as has been already explained cholera is limited to one or two cases in a place, anc where isolation and disinfection have been practised i may hastily be concluded that the outbreak has been limited by these means ; but isolated cases are com mon in villages and towns where isolation and disinfec tion are never practised, and were common long be fore these measures were considered as likely to arrest cholera. 1 See rules for the management of cholera issued by the Quarter- Master-General, July 1 877. 26 Facts in India. Once there is evidence that a severe outbreak Removal from the is threatened, removal from the a " a^arr^ fected locality is the only measur ing an outbreak. which is productive of benefit, an this measure in India has been most successfull carried out in the case of both troops and prisoner times without number. It has proved successful even when the party moved have carried their sick to th new place, and have drawn their supplies, including their water-supply, from the affected place whic they had left. For successful removal, it is essentia that the measure be carried out early before the in fluences of the affected place have done evil, and th chances of success are much increased if removal b to some distance and to a place where cholera a shown by experience is little wont to prevail. Th benefits of early removal of troops from the canton ment of Meean Meer along the line of railway for 10 miles or more towards Mooltan, till that region i reached where, as already mentioned, cholera is rarely found, have been again and again exemplified. In 1 88 1, when the last outbreak occurred at Meean Meer the decided results which followed from such a move were most strikingly illustrated. The body of troop removed had not a single case after leaving Meean Meer; twice they returned to the cantonment, am twice having been again attacked, they found safety in- their distant place of shelter. Nor need any fea be entertained that the removal of bodies of men even when suffering from cholera will prove a source o Facts in India. 27 danger to the community at large, and especially to the community to whose neighbourhood they have gone. Among the many moves made in this country there is no instance of this kind on record. On the contrary, there is much evidence the other way. O this a remarkable instance was afforded in 1872, when in consequence of a severe outbreak of cholera among the boys of St. Peter's College, Agra, 65 were sent t their homes in different parts of the country. O these 12 were attacked and 5 died, but in not a singl instance did a boy cause any attack in the plac where he was sent. 1 The benefits of movement ca be explained only by remembering that localisatio is one of the most remarkable peculiarities of cholera As shown by the statistics of towns and villages am of barracks occupied by troops and prisoners, th localities exempted are, as a rule, more numerous tha the localities affected. A change from an affectec locality will, it is hoped, lead to the occupation of locality which is not affected, but the hope is no always realised, and then further movement must b made. When, as in the case of the area lying to wards Mooltan, movement is made to a place littl subject to cholera, the result is naturally most likely to be successful, especially if the move be made early Since 1877 a record has been kept of the numbe Attendants on the of attendants on cholera cases treat sick suffer no more . . ... .... . than others. Ed in military or jail hospitals throughout India, and the number of these that have 1 See Annual Report of the Sanitary Commissioner with the Govern ment of India for 1872, page 71. 28 Facts in India. themselves been attacked. The body of evidence thus accumulated stands thus : Number of cases of cholera concerned . 5,696 Number of attendants on these cases . 10,599 Number of these attendants themselves attacked 201 Percentage of attendants attacked . . I'g Considering that one case of cholera occurring i a community has been so often regarded as the caus of hundreds and indeed thousands of deaths from th disease, the result that 5,696 cases of cholera unde careful observation can be credited with only 20 attacks at the utmost is very remarkable. The fallacie which surround this question are many, but they a tend to attach undue importance to the mere fact o attendance on the sick, and to make the proportion o attacks in the above statement, small as it is, large than it ought to be. If an attendant is attacked, it i too often assumed that contact with the cholera patien must have been the cause of attack, although othe persons in the same place who have not come in contact with the sick have suffered quite as much a the attendants. The circumstances under which th attendants are placed are all favourable to attack — th want of rest, fatigue, and in many cases anxiety and sorrow. And especially in these later days the element of fear is not to be left out of account, for experience shows that it has a very baneful influence, and that it induces a proneness to cholera. When attendants enter on their duties under the impression that they are undertaking a service of extreme danger, it would Facts tn India. 29 not be surprising if they did suffer severely. It is of the greatest importance, not only in the interests of the sick, but also of the public at large, that this delusion should be dispelled, for it is altogether contradicted by the most carefully recorded statistics. Among other facts which deserve attention in Other facts deserv- tne Indian experience of cholera ing attention. are — (a) The frequent prevalence of diarrhoea, both before and during a cholera outbreak, showing the general influence which seems to affect the community. (b) The importance of checking this diarrhoea at once, as one of the most successful means of dealing with an outbreak. (c) The danger during a cholera time of produc- ing the disease by taking saline or other violent purgatives which might be taken with perfect safety at ordinary times. (d) Epidemics not unlike cholera occur under circumstances which leave no room fo supposing that they are due to anything but peculiar atmospheric conditions local ised in a strange and unaccountable man ner. The Simla epidemic of 1880 is a remarkable illustration of this. It is thus described in the Sixteenth Annual Repor of the Sanitary Commissioner with the Gov- ernment of India : — From about the 13th of June till the end of the Facts in India, 30 first week in July 1880, nearly the whole adult male population of the place was more or less prostrated by copious, painless, and severe diarrhoea, attended with great depression, and often with vomiting. Very few escaped, and many of those who did escape the diarrhoea suffered from nausea, loss of appetite, and general malaise. A few cases had occurred before the 13th June, and a few others occurred after the Bth July ; but these last were chiefly relapses in those formerly attacked. The extreme prevalence of the disease when it was at its height was matter of common talk at the time. The Government dispensaries and the druggists' shops for days were almost besieged with prescriptions for astringent and other remedies, but no remedies seemed to have the smallest effect. In the Park Hotel every adult resident was attacked, as well as the family of the proprietor and many of the servants. In a house near the top of Jacko (8,000 feet) only one out of five adults escaped. In another house with five adult residents only one escaped. In the United Service Club, out of thirty-four residents, two only are said to have been free of the disease. In Government House every European but one was attacked Many other examples might be given to show how very generally the people were affected. There were, however, several remarkable points in the distribution of the epidemic. Europeans suffered much more than natives. European males suffered more than European females. Children almost entirely escaped ; a case among them was extremely rare. Facts in India. 31 " Many efforts were made to discover the cause of this sickness ; naturally the water was at first suspected. The new supply had only lately been brought in. It might be that, owing to some pollution of the gathering ground, or some defect in the soldering or other arrangements of the pipes, this new supply was at fault, but the arguments against any such conclusion were unanswerable — 11 (a) The municipal water had been in use for weeks before the sickness commenced, and no ill-result had been observed. '• (b) People still drew in parts of the settlement from the old springs, and they suffered just as much, and at the same time, as those who used municipal water. 11 (c) It was most improbable, and indeed almost impossible, that these numerous spring and the municipal water could all have been defiled at or about the same time especially as the gathering ground for the municipal supply is 14 miles from Simla in an open and almost uninhabited coun try. Over half an inch of rain had fallen on the Ist June, and there was none again till the 16th June ; by that time the epidemic had been fully established. The baolis, or receptacles at the springs, hole but a few gallons at a time, and any pollution caused in them by the rain of the Ist June must have shown itself rapidly. Be- Facts in India. 32 sides, during the first half of May, rain had been frequent and heavy, but there had been no diarrhoea. " (d) Non-water drinkers suffered as much as water-drinkers. ' ¦ (c) Children, who drink much more water than adults, enjoyed almost complete exemp- tion. " (/) It so happened that the municipal water was analysed shortly before the epidemic, as well as after, by Dr. Lewis, and was found to be as perfect as any water-supply can well be. " The arguments against milk being the cause are stronger even than those against the water, for there are no dairies at Simla, and almost every family makes its own independent arrangements for cows. Children who use milk most suffered least." These facts may be studied with advantage by those who believe that an outbreak of cholera can only be due to a specific germ propagated in the bodies of the sick. But, in a practical point of view, the most important Sanitary improve- of all the facts relating to cholera cTo^a haV as d sh m own h by «> India if that sanitary improvethe statistics of troops men t s have diminished cholera. Of and prisoners during the last 23 years. this the statistics of both prisoners and troops afford abundant evidence. Among prisoners the results have been much disturbed by the effects of famines, which render any fair comparison, especially Facts in India. 33 in the Madras and Bombay Presidencies, impossible. In the Bengal Presidency, the great fact stands out that the annual average death-rate from cholera among prisoners during the period 1859 to 1867 was 10*77 pc 1,000 ;in the next period, 1868 to 1876, it was 3283 '28 ;am in the third period, 1877 to 1883, it was 3'6i. In the three Presidencies, among European troops, who are not subject to the disturbing effects of famines, the results are still more striking, and stand thus :—: — Annual average death-rate from cholera. Presidency. — — ¦ 1860-69. 1870-79. 1880-83. Bengal . . . 9*24 4-18 2*49 Madras . . . 2*56 r6B o*9o Bombay . . . 4'Bo 1-53 0*45 The periods are sufficiently long to establish the great truth that sanitary improvements — not one sanitary improvement only, but attention to all the requirements of health — have a marked effect in diminishing cholera. At the same time it must be remembered that the results cannot be constant, as they much depend in no small measure not only on the frequency with which epidemics recur, but also on their intensity. Summary of the great facts regarding cholera in India. The foregoing facts regarding cholera in India may be briefly summarised as follows : (1) Cholera has been known in India from the earliest times. (2) In Lower Bengal, over an area which cannot c Facts in India. 34 be exactly defined, the cause or causes which produce cholera are always more or less present. (3) Outside this area these causes are present with varying degrees of persistent intensity in different parts of the country. (4) In some of these parts cholera is comparatively unknown, and generally present only in a very few isolated cases. (5) In all parts, both within and without the endemic area, cholera is most prevalent at certain seasons of the year and least prevalent at other seasons, the prevalence being much greater in some years, known as epidemic years, than it is in others which are known as non-epidemic years. (6) The areas of prevalence and freedom from cholera are in no way determined by the facility or difficulty of human intercourse and the improved means of communica tion of more recent times have not alterec the direction or frequency of epidemics, or the rate at which they travel. (7) Quarantine and cordons have entirely failed to afford protection or to influence the progress of the disease. (8) Attendants on the sick have not suffered more than others. (9) Cholera extension, either in its direction or in its rate of progress, has no relation to Facts in India. 35 human intercourse or contact with the sick. (10) The unknown cause or causes which produce cholera, although often widely manifested, are by no means universally present even within the general area covered by a severe epidemic, but are localized in a very remarkable manner. (n) Sanitary improvements — improvements in the conditions of localities are the best (safeguard against cholera, but if an outbreak threatens, early removal from the affected locality is the best means of escape. 36 Facts out of India. CHAPTER 11. Facts regarding cholera out of India. But it may be said, and indeed it has been said, Indian experience is that all Indian experience in respect not valued as it ought ¦• . t * to be. of cholera is ot little or no value as a basis for forming correct conclusions on the cause or causes of the disease. All the facts, it is urged, which have been collected, very definite though these facts may be, very consistent in the story they tell, collected by many independent observers over a large area and over many years, still are all open to fallacy, and therefore not to be trusted. The source of infection in India is so close at hand, the chances through which this infection may be and are conveyed are so numerous and so impossible to discover, that India must be set aside as a field of cholera observation from which any really valuable data can be expected. This is indeed a strange doctrine, and one which cannot be admitted. The facts regarding cholera in India are of the greatest value, as all facts must be which are really facts and not merely a partial or inaccurate representation of facts moulded according to preconceived theories. And the data which have been collected by the Sanitary Department of India from troops and prisoners and the general population of the country during these twenty years, imperfect though these last may be, are still the most complete and valuable data which have Facts out of India. 37 ever been collected regarding cholera. But setting aside all this, and accepting for the time the dictum that Indian facts are open to special sources of fallacy, the great facts regarding the disease out of India may now be examined and compared with those which have been observed in this country. Do they tell a different tale from that which has been already told ? The first point to be observed is that, as cholera Cholera has been has been known in India from the known in other coun- i; . .« r 1 • i tries from the earliest earliest times of which there is any times. re*nr\rn en alcr» hoc if Koon lrnr\\\m record, so also has it been known in other countries. It is mentioned by Hippocrates, it is described by Celsus, and reference is made to it in the old writings of China and Japan. There can be no question that the disease existed in the form not only of isolated cases but also of epidemics, in England, Scotland, France, Germany, America, and other countries of the West, long before the great Bengal epidemic of 1817 and the European epidemic of 1832 attracted so much attention to it. It is the European anc American experience of cholera which is most im portant ; it is with this that Indian experience is now to be compared, and as the first point of comparison, it is sufficient to note here the great fact that in the wes cholera is not a new disease any more than it is in the East. But before examining the general history of cholera Ships sailing from in Euro P c and America, the facts Indian ports suffer regarding: the great link which binds very little from cholera ; t> o e> India with these two continents — the facts regarding ships which sail from India to those 38 Facts out of India. parts of the world — claim attention. If cholera be a disease which can be produced only in India, if its appearance in other countries be due to its having been carried to them from India, then important evidence is surely to be gained from the history of voyages between the east and west. If contact with the sick, either direct or indirect, is the great means b which cholera is spread, then ships should be speciall subject to outbreaks of the disease. The facilitie for taking cholera infection on board, if there b any such infection, are undeniable, for at most o the chief Indian ports cholera is always more o less prevalent, and until very recently no precautions were ever taken against it. The trade which India has had with Europe and America for years has been very large. Numerous ships have sailed to these countries from the earliest times. In olden days they were often overcrowded, filthy, and ill-ventilated ; the conditions were in fact the most favourable that possibly could be for the propagatoin of cholera if modern theories regarding this mode of propagation be correct. But it is matter of common observation that, instead of having suffered severely from cholera, ships sailing from India have been remarkably exempt,-— -not only passenger ships and troop ships and merchant ships, but ships carrying pilgrims to Mecca, and ships carrying coolies to the West Indies and Demerara and other colonies. With rare exceptions they all tell the same story. A few cases have often occurred on leaving Calcutta, perhaps one or two in the river, or within the first few days at Facts out of India. 39 sea ; but when sailing from other ports directly on the seaboard, and when passage through a cholera country had not to be made, even these isolated cases have been almost unknown. Severe outbreaks even in ships sailing from Calcutta have been extremely rare. Since 1842, when the Red Sea route was opened, and do not carry the traffic between India and Europe cholera to other coun- ' has been constant ; and since 1869, tries. when the Suez Canal was opened, it has gone on increasing. Day after day, ships are passing through the canal, and the great majority of these are from Indian ports. There has thus been the most ample means of testing two great points on cholera history : ist, Do ships leaving India suffer fron cholera as might be expected if modern views be cor rect ? and 2nd, Do they convey cholera from India to other countries ? The answer to both these questions must be decidedly in the negative. The proportion o ships in which cholera appears at all is extremely small, and instances in which it assumes anything like the proportion of an outbreak are most rare. It is moreover, a very important and significant fact that even during these recent years in which there has been constant, rapid, and direct communication between India and Europe via Egypt, not a single instance is to be found in which an epidemic can be shown to have been caused by the arrival of a ship from India. And what is even more remarkable still is that no attempt has been made to connect epidemics with the Facts out of India, 40 arrival of ships from India except in one or two instances, and that even in them a more accurate examination of the facts has subsequently shown that no such connection was even plausible. In 1865 the invasion of Arabia by cholera was at Cases which seem first attributed to an Indian vessel to be at variance with , . this view. arriving at Jeddah, but a more careful investigation satisfied those who had made the original statement that this conclusion was not in accordance with the facts, and that the ship in question, instead of having brought cholera from India, had in reality become affected at the port of Makalla 1 in Southern Arabia, where cholera was already prevalent. The outbreak at Southampton in 1865 was attributed to the arrival of one or more of the Peninsular and Oriental Company's ships. Professor Parkes made an elaborate enquiry into the subject, but the utmost he was able to show was that the persons first attacked " were from the nature of their occupation more exposed to chances of contagion, introduced into the town and vicinity from the port, than the rest of the community, although none had had corrmunication, direct or indirect, with the Peninsular and Oriental Company's vessels." 2 In other words, none of the many persons who must have had direct and indirect communication with these vessels, and who were therefore exposed to the great danger supposed to be 1 Report of Medical Officer of the Privy Council. New series, No. V, 1875. 3 Page 55. Facts out of India. 41 connected with them, suffered at all. The case of the S. S. Columbian also deserves a passing notice. This ship was supposed to have imported cholera into Aden in the autumn of 1881. The idea was that one or more of the bags of rice which formed her cargo had been tainted with cholera discharges before leav ing Bombay, that the germs of cholera were thus carried to Aden, and that these germs fastened on certain of the coolies who were employed in unloading the ship, and who were in consequence attacked by the disease. This was the explanation of the slight cholera outbreak at Aden in 1881 which was advanced by a special committee, but the explanation was not in accordance with the facts. There was no evidence that any of the rice bags had been contaminated. If they were, the fact remains that the 700 people on board between Bombay and Aden did not suffer from them, while the community to which the unloading coolies at Aden belonged, had already been suffering much from sickness before the Columbian arrived, and after that ship arrived cholera waschiefly localised among these Somalis. The case of H. M. S. Crocodile is not one of any The case of H. M. great importance in itself, but hay- S. Crocodile in ,884. ing occurred reC ently and at a time when Europe was alarmed at the threatenings of a new cholera invasion, it has attracted considerable attention, and has been cited as an illustration of the great danger of the disease being imported from India. The Crocodileleit Bombay on the 3rd April 1884, having on pacts out of India* 42 board 1,283 troops, including women and children. The number of the crew is not stated. The troops were nearly all from the dep6t at Deolali, which is 1 13 miles from Bombay, but the exact number received from that depot is not stated. From Deolali they were conveyed to Bombay by rail. A sergeant-major, who accompanied the first detachment, and embarked on the morning of the 2nd April, was found on arrival to be suffering from violent diarrhoea and died the same day. His case was returned as one of " diarrhoea with debility." But as it was suspicious, it was treated as if it had been one of undoubted cholera ; his bedding, clothing, &c, were sunk in the sea, and the hospital ? . thoroughly fumigated. There were * April 6th .1 . & J ° „ 10th . 1 eight cases during the voyage. a "„ 16th .' i The position of the ship when each 11 19th . 2 occurred is not stated, but they all „ 20th . appear to have shown themselves Total . 8 before reaching Malta. All those who were attacked came from Deolali except one, a man of the Army Hospital Corps, who belonged to the permanent staff on board. Of the 8 cases, 5 were in men who had been in attendance on the sick. None of the crew suffered ; " they partook of the same food and water as the troops." x The greatest care was taken to isolate the sick and to carry out disinfection to the utmost. Although not forming part of the events on board the Crocodile, it is to be noted that two of the 1 Official report. Facts out of India. 43 children of the sergeant-major — the first man attacked o board the Crocodile with suspicious symptoms — wer seized with cholera at Bombay on the 4th April. The also had come from Deolali, and were left behind whe their father died. It will be observed that the case were very few — only 8 in a population of some 1,400, — and that, with one exception, they occurred among persons who had all come from the same locality. Th same remark applies to the two children who had als come from Deolali, and were attacked in Bombay instead of on board the Crocodile. It will naturally be urged that the cases were so few because isolation and disinfection were so carefully practised ; but, a already remarked, isolation and disinfection have neve stopped an outbreak on shore, and cannot therefore be credited with the results on boardship ; and, moreover the experience of the Crocodile in respect of the limited number of attacks is but a repetition of the experience of hundreds of other vessels in which without any such measures cholera has been iimitec to a few cases. It may indeed be questioned whethe the isolation and disinfection, although very properly taken, did not do barm by inducing a dread of the disease. "It was too evident," says the report," that there was a feeling of alarm among the troops, as they refused to volunteer when called on to do so to aic the sufferers." Although disinfection and isolation are powerless to check an outbreak, there can be no doubt of the mischievous influence of fear, in rendering men more liable to attack. Of the antecedents Facts out of India. 44 of the man of the Army Hospital Corps who wa attacked nothing is said except that he had been on shore the day before the Crocodile left Bom bay. Importance may be attached to his case from the fact that he was the only person attacked on Doard who had not come from Deolali, but in the ab sence of full details much weight cannot be attachec o this. Others again may think that when person n attendance on the sick are attacked this is quite ufficient to shew that the attack was due to infection rising from attendance, but such a conclusion is no nly illogical but opposed to the teaching of experience So far from the Crocodile being an illustration Practical conclu- °* tne danger of ships from India rca^tTcvr conveying cholera, it is merely a dile and other ships. fresh illustration of how rarely any cases of cholera occur on board ships sailing from Bombay, and how little danger there is of a severe out break taking place on board them. No doubt there are instances of severe outbreaks of cholera on boarc ships, and these will be referred to subsequently. The points to be noted now in the general history of cholera on board ships sailing from Indian ports are, that on board such ships cases of cholera are rare, that when they do occur they are generally limited in number and confined to persons who had come from a particular locality, and that no single instance can be produced in which a ship from India has carried cholera and produced an outbreak, still less an epidemic, in another country. If ships from India were the common Facts out of India. 45 carriers of cholera, as they ought to be according to the opinions usually accepted, then there should b no difficulty in producing, not one or two doubtfu instances in which the evidence breaks down at one on examination, but hundred of instances in which th evidence is clear, complete, and incontrovertible. Leaving ships, the great facts regarding cholera in General summary of countries Out of India must now b the history of cholera . . . _ . . , in Europe and Amer- considered. It is not possible to con j, c c e a art ri a g nd h fi'sf ¦£ or even attempt to consider ?£s?.<>& th P Pce c e e P t the V \ete history of choler demicof 1829 to 1837. outside of India. In regard to many countries there is practically little or no in ormation to be had ; in regard to others it is often ague and unsatisfactory. The object in view i ot to write a history of cholera, but merely to illus rate some of the great truths regarding it. For thi )urpose a very short summary of the events of the las 5 years from 1829 to 1883 will suffice, and this may with advantage be restricted to Europe and America egarding which the information is more complete than is regarding other parts of the world. Since 1829- — nd it is not necessary to go further back than this — le time may be conveniently divided into three )eriods. First there is the period between 1829 anc 864 ; then there is the period from 1865 to 1880 ; anc lirdly, the period from 1880 up to the present date — ¦ October 1884. In the first of these periods, there were three great epidemics of cholera in Europe anc America: the epidemic which commenced in 1829 anc 46 Facts out of India. lasted till 1837 ; the epidemic which commenced in 1847 an d lasted till 1851 ; and the epidemic which commenced in 1852 and ended in 1855. All three epidemics appeared first in the east of Russia ; the first was the most prolonged, the second was the most powerful in its intensity, and the third the most rapic in its progress. The epidemic of 1829 t0 I^3l was rs heard of at Orenburg in Eastern Russia in August o 1829. In 1830 it advanced to Novgorod, Moscow, am •Odessa. In 1831 it advanced still further westward a over Russia, attacked Sweden, Germany, Austria Hungary and Turkey, and appeared in England at Sunderland in the end of October. In 1832 it attacked France, England, Scotland, and Ireland, and crossed over to America, appearing at Quebec on the Bth June, Montreal on the 10th June, New York on the 23rd June, and Philadelphia on the sth July. In 1833 £g)ain was invaded for the first time in the epidemic, and most of the countries which had suffered in 1832 suffered again, but with less severity. In 1834 Spain continued to suffer. In 1835 the south of France was attacked, and particularly Marseilles and Toulon. In August the north of Italy was attacked. In 1836 the epidemic was over Italy generally. It appeared at Milan in April and at Naples in October. In 1837 Malta and Palestine were attacked. The disease in epidemic form was not heard of Epidemic of 1847 to again in Europe till 1 847, when it *°5 1 ' annparpri at Orpnhnror in Aiimicfr appeared at Orenburg in August. It advanced as far as Moscow and Constantinople, Facts out of India. 47 and a few isolated cases occurred in Britain and France. In 1848 the whole of Russia Poland, and Sweden were attacked. It was at Berlin in July, in Holland in September, London in September, Edinburgh in October, Belfast in December, and in America on the 2nd December. In 1849 the greater part of Europe and America suffered, and many places with great severity. In 1850 Egypt was attacked ; also Malta, Gozo, Mexico, California, Cuba, and Jamaica. In 1 85 1 there were only isolated outbreaks in Poland, Silesia, and Pomerania. The epidemic of 1852-55 seems to have corn- Epidemic of 1852 to menced with cases in East Russia, x^s&" Prussia anrl Pninnrl. Tn tRC2 Prussia, and Poland. In 1853 Russia, Denmark, Norway, England, Hanover, Holland, and France were attacked. London suffered in September and October. Towards the end of the yea the disease appeared in America, in Mexico, and in the West India Islands. In 1854 nearly every part o both the Old and New World was under the influence of the epidemic, and in 1855 the same was s tiU true though in a minor degree. From 1856 to 1858 there is no record of cholera in Europe or America, but in 1859 it reappeared in Hamburg, in several towns of the Gulf of Finland, in Algiers and in Morocco ; and a few cases occurred in England, chiefly in London anc Hull. From that year up to 1864 there was again a lull The history of cholera in Europe from 1865-80 Cholera in Europe has been given by Mr. Netten and America 1865- _ . ..„ ' . c . . 1879. Radcline, and from his re- 48 r acts out of India* ports * the following dates regarding the appearance of cholera at certain places and other facts are taken : — 1865. — Suez, 2istMay; Alexandria, 2nd June; Mar seilles, 18th June; Malta, 20th June ; Constantinople 28th June ; Ancona, 7th July; Gibraltar, 18th July; Kus tendji, August 2nd ; Odessa, August 10th ; Kertch August 29th; England, September 17th [confined to two local outbreaks, one at Southampton and the other in the parish of Theydon Bois in Essex] ; Paris, 18th September ; Naples, October 6th. Reached the United States in November. 1866. — Was prevalent over nearly all Europe, including the United Kingdom and America. 1867.— Continued more or less prevalent in many parts of Europe and America, and invaded Switzerland. 1868.— Epidemic was confined to two localities in Europe, a district in the province of Kiev in Russia, and a valley in Essen in Germany. 1869. — Eleven governments of European Russia affected. 1870. — Thirty-seven governments of European Russia affected. 1871. — Generally diffused throughout Russia ; in Poland also there was a severe epidemic — 126,937 persons died. Prussia suffered to a considerable extent, and also Sweden. 1 Report of the Medical Officer of the Local Government Board, new series, V; and Transactions of the Epidemiological Society, Volume IV, Part IV. Facts out of India. 49 1872. — Again widely spread over European Russia, causing 1 13, 196 deaths. Poland, East Prussia, Silesia, Roumania, and Gallicia were also invaded. 1873. — Reappeared in 14 of the governments of European Russia — the number of deaths fell 104,395 ; but in Poland the epidemic was very severe, causing 29,733 deaths, In Austria there were 103,721 deaths. In Hungary, Roumania, and Turkey there was some prevalence. In Prussia 23,242 persons died ; several towns of Bavaria, including Munich, suffered. Belgium and France also suffered, but not severely so far as can be ascertained. In England some cases occurred, but they were all supposed to be imported cases. 1874. — Seriously present in parts of Central Europe, especially in Hungary. In 1875, 1876, and 1877 there is no notice of any cholera in Europe. In 1878 it was reported to have broken out at Voronej, a place 300 miles south of Moscow, and to have attacked 60 persons. The year 1879, again, is blank. In 1880 it was reported at Saratov on the Volga, and 700 soldiers are said to have been attacked at Orel in Central Russia. Since 1880 the facts are all of importance as in the period 1880 bearing on the history of the epito 1884; the present . . _ , epidemic. demic now in Europe. Un the 3rd August 1 88 1 the disease broke out at Aden, and 30 persons were attacked. In September cases appeared among the pilgrims at Mecca. v Facts out of India. 50 1882. — Again prevalent at Mecca and Jeddah. 1883. — Appeared at Chiappa in Mexico. 1 On the 23rd June first case reported in Egypt at the decayed port of Damietta on the Mediterranean. On the 2nd July a case occurred at Alexandria, and on the 15th it appeared at Cairo. Alexandria suffered little, but the epidemic was severe in other parts of Egypt, and there was an outbreak the among British troops at Suez. 1884. — The information regarding the cholera epi demic now in Europe is still very meagre. The follow ing are the chief facts which are yet known : 23rd June cases reported at Toulon; 28th June, reported at Mar leilles j 30th June, a death from cholera at Rome ; 8t uly, deaths at Alexandria ; nth July, a case at Paris 2th July, reported at Lyons; 14th July, a case at Alex ndria ; 19th July, a few cases at Aries and Nismes Ist July, 8 deaths in Paris; 26th July, reported a Spezzia ; 30th July, a mild outbreak at St. Petersburg and Charkoff ; 2nd August, slowly spreading through out Italy ; 20th August, afew cases in Birmingham ; 22m liugust, reported at Geneva, Milan, Turin and Genoa sth August, increasing in Italy, military cordons es iblished ; 29th August, broke cat at Naples ; 3rd Sep imber, broke out at Alicante in Spain ; 4th Septem er, 100 cases daily in Naples ; Bth September, 45 cases to-day in Naples, and 154 fatal; 1 ith September f7 cases in Naples, 365 fatal ; 15th September, cholera creasing at Naples. 1 "Lancet," 3rd February 1883. Facts out of India. 51 Such are the main facts regarding cholera move- During fifty-five ment in Europe and America since years places in most o t,ti ,1 ¦> direct and constant *82Cj. What are the general COncommunication with r l n o; on q which the exnerienre of the fe^ia have suffered CiUSlons wnicn me experience or tne st. fiftv-fivp years warrant ? Tfrholpra fifty-five years warrant ? If cholera really be spread by human intercourse which convey the disease from India to other countries, it cannot b difficult to establish a clear and definite relation be tween the great routes of traffic from India to Europ and the general history of cholera extension. Do th facts show any such relation ? Have the place which are in the most constant and rapid communica tion with India suffered more frequently than other which are off the main route, or have epidemics movec along the main lines of communication more rapidly than along the slower and more unfrequented routes The dangers of direct and constant traffic and th facilities for the introduction of cholera thus affordec cf late years have been frequently insisted on by writers on cholera. Have these fears been realised It will be remembered that the Red Sea route wa opened in 1842, and that in 1869, when the Suez Cana was completed, a vast extension took place in the traffic along this route. For years now the Cape route has t;en almost deserted, and communications and comerce between India and Europe have been carried on vid Egypt. Has Aden, which is within a few days' sai of India, suffered in consequence ? It suffered in 1865, and again to a slight extent in 1867 and in 1881. That is to say, notwithstanding most frequent and Facts out of India. 52 rapid intercourse with India, Aden since 1865 ha suffered three times during the last nineteen year during which the Red Sea route has been in use Only twice has it suffered during the last fifteen year since the Suez Canal opened, and both times ver slightly. Yet Aden is on the highway of Indian com merce. Moreover, it is situate at the point of greates theoretical danger, because it is nearest to India. Anc what has been the history of Egypt during the sam period ? It has been a history of equally striking im munity. In 1850 Egypt suffered from cholera in th extension of the epidemic which entered Europe vi Russia. In 1865 it suffered again, and then in spit Ii all the Indian traffic it remained free for eightee ears till 1883. And while there has been thi marked immunity along the highway of communica tion between India and Europe, what has been th experience of places in Europe removed from thi highway? The epidemic of 1852 to 1855 invadec Europe through Russia, just as the epidemics of 1829 and 1847 had done. The Red Sea route made n difference in the route taken by this cholera. During the twenty years since 1865, as already shown, Egyp and Aden have both suffered on three occasions During the same period, one or other part of Europ has suffered on at least thirteen occasions, and on several of these the epidemic was general over great part of the Continent. East Russia and other parts o Europe, remote as they are from India and Indian traffic have suffered many times oftener and more severely Facts out of India. 53 from cholera than Aden, which is but a week's sail from India, and has been in daily communication with India for many years. Or to apply another test — since the East and West Since direct and have been in more direct and conconstant communica- . i i-> tion was established stant communication, has liurope lurTp" Etope has suffered more frequently from chosuffered from cholera l era epidemics than it did previousinvasion less frequent- .««,., • ? ly than it did before. ly ? The facts during the last fiftyfive years stand thus : Epidemic invading Europe in ... 1829 Interval of 17 years . . . 1 830-1 846 Epidemic invading Europe in ... 1847 Interval of 4 years . . . 1 848-1 851 Epidemic invading Europe in ... 1852 Interval of 12 years . . . 1 853-1 864 Epidemic invading Europe in ... 1865 Interval of 18 years, . . . 1866- 1883 Epidemic invading Europe in ... 1884 The foregoing may be divided into two periods, the first extending from 1829 to 1852, or twenty -four years, when there was little or no communication vid the Red Sea, and no suspicion that cholera was ever introduced into Europe along this route. During this time there were two epidemics, — one after an interval of seventeen years, and the other after an interval of only four years. During the second period of thirtytwo years, when communication became direct and rapidly increasing, there were also two epidemics in Europe, — one after an interval of twelve years, and the other after an interval of eighteen years. The latter Facts out of India 54 period is more favourable than the former, and the last interval during which direct traffic with India ha been many times greater than it ever was before, i the longest period of exemption from new invasio which Europe has enjoyed during the last fifty-fiv years ; or, in other words, the longest interval on record. Since 1829, when cholera first attacked Europe as in spite of railways an epidemic of modern times, the and all the other im- me ans of communication have enorproved means of communication, the pre- mously improved. What with steamsent European epide- . .. . mic travels no faster ers and railways, people can now than did that of 1832. traye j much faster thaί they didj and hundreds travel now-a-days for every one that used to travel in olden times. In this respect there has been a vast change during the last fifty-five years. But does an epidemic travel to Europe any faster than it did ? Certainly not. The present epidemic appeare( in Egypt on the 23rd June 1883. In all probability i was there earlier, but the first case in Europe was no reported till the 2nd June 1884 — a whole year after wards. As a matter of fact, there is no relation and never The extension of has been an y relation between the cholera in Europe and pace a t w hich cholera extended in America has never x borne any relation to Europe or America and the means the means of commu- r .... , nication existing at the of communication existing at the time. 4-It-^.Q A »Ti nxrnm^nl-i'nn A->{ ->*-.-«T time. An examination of any of the epidemics will illustrate this truth. Even in 1832, when the means of travel were comparatively slow, it cannot be asserted that it took two years for ordinary traffic to go from Orenburg to Berlin, or nearly four years for it to go from Berlin to Northern Italy. Cholera, moreover, has not moved more rapidly from one place to another where the means of travel have been quick, than between places where the means of travel have been slow. Nor since railways have increased, and it has been easy to go from one end of Europe to the other in as many hours as it formerly took days, has cholera extended at all more rapidly than it did. Dr. Akhangelsky remarks regarding the Russian cholera of 1870 : "Notwithstanding the considerable network of railway communications and the great extension of steam navigation on the rivers, cholera spread itself very gradually;" * and the same has been the general experience of other countries. As has already been shown, cholera was in East Russia and Central Europe many years without advancing further, although railways extended in every direction, and theoretically it might in a few hours have been conveyed to any capital in Europe. Similar was the experience of Egypt in 1883. There for a whole year cholera was stayed, and there was no extension either by land or sea. It may be said that the epidemic was arrested by quarantine, but the fact that the exemption was general, and that countries in which there was no quarantine suffered from cholera no more than those which had quarantine, is sufficient evidence to show that the restrictive measures had no influence 1 Quoted by Raricliffe, p. 131. 55 Facts out of India. 56 on the results. The real truth is, and it is a truth which is exemplified both in India and elsewhere, that although the first manifestation of an epidemic is often by leaps and bounds over great distances, the steadyonward progress of the main body of the epidemic itself is, as a rule, much slower than the ordinary progress of human intercourse even in those days when such intercourse was very much slower than it is now. Although cholera has occurred in European coun- Even in temperate trieS at all * imes ° f the y ear > {t is countries there is a b y no me ans independent of season. distinct relation be- * . • tween season and In England it has usually been cholera prevalence. , . , L ? most severe in the autumn, at the time when diarrhoea is most apt to prevail. The following extract on the subject from a recent paper by Professor Pettenkofer 1 is of much interest and im- portance. "In proof of the existence of a powerful seasonal factor in connection with cholera, I can adduce no more instructive example than that of the seasonal occurrence of the disease in the kingdom of Prussia from the year 1848 to iB6O. During that period cases of cholera occurred every year, although of different strength and in different provinces. Brauser has collected all the ascertained cases occurring during the period and arranged them according to months. Of the fatal cases during these 13 years, 112 occurred in April. 446 „ „ May. 4,39 2 » » J une « 8,480 ? „ July. 1 Published in the "Latest News," Munich, 1884. tacts out of India. 57 33,640 occurred in August. 56,561 „ „ September. 35.271 „ „ October. 1 7*630 „ „ November. 7,254 „ „ December. 2 »3!7 » ? January. 842 „ „ February. 214 „ „ March. In the face of such a fact, which is independent of any theoretical consideration, — in the face of this astounding regularity in the rise and fall in number of cases according to months,— one may well feel constrained to take the seasonal element into account, and to assume the dependence of cholera and the infecting cholera fungus on a seasonal element as well as on locality." In Europe, as in India, the countries invaded Many places have by cholera are not universally atescaped and others ¦, , , , ?«. , have suffered in vary- tacked, nor do the dinerent places ing proportion. ff f 11 • .. suffer at all in the same pro- portion. Many places escape altogether, others suffer little, and others suffer a great deal. The information of this kind which is contained in the reports of epidemics which have occurred out of India is often very defective, but there can be no doubt of this general truth. In their report on epidemic cholera in England which was published in 1854, Drs. Baly and Gull observe 1 : "Of the characters here referred to, the most obvious one is the unequal and very partial distribution of the epidemic. . . . Cholera left whole districts unvisited, and has fallen severely on comparatively few localities. The unequal and partial 1 Page 7 58 Facts out of India. distribution of the cholera epidemic is manifest, whether Europe is regarded as a whole, or the attention is confined to this country alone, or even to a single town or a single public institution Four-fifths of the deaths from cholera in England and Wales during the year 1849 (namely, 46,592 cut of 53,293 deaths) occurred in 134 registration districts, the total number of districts being 623 ; on the other hand, there are 85 districts in which no death was caused by cholera, . . . The mortalit caused by cholera was considerable in a comparativel small number of places, while over the general surfac of the country no deaths were caused by it, or only single deaths." In American epidemics experience has been to the same effect. The violence of the epidemic of 1873, for example, fell on the valley of the Mississipi, though exact data are wanting, and it is no possible to learn from the official report, 1 large as it tsuch simple and important facts regarding each ate as the population at the time, the number of towns and villages, the number of these attacked, the number of persons attacked, the number of deaths, or how the epidemic was distributed as regards time and season. The next point to be observed is that in both Quarantines and Europe and America quarantines cordons have alto- j mrf 1 nn o have Pntirplv failpH gether failed to afford ana cordons nave entirely railed any protection. to a ff O rd the smallest protection. Of this there has been abundant evidence, times 1 Cholera Epidemic of 1873 in the United States, 1875; 1,025 pages. Facts out of India. 59 without number, in Russia, Sweden, France, Spain Italy, Gibraltar, Malta, Egypt, the United States and other countries. During the epidemic of 1866 it is alleged that the Island of Sicily escaped be cause of the great stringency of the quarantin in its ports, and that the disease appeared ther only when, in consequence of an insurrection at Palermo, it was necessary to send troops and brea the quarantine. In cases of this kind there is amp] room for fallacy. Many places have escaped whe they had no quarantine, and it is therefore somewha hasty to ascribe the escape of any place to the mer fact that it had quarantine. The case of the militar station of Jullundur in the Punjab in 1881 is instruc tive on this point. In that year the local authorities contrary to the regulations, imposed quarantine forth protection of the cantonment. The orders were coun termanded by His Excellency the Commander-in Chief, and the quarantine was withdrawn. The diseas was very prevalent in the town and neighbourhood o Jullundur, but the cantonment almost wholly escapee Had the quarantine restrictions been sanctioned in this instance, the exemption of the cantonment would without doubt have been attributed to the action of the local authorities, and the case would have been cited as evidence of the value of quarantine as a protection against cholera. Recent events in Egypt France, and Italy have again demonstrated tha quarantine is no protection against the entrance o an epidemic. 60 Facts out of India. And while these measures have done no good and have done much whatever, there is no doubt as to mischief. flip harm \\\e>\r \\r\xr(± rlrmp. THpu the harm they have done. They have paralysed trade ; they have aided materially in producing an unreasoning panic, thereby render ing the people more prone to attack ; and they hay diverted the public money and the public attention from the real evils to be remedied — the filth and over crowding of towns and villages, and the other grossl insanitary conditions in the middle of which the peopl live, and which all aid in favouring disease. What ha Egypt, or France, or Italy, or Spain, in this epidemic now going on, to show in return for all the worry am annoyance and the serious falling off in trade which they have suffered ? In what respect have they been better off than England, or Scotland, or Ireland ? Have these measures delayed the attack, or will they suffe less severely ? So far they have gained nothing, am are much worse off than any of the countries which have set aside quarantine as an absurdity. No one has in fact derived the smallest advantage from qua rantine except the quarantine officials. They have benefited largely, not only during the time of danger but also prospectively, because it is only by their activity at such a time and their pretence of staying the epidemic that their existence can be justified. They have benefited, but they have benefited at the expense of the prosperity, the comfort, the convenience, and in many instances the social happiness of the public by whom they are paid. It has been argued that no quarantine at Suez or The suggested qua- in European ports can ever be efr^Rlfsea'crufd fectual, that what is really wanted be of no use. * n nrnfprt thp wpeen discussed by Professor Pettenkofer, and the fallacy of attributing the striking results on them to contagion has been fully exposed. But how are the facts to be explained ? In those instances in which the disease is imited to a few cases occurring soon after leaving a )lace where cholera was present, the disease is natu rally to be attributed to that place ; where the cases occur some time after departure, and still more when they are numerous, it seems most probable that the ship has passed through an area where the cholera )roducing cause was at work. Such areas beyond al question do exist on land, and it is only natural and in accordance with the facts that they should exist also on the sea. It is remarkable that nearly all the severe outbreaks which have been recorded on boardship have taken place when there were unmistakeable signs of epidemic movement between different countries across the sea over which they were passing. And so ar as the seeming relation between the movement o man and the movement of cholera is concerned, it is with ships exactly as it is with travellers on land. The hip comes through an epidemic area, it suffers from cholera, it travels faster than the epidemic, and so when it arrives at its destination, it seems to have been the carrier of the cholera. In reality it has brought only persons suffering from cholera. The cholera-produc in the light of the facts. 87 ing cause follows more slowly after it. Just as troops moving away from an affected area so frequently escape further attack, so a ship which is on the move passes at once through the localities where the causes producing cholera are at work. It does not remain in them, and so, as a rule, it is little subject to them ; but now and again, when the movement of the ship and the movement of the epidemic are synchronous, the ship suffers severely. This would seem to be the explanation, not only of the general immunity of ships and of the occurrence in rare examples of severe outbreaks on them, but it also accounts for the fact that when ships are in harbour they have no such immunity ; on the contrary, they are very prone to attack in places where cholera is present at the time. This has been attributec to the men having been on shore, but it appears more probably due to the fact that the ship is stationary If sent out to sea without delay, as has again anc again happened in the Hooghly, cholera disappears. But it may be said, What is this imaginary cholera Epidemic influence cause or influence which from the is a necessary factor foregoing remarks would seem to even with the conta- 00 gionists. be claimed as a thing existing beyond all doubt ? What it is as yet we do not know, but of its existence there can be no question, because Us effects are manifest. Even those who believe in the contagion doctrine are obliged to admit its presence and its power. Why is it that when a country is attacked with cholera, some places escape altogether, others suffer a little, and others suffer severely ? Why is it that cholera shows itself in a place as only 88 The Theories examined a few isolated cases in one year and as a severe out break in another year ? The ordinary reply is, it i the epidemic influence. The contagious matter ha been carried here and there, but in some places th epidemic influence is wanting, and so the contagion causes little or no result ; in another place this epidemi influence is present, and the result is that many suffer The' epidemic influence, in fact, even with those who Delieve in contagion, is the governing factor — the ele nent which determines whether there is to be an out )reak or not. With those who do not believe in conta gion also it is the governing factor, but with them it is nore, it is the cause of the disease — in some places so strong as to produce a violent outbreak, in others so weak that it produces but a few isolated cases, or is only shadowed forth in the form of prevalent diarrhoea The contagion is a superadded element which canno Ie made to accord with the admitted facts of epidemic lfluence. What known poison is dependent for its ower on locality or season or epidemic influence ? And what proof is there that this imaginary cholera poison, or the discharges which are supposed to contain it, is more virulent at certain times or places than it is at others ? The doctrine of susceptibility is another hypothesis The doctrine of sus- to which reference must be made. ?£3?te?£S J t said that certain persons are ing cholera. attacked because they are susceb- attacked because they are suscep- tible — the contagion can affect them ; and others ii cannot affect — they are not " susceptible." But this doctrine of susceptibility, as has been often pointec in the light of the facts. 89 out, will not explain the facts regarding cholera. Th (isease often visits a place, disappears, and after a few lonths returns, to commit far more havoc than it die before. It is hardly possible that the persons wh escaped in the first outbreak have become " suscep tible" in the interval which elapsed before the seconc took place. It must be remembered that a perso who has once suffered from cholera is by no mean protected thereby from a further attack. There is n lusceptibility or insusceptibility of this sort such as i bserved in other epidemic diseases. There is nothing 0 show beforehand why one person should be seizec nd another escape. The result appears to depem chiefly on locality, though, as already stated, fatigue exposure, grief, fear, or the use of saline purgatives, a' seem greatly to favour attack. In most instances, how ever, all that can be said is, that so-and-so has been Ittacked and so-and-so has escaped, and the doctrin f susceptibility will no more explain the facts than i would explain why certain men in a battle are woundec or killed and certain men are untouched. In the case of both, much depends on the exact spot where eacl man happens to be. The supporters of what is known under the name The facts of im- of the "water theory " claim to have mTertain^L-rcesTe^id demonstrated in certain cases tha no countenance to the c h o lera is due to a specific con doctrine or contagion ; r case of Calcutta. taeium. Certain cases are adducec tagium. Certain cases are adduced in which, coincident with decided improvement in the water-supply, there has also been a decided diminution The Theories examined 90 in the mortality from cholera. As examples or sue cases may be taken Calcutta, Fort William, the city of Nagpur in the Central Provinces, and vessels car rying emigrants to Assam. In Calcutta the introduc tion of good water was immediately followed by a marked decrease in cholera, and this decrease, althougl it has not fulfilled the promise with which it com menced, yet has certainly distinguished the perioc ince the new water was laid on as compared with the >eriod before its introduction. It would indeed have >een most disappointing if so great a sanitary blessing as the provision of good water to the inhabitants o a large city had not been attended with a decidec mprovement in the health of the inhabitants, and a de- lided reduction in one of the chief diseases from which hey suffer. But that this reduction has not been due tThe City of Calcutta. 1881. 1882. 1883. January ... 63 129 204 February. . 72 HI 129 March ... 227 170 227 April . . . 370 3'B 490 May ... 138 380 393 June ... 3 6 2 54 13° July ... 49 54 38 August ... 59 52 38 September . . 80 38 38 October . . . 100 91 162 November . . 232 232 103 December . . 267 411 85 Total . 1,693 2,240 2,037 Ratio per 1,000 . 3^9 s"i 47 to the exclu sion of any specific germ or poison from the drinkingwater is pro vec by incontestible evidence The cholera mortality, although happily reduced, has observed the same relative p re valence, in the light of the facts. 91 The Suburbs of Calcutta. 1881. 1882. 1883. January ... 95 145 300 February. . . 122 150 229 March ... 341 223 366 April ... 343 231 303 May ... 85 331 246 June ... 36 187 139 July .-• 35 515 1 46 August ... 70 46 21 September . 79 74 52 (ctober ... 103 172 139 ovember . . 234 210 195 ecember . . 336 529 141 Total . 1,879 2,349 2,177 Ratio per 1,000 . 7*4 9*3 B*6 according to season as it die b efore, — the yearly rise in the spring, the decline in the rains, and the increase again in the enc of the year Moreover, i has fluctuatec c n ormously from year to year, reaching in some years to very nearly as high a figure as what it was before the new water was introduced. In 1882 it equalled 2,240, and in 1883 2,037. In 1868, before the new water was intro duced, it was 2,270. The concurrent history of the suburbs of Calcutta is even more telling as evidence that the diminution of cholera in Calcutta has not been due to the exclusion of a specific germ from the drinking-water. The suburbs have as yet no proper water-supply, and they suffer in much larger proportion than the city itself, but the rise and fall of the disease in the two is synchronous. When cholera is at its height in the one, it is at its height in the other when it is at its lowest in the one, it is at its lowes in the other. The facts show that, though Calcutta has benefited largely from the improvement in its The Theories examined 92 local conditions, it is still subject, though in a minor degree, to the same general influence as the suburbs, where no such improvement has been effected. These points are all illustrated by the figures given in the margin above. Much has been made of the case of Fort William, Case of Fort Wil- where it is alleged that the dccili.llll. euro r\ iminn + i/~»n r\f r>nnipra U73C ov_ sive diminution of cholera was ex- actly synchronous with the introduction of the Calcutta water, but the facts do not bear out this conclusion except to an extent such as might be expected to result from any great sanitary improvement. The troops in Fort William were supplied with water from the municipal stand-pipes by means of carts from 9th July 1872, but the water was not laid on to the Fort till 25th March 1873. Before 1872 other great sanitary improvements had been effected, overcrowding had been prevented, and conservancy had received great attention. With these improvements, cholera was largely reduced from what it had been previously. In 1869, and again in 187 1, not a single death occurred from cholera among the garrison, and yet in 1871 the water-supply was in a most unsatisfactory state and subject to great pollution. And now-a-days, in spite of this new water-supply, cholera still appears, and the few cases observe their seasons and their years of greater and less prevalence as they did before, although, as a striking illustration of the benefit of sanitary improvements — a benefit conspicuous before the Calcutta water came into use — the cases are now very few. in the light of the facts. 93 The case of Nagpur in the Central Provinces is The case of the city deserving of attention. In July of Nagpur. \Rni this city was nroviderl with 1872 this city was provided with a good water, and over a series of years the reduction in cholera mortality was most marked. In 1883, however, cholera was again prevalent, and the death-rate from this cause rose to 2*49 per 1,000, or eight time? higher than it had been for 13 years. This outbreak had not occurred when Nagpur was cited as a striking illustration of the theory of contagion by means of water. The great increase in cholera mortality without any change in the water-supply is sufficient answer to those who seem to think that once provided with a good water-supply, a town has nothing more to do, and is absolutely safe from cholera. But one argument as regards Nagpur was founded not only on its relative immunity from cholera, but also on its relative immunity as compared with the district generally during a long series of years. The fallacy of such comparison is apparent to any one accustomed to deal with the history of cholera. As has been already explained, it is a disease of which perhaps the most remarkable characteristic in an epidemiologic point of view is its localisation. It attacks certain centres of population and leaves others untouched. To compare one of these centres of population, be it a town centre or a rural centre, with another centre of population over a series of years, and in this way to test their relative sanitary condition, is fair enough ; but to compare one of them — Nagpur in The Theories examined 94 this instance — with the annual average of all the other put together, is not fair, and can lead to no sounc conclusion. Certainly, if Nagpur with a good water supply is not better protected from cholera than i used to be before, there can be no truth in sanitatioi at all. The question is not, has the new water-sup ply diminished cholera in the city of Nagpur — o this there can be little doubt, — but has the diminution been so decided and so persistent as to show that the one sanitary improvement of a good water-supply can banish cholera ? The answer undoubtedly is, No. It has been urged that the experience gained in The case of immi- conveying immigrants by steamers £m" tb g ° ng up the River Brahmapootra has been so remarkable as to leave no doubt whatever that a well-protected water-supply does act by keeping out the specific germ of cholera. The mortality among these immigrants during each of the last seven years is contrasted in the Resolution of the Chief Commissioner of Assam on the Sanitary Report of that Pro- 1 Number of Batio er Year. deaths on IU * the river. 1877 . 604 23*9 1878 . 794 338 1879 . i«j6 B*2 1880 . 23 2-2 1881 . 18 r6 1882 . 106 6-5 1883 . 138 6-6 vince for 1883, and the results are shown in the margin. It was in 1877 that attention was first drawn to the use of filthy water for the purpose of washing and drinking on the steamers, and arrangements were made for the supply of a pure filtered water. From that time the mortality decreased, and in 1880 and 1881 it was I 1 I'll /¦ I t /¦ » in the light of the facts. 95 not a twentieth part of what it was in 1877 anc 1878. These statistics are no doubt very striking, bu when the marked diminution in cholera mortality o board the Assam steamers was first claimed as direct proof of the truth of the water theory, it wa pointed out that one most important part of the cvi dence had been entirely left out of account. The con current history of cholera among the people of th country through which the steamers had passed wa completely ignored. The diminution of cholera among the immigrants was credited to the change in th water-supply, but although there had been no chang whatever in the water-supply of the general population on either side of the river along which the immigrants travelled, the diminution of cholera among them ha( been just as marked as it had been among the immi grants. Since then the results have not been quite so satisfactory. The mortality has considerably in creased, and there have been several severe outbreaks of cholera on board Brahmapootra steamers. For ex ample, in 1882, on the Nepal there were forty death from cholera among the immigrants. The comparison moreover, between different years is no comparison at all because the fact has been lost sight of that the length of the voyage in the case of the great bulk of the im migrants has been reduced from sixteen days to an aver age of about eleven days. In 1877-78, when the perio( of comparison commenced, about 70 per cent, of them embarked at Goalundo, but gradually this route was to a great extent abandoned, and the immigrants joinec 96 /rIL- t flt-L/r tcO ts*\ It ffl CFtC LC the steamers at Dhubri, a place further up the rive So great has the change in this respect been that i 1883, the year in which the comparison ends, less tha 20 per cent, embarked at Goalundo. The statistics therefore, are altogether misleading, and the importan fact, moreover, is left out of account that by escaping the five days' river journey between Goalundo anc Dhubri the immigrants also escape a five days' journey through the endemic cholera country. Still, making due allowance for all this, the results are most gratify ing, and they are all the more gratifying because th^ mortality from other diseases has been reduced in yen a more marked degree than the mortality fron holera. The experience of the Assam immigrants bus, so far from teaching that cholera is to be )anished by preventing a specific germ from entering he drinking-water, adds another to the many lessons o show that not only cholera but all other diseases are o be most successfully met by sanitary improvements r urther details regarding the Assam immigrants wil c found in Appendix B. The figures for the earlier ears cannot be obtained. All that is known about them s, that of 2,613 immigrants embarked at Dhubri during 875-76, 28 died and that of 3,593 embarked at the same >lace in 1876-77, 32 died. The deaths from cholera re not distinguished from those due to other causes The water theory is negatived not only by the I The water theory is gatived by the whole ;tory of cholera in dia. experience of individual places as aDOve cited, but by the general ' * # ° history of cholera in India year in the light of the facts. 97 after year. Is a year of great epidemic prevalence to be explained by the fact that in that year the watersupply over large areas has been polluted with cholera discharges, while in another year, when cholera is at a minimum, such pollution has been comparatively unknown ? Is it to be supposed that when an epidemic is distinguished by unusual intensity, this intensity is due to the extreme virulence of the discharges, and that when an epidemic is distinguished by its comparative weakness, this weakness is due to the discharges being less potent than ordinary ? Instances innumerable can be cited in which a community using numerous independent sources of water-supply have suffered at the same time and ceased to suffer at the same time, and others can be cited in which out of a community one well defined portion has entirely escaped, although the whole community were using the same water-supply. An instance of this has already been given in the case of H. M. S. Crocodile, and the same has occurred in many other ships and in many outbreaks among troops and prisoners where the facts were most carefully ascertained. The real lesson to be learned from the experience of places provided with a good water-supply is that this supply is a grand sanitary improvement calculated to improve the public health, but that it is only one of many requisites for health, and that the people who have* provided a good water-supply for themselves have no reason to fold their hands and imagine that they are now quite safe from cholera. G The general freedom of attendants from attack . . . has already been mentioned as one Instances in which J attendants on cholera of the great facts which have been patients have suffered more flmn others are observed regarding cholera. Every generally to be ex- , • . < . • plained in another now an d again instances do arise way than by contagion. which at first seem tQ fayOr the idea that the attendants have suffered because the 1 had come in contact with a contagium emanating from the sick, but a careful consideration of all the facts generally leads to a very easy explanation. In some cases where attendants have suffered much, i will be found that they yet have suffered no more than others. The outbreak has been severe throughou the whole community. A striking illustration of this occurred in the Goorkha Regiment at Dhurmsala ir 1875. Eleven attendants were attacked, and this was adduced as undoubted evidence of contagion, but an examination of the figures showed that the propor tion of attendants attacked was only about one-hal per cent, higher than among non-attendants. In this case, and also in others which have attracted attention the hasty conclusion that the attack of attendants was due to contagion has led to mischief. The separate buildings which the attendants occupied, so as to be conveniently near the hospital, have not been vacated as they ought to have been, and as any other building would have been on the occurrence of a case among those residing in it, and in this way there is reason to believe that the attacks among attendants were more frequent than they otherwise would have 98 in the light of the facts. 99 been. When attendants are attacked, it will be found that the largest number has been attacked just abou the same time as the largest number occurred among the rest of the community. The attacks are thus to be attributed, not to attendance, but to the genera epidemic influence at work. Moreover, the proportion of attendants attacked is frequently made to appear larger than it really was because the number of attendants has been incorrectly given. And further, it is not to be ignored that fear, which is so favourable tc attack, is a factor which grows more and more powerful as a natural result of the contagion doctrines so generally inculcated in these days. The difficulty of obtaining accurate information on Illustration given. such a simple matter as the num ber of attendants on the sick and the number o these that were attacked is well illustrated by the following extract from the Fourteenth Annual Report of the Sanitary Commissioner with the Government o India : — " In the report on the outbreak in the Alipore Jail, it is stated that of sixteen attendants four had been attacked, anc this number has accordingly been entered in the tabular statement given in the Appendix. But the record is altogether fallacious, and represents a proneness on the part ol attendants to be attacked, which is unwarranted by the actual facts. Correspondence having failed to elicit an accurate account of what actually happened, a persona enquiry was made, and the following points were then established :—: — (a) The attendants on the case in January, which forms 100 Ihe I heories examined one of the eighty on the register, are not included in the statement ; none of them were attacked. {b) The cholera hospital was opened on the 12th June when the second and third attacks took place; bu it was usual throughout the outbreak to bring every case to the ordinary hospital, unless it was undoubtedly a case of cholera. In this way many cases which afterwards proved to be cases o undoubted cholera were treated in the ordinary hospital for hours, and some of them for a day or two, until the symptoms became pronounced, anc they were then transferred to the cholera hospital The attendants on such cases were not includec among the cholera attendants. (c) Several cases— the exact number is not known — in which the symptoms were very severe, and which might well have been returned as cases of cholera, I were entered as only cases of diarrhoea, and were treated throughout in the ordinary hospital. The attendants on these are not included in the statement, (d) In several instances friends among the prisoners were allowed to wait on those ill of cholera. The number of these is not known ; none of them appear in the statement of attendants. (f 1879, 1 much stress has been laid, but it is altogethe 1 Report of the Sanitary Commissioner with the Government of India for 1879. 102 The Theories examined fallacious. Even if it were proved that the cause of cholera is carried, and that it is never distributed faste than man can travel, it does not follow that it mus be carried by man. Precisely the same argumen might be applied to the monsoon. The monsoon gene rally takes many days to travel across India : it take much longer than the time in which a man can now ac domplish the same distance with ease ; but no on argues that because the monsoon never travels faste than man, therefore man must be the carrier of th monsoon, or of the marked changes in the atmospheric conditions which the monsoon brings with it. The il lustration is selected with no view to claim connection between cholera and the monsoon, but only to show that the mere fact thai cholera never travels faster than man, even if this were established, does not prove tha cholera must be carried by man, for other great phe nomena, on which it is self-evident that human agency can have no influence whatever, are often distributee no faster than man can travel. Again, it is often argued that cholera must be caras well as the argu- r \ e^ by man because it so often ment based on the tact J that seaport towns are appears first in the seaport towns so often the first at- , ? . ..... , tacked. ot the countries which it invades. This experience is by no means invariable. The epidemic occasionally shows itself right in the heart of a country, but even if it did invariably attack seaport towns first this would prove nothing. Here again the south-west monsoon affords a very apt illustration. This monsoon always breaks on the coast. Year after year its bursting at Bombay is heralded as the first unmistakeable evidence of its arrival on the shores of Western India. But no one would argue that because it shows itself first at Bom bay it must have come by ship. It is only what is U be expected that a great atmospheric change sweeping across the ocean should first make itself felt on the shores of the country which it has reached ; and i cholera be really but the result of another great atmos pheric change which, so far as is yet known, manifests its presence by inducing in human beings those symptoms which are known as cholera, is it strange that i should first appear in centres of population on the coast — in the seaboard towns where human beings are congregated ? The suggestion that cholera may be due to an Other atmospheric atmospheric change is frequently phenomena are often , m. ji i , it , •/• , , localised in a remark- met with the retort that if cholera able manner. nrprp rlil£» fr» fVIO atmncnhAro n/~K r\na were due to the atmosphere no one would escape, and this argument is usually acceptec as conclusive. But it is by no means conclusive Other atmospheric phenomena which can be seen anc felt in a manner about which there can be no mistake are often localised in quite as remarkable a way as the cholera-producing cause seems to be. Even over a limited area the rain does not fall equally in all parts In some it is much heavier than it is in others. The storm of wind or hail often has a very definite track over which it may be most destructive, and yet the places on either side of this track art- left unscathed. 103 The Theories examined 104 And even within this track all parts do not suffer alike The uprooted trees, the ruined buildings, and many other signs, all testify to the fact that even within th general area it has covered, its violence has fallen chiefly on particular spots. So far as can be judgec >y the results, the same would seem to be the case wit he atmospheric conditions which are known by thei results in the form of cholera. In these days, when the tendency is to ascribe so Atmospheric condi- much to germs or specific poisons, tions have a most im- ,1 1 i.t__i j« 1 portant bearing on the conclusion that disease, and QlSease> £»ei-»f*r»iall*r orMHomi/~» rlicooca t-ifiTT especially epidemic disease, may 3e due to a condition of atmosphere will not be eadily accepted. The mere existence of the disease s urged as sufficient evidence of the existence of an ntity producing it. The result, it is argued, must be ue to something. True, it must be due to something iseases, like everything else, are due to a cause whicl >roduces them, but it by no means follows that this ause is an entity. Disease may be due, as many ther things are due, to a mere force. The greates >owers in the world are not entities at all, — such, fo example, as light and electricity, heat and cold. No ne doubts their power, and yet in not one of them are le tremendous results to be ascribed to the existence f any entity, to anything which can be seen by the aked eye or demonstrated under the most powerfu microscope. It will be admitted that electricity kills nd leaves no trace of any germ behind it, but it wil )e said that, so far as is known, electricity or the want in the light of the facts. 105 of electricity in the atmosphere does not produce disease. So far as is yet certainly known, this is true but are there not other conditions of atmosphere which do produce disease ? Have heat and cold nothing to do with disease ? The atmospheric and other condi tions under which people live are of far more impor tance to health than is generally supposed in these days To the contagionist the air a man breathes, the fooc he eats, the water he drinks, the clothes he wears, — in fact, the whole circumstances of his life, — are of not the smallest importance in respect of cholera, so long as he does not swallow or take into his system in some way or other the specific germ of that disease. But this narrow view is negatived by all experience. The accusations made against India in respect of It is very necessary cholera have been many. Not only to have a full state- has it been accused of being the ment of all the facts t ° on which conclusions one part of the world which manuare based ; r , , , . factures cholera and exports it to the destruction of the human race in all other countries, but the Government has been accused of suppressing facts which go to prove that this commonly accepted view is correct. For example, in the House of Commons on the 15th July last, the Under-Secretary of State for India was asked whether the Government of India had not reprimanded the Sanitary Commissioner of Madras, because in his Report for 1881 he had stated facts which seem to prove that an epidemic of cholera in Southern India had been due to the importation of the disease from Tirupati and its 106 The Theories examined dissemination by infected pilgrims. What the Go\ ernment of India did complain of in this instance wa that the Sanitary Commissioner had enunciated theory without taking the trouble to examine the fact and that if he had examined the facts, he would hay found that they were diametrically opposed to th theory. He would have seen that in the district wher this Tirupati fair was held, out of 5,241 villages only 69 returned deaths from cholera, that the district which suffered most were those far removed from th air; that the intermediate country hardly suffered a 11 ; and that, in fact, there was no evidence of any con ection between the fair and the distribution of the holera. Unless a careful supervision is exercised here is a constant tendency to substitute mere theorie or facts, even when, as in this instance, they are a irect variance with the facts on which they are sup >osed to be based. Other errors also occur. Fo xample, the Sanitary Commissioner of Madras, in the eport above referred to, considered that the ratio o male births should be calculated on the male popula on, and the ratio of female births on the female popuation, and failed to see the absurdity of such a methoc yen when it had been pointed out to him ! I Again, it has been asserted that medical officers in ,d to collect the India have been discouraged and tbrak in'alHtoS indeed prohibited from reporting cts ' fart<; whirh favour thp rnntacn'nn facts which favour the contagion theory of cholera. A more groundless assertion was never made. The printed form of report is in itself in the light of the facts. 107 a complete answer to it. This printed form for convenience sake asks a series of definite questions to which answers are desired. They are divided into six sections. Regarding the first five, A to E, it is noted that " they should be strictly confined to a statement of facts, and should contain no opinions,' but in section F medical officers are invited to give any " information or opinions not included in the above." The freest scope is thus afforded for anything and everything the reporter may wish to say. Al that is desired is that the facts should be accurately stated, and that they should be kept in a separate section from the opinions which may have been based on them. Most medical officers prepare their cholera reports with much care in this and all other respects, but it occasionally happens that great difficulty is experienced in getting at the exact facts ; and mere opinions are often substituted for facts. In reply, for example to the question " Could the first case be traced to importation ?" such vague answers as these are not unfrequently given : " The first may have contractec it in the bazar ;" "It may have been imported ;' " The first case probably imported itself ;" "He may have caught the disease in the railway train ;" &c, &c If the facts are not known and cannot be ascertained this should be clearly stated ; if they are known they should be detailed. A bare assertion of probabilities is not evidence at all. And while endeavour has thus been made to col- 108 The Theories examined lect all the ordinary data regarding For many years a ' . . r . special miscroscopic cholera in India, scientific enquiry enquiry into cholera , , ?, , , , was carried on in has been neither undervalued nor India. ?~~l^4.^J TU. n~,, ~,~,~4. ~C neglected. The Government of India was in fact the first to undertake a specia microscopic enquiry into cholera. In the beginning o 1869, two medical officers, T. R. Lewis of the Army Medical Department, and D. D. Cunningham of the Indian Medical Department, were selected for this purpose. For upwards of ten years they were devoted entirely to it, and the results of their investi nations, which were published from time to time, are well known and have been highly appreciated. It is rue that so far as the discovery of any specific cholera erm is concerned, these results were altogether nega ye. They failed to discover anything of the kind le conclusion to which all their researches pointec was that no such germ existed, and that it certainly is ot to be found in the discharges or in any of the ssues of persons suffering from cholera. But it will no doubt be replied by many that Pro- Koch s bacillus— fessor Koch has discovered wha the German Cholera , , Commission in Egypt. Drs. Lewis and Cunningham failec to discover — he has found the microscopic cholera I erm in the discharges and intestines of cholera atients, the " microbe " or " bacillus " of cholera c has proved beyond all doubt that this is the specific cause or germ of the disease, and has solvec the whole cholera mystery. Such assertions have in the light of the facts. 109 been common during the last few months, not onl in the ordinary newspapers of all countries, but ak in the medical journals. But are these assertion correct ? The facts briefly stated are as follows Towards the end of 1883, when cholera was still i Egypt, a Special Commission was sent there by th German Government to investigate into the disease This Commission consisted of Messrs. Koch, Gaffkey and Fischer. Dr. Koch was the head of this scientifi mission, and all the official information regarding i is contained in the provisional reports of their wor which he has sent in from time to time. The fu report has not yet been completed, or if it has, n topy has yet reached India. In his first report from !gypt Dr, Koch writes :—: — " Neither in the blood nor in the organs which in othe infectious diseases are usually the seat of micro-parasites— tz., the lungs, spleen, kidneys, liver — could any organisec nfectional matter be detected. Occasionally bacteria were ound in the lungs, which, however, as appeared from their :orm and from their situation, had nothing to do with the rea )rocess of the disease, but had been inhaled into the lungs with matter vomited from the stomach." 1 I The vomit was comparatively free from microrganisms, but the evacuations were found to contain onsiderable quantities of them, and a particular kinc f bacterium was found in the coats of the intestines Regarding these bacteria Dr. Koch thus continues : — " They resemble most nearly in size and form the bacilli 1 Report dated Alexandria, 17th September 1883. The Theories examined 110 found in glanders. In cases where the intestine shows th very slightest changes microscopically, the bacilli had pene trated into the follicular glands of the intestinal mucou membrane, and had there occasioned considerable irritation as evidenced by the widening of the lumen of the gland, am agglomeration of multinuclear round cells in the interior o the gland. In many instances the bacilli had also burrowec beneath the epithelium of the gland, and multiplied between the epithelium and the glandular membrane. Moreover the bacilli had copiously settled on the surface and in many cases penetrated into the tissue of the intestinal villi. In the more severe cases, where blood had filtered into the in estinal mucous membrane, the bacilli were found in grea umbers, and had not limited their invasion to the follicula jlands, but had travelled into the surrounding tissue, the eeper layers of the mucous membrane, and in parts even s far as the muscular coat of the intestine. The intestina illi also were in such cases copiously occupied by bacilli "he chief seat of this devastation is in the lower portion o ie small intestine. If this discovery had not been obtainec rom qaite fresh corpses, it would have been of little or no alue, because the influence of decomposition is sufficient to >ring about such growths of bacteria in the intestine." Numerous experiments were made with animals with the object of inducing cholera in them either by feeding them with cholera evacuations or by inoculating them with these bacilli, but they all failed. Among other reasons for the failure it was supposed that perhaps, as the epidemic was dying out in Egypt, the virulence of the morbid matter was expended. It was therefore resolved that the Commission should go on to India. in the light of the facts. 111 They accordingly proceeded to Calcutta, arrived Their work in India, there on the iith December iBB' X and continued their investigations in that city ti the beginning of March. The result of these inves tigations went to confirm all that had been observec in Egypt. The same bacilli were found in the dis charges of cholera patients, very rarely in the vomitec matters, but abundantly and constantly in the othe evacuations. They were also found in the intestine of those who had died of cholera. These bacil were carefully isolated and propagated. Their char acteristic peculiarities in shape and growth were ascer tamed, and they were clearly differentiated from othe bacilli. They were not found in the blood or tissue of cholera patients, nor were they found in the numer ous examinations which were made of the bodies o persons who had died of diseases other than cholera These bacilli are described as not quite rectilinea like other bacilli, but slightly curved like a comma and their behaviour in the intestines is described as follows ' : — "In the first evacuations of the patients, as long as they are of genuinely faeculent character but few cholera bacilli are found ; the succeeding watery, inodorous dejections, on the other hand, contain the bacilli in abundance, while, at the same time, all other bacteria almost entirely disappear, so that the cholera bacilli at this stage of the malady are almost isolated from all other bacteria. As soon, however, as the cholera abates, and the evacuations resume the faeculent char- 1 Dr. Koch's report dated 2nd February 1884. The Theories examined 112 acter, the comma-shaped bacteria gradually disappear again and upon the complete recovery of the patient are no more t be found. The results of examination of the cholera corpse is similar. No cholera bacilli are found in the stomach. Th state of the gut varies according as death supervened durin the actual attack of cholera or after it. In the freshest cases in which the intestine presented a uniform bright red tin the mucous membrane is as yet free from infiltration o / blood, and the contents of the intestine consist of a whitis inodorous fluid, the cholera bacilli are found in the intestin in enormous masses, and almost without admixture of othe kinds of parasites. Their distribution corresponds very closely to the degree and extent of inflammatory irritation of the intestinal mucous membrane, being generally less numerou in the upper part of the small intestine, and more abundan near its inferior extremity. But when death has occurred a a later stage, the signs of a serious reaction are found in the intestine. The mucous membrane is of a dark-red hue in the inferior part of the small intestine, permeated with extravasated blood and often mortified in the superficial coals The content of the intestine is in this case more or less tinged with blood, and, in consequence of the now renewed copious development of decomposition bacteria, of putrid character and foetid. At this stage the cholera bacteria become less and less prominent, but are still fora while pretty copiously present in the follicular glands — a circumstance which at first directed attention to the presence of these peculiar bacteria in the intestine in Egyptian cholera cases. They are wanting- entirely only in cases where, after recovery from cholera, death has been due to a succeeding malady." The following remarks regarding these bacilli are also of great importance :—: — " It has been further ascertained that their growth proceeds in the light of the facts. 113 normally in nutrient substances with alkaline reaction. Even a very small quantity of free acid which has no perceptible influence upon the growth of other bacteria strikingly retards their development. In a normally acting stomach they are destroyed, as appears from the circumstance that repeatedly in animals to which cholera bacilli had been constantly administered, and which had afterwards been killed, the bacill could not be traced either in the stomach or the intestina canal. This last-named peculiarity, together with the sligh lower to resist the effects of desiccation, serves to explain 'hat is daily observed, viz., how seldom cholera is contractec y immediate intercourse with cholera patients and their pro ucts. Hence the concurrence of other circumstances i learly necessary in order that the bacilli may be put into a ondition to pass the stomach, and then to provoke the cholera process in the intestine. Perhaps the bacilli ma pass uninjured into the stomach if digestion is disordered — a supposition favoured by the observation made in all choler epidemics, and also regularly here in India, that such person lery frequently contract cholera who have been suffering rom indigestion. Perhaps also a particular condition in vhich these bacteria are placed, and which may be analogou o the permanent condition of other bacteria, may enabl hem to pass the stomach uninjured." 1 The proceedings of the Commission, so far as they Their account of an outbreak of cholera believed to have been caused by bacilli in the drinking-water. have yet been referred to, concern only the microscopic and othe 1 • 1 1 • . • c i physical characteristics of thes bacilli, but in his report dated 4t March 1884 Dr. Koch narrates certain occurrence in connection with an outbreak of cholera in a subur 1 Report dated 2nd February 1884. v The Theories examined 114 of Calcutta and the discovery of the bacilli in the water of the neighbouring tank from which the inhabitants draw their supply. The circumstances are thus described: — "For a few days unusually numerous cholera cases were reported from Saheb Bagan, at Baliaghatta, one of the suburbs of Calcutta. The attacks were limited exclusivel to the huts inhabited by several hundred persons situat round a tank, and out of this population seventeen person died from cholera, while at some distance from the tank, am throughout the same police district, cholera did not prevai It is worthy of note that the same spot has been in recen years repeatedly visited by the cholera. Upon the origin and course of the epidemic careful investigations were now instituted by the Commission, wherefrom it appeared that the tank was used in the usual way by the neighbouring dwellers for bathing, washing, and drinking, and also that the soile( linen of the first fatal cholera case was cleansed in the tank A number of samples of the water were then taken from different parts of the tank, investigated by means of culture in nutrient gelatine, and cholera bacilli found in considerable abundance in several of the first specimens. Of the later samples which were procured towards the end of the epidemic, only one, which came from a particularly foul part of the tank, contained cholera bacilli, and these only in very small number. When it is remembered that hitherto cholera bacilli have been vainly sought for in numerous samples of tank water, sewage, river water, and other water exposed to all sorts of impurities, and that these bacilli, with all their characteristic peculiarities, have been found for the first time in a tank around which cholera epidemic was raging, this result must be regarded as a most important one. It is evident that the water in the tank was infected by the cholera «« /# T₯TiII nn nnnKt caw venting cholera, will no doubt say that the striking reduction of the disease among f'oops and prisoners in India, on which so much stress as been laid, is really to be explained by the measures of this kind which are authorised by the regulations and which have been carefully taken by medica officers. But this argument cannot hold good, fo quarantine has been absolutely prohibited in canton ments for many years. Under the most favourable circumstances it was never really a quarantine at all or hundreds of people passed in and out every day to >ring grass and other supplies for the troops. In jails n the same way, the quarantine has been quarantine merely in name, and the intention of it has been not to cut off communication with the outer world which is an mpossibility, but merely to direct special attention to new arrivals as requiring mare than ordinary care £yen if quarantine had been a fact both for canton ments and jails, the mere coincidence that cholera hac at the same time abated in an extraordinary degree would be by itself an argument of little value. It must )e shown that the danger existed around, and that it lad been averted by quarantine. If an engineer were o say that a city required an embankment to protect t from floods, and were to induce the authorities to act on his advice, it would not be sufficient for him at he end of the rainy season, as confirmation of the wisdom Practical Conclusions. 133 of his opinion, to point to the escape of this city as evidence that the embankment had proved its safety It would be necessary for him to show that the floods came, that the water was held back by the embank ment, and that otherwise it must have descended on he inhabitants. There is no evidence of this kind in he case of quarantine, either for a jail, or a town, or a ract of country ; and as for isolation of the sick am isinfection of the discharges, the case is altogethe imilar. There is abundant evidence to show that hey are valueless, and, as far as the regulations are oncerned the best evidence that they have been founc T anting is the fact already mentioned, that remova rom the affected [not infected^ locality, is peremptory though the practice in regard to troops anc )risoners in India is slightly different from what it is mong the people generally, this difference arises not >ecause of any difference of principle, but because o ifference of circumstance. There is no danger here f causing oppression or social misery. The bodies re under complete control, and hence it is quite easj o carry out that change of locality which has been found so successful with troops and prisoners, but which it would be extremely difficult, if not impossible to carry out among the ordinary inhabitants of any country. Sanitary improvements to prevent cholera and movement, if an outbreak unmistakeably threatens — these are the two and only safeguards as shown by al Indian experience. Nor will these safeguards completely banish cholera any more than they will completely Practical Conclusions. 134 banish other diseases, but they will do more than anything else that can be done, and they will do it without interfering with the liberty and happines of the people. It has been said that England object to quarantine only because quarantine is such a hindrance to trade ; that her action in this matter is purely selfish and that she cares not what dangers the world at large is exposed to from India, so long as he 'commerce is not interfered with. But such assertions are altogether contradicted by the fact that in India where her own interests are so directly concerned in preserving the health of the European troops, the same procedure is adopted as is recommended to other countries and quarantine is prohibited, for the very sufficient reason that it has been found to do no good and to do much harm. What more can the believers in contagion do so Even if the conta- as to act up to their beliefs ? Many &£*KS££ of them discard quarantine. They be based on it. cay it is thpnrptiraiiv rnrrprt hut say it is theoretically correct, but that it is practically impossible and therefore useless They would isolate the sick on the supposition that every sick person is in reality a manufactory of bacill or other germs. He is producing millions of them, therefore he is to be isolated, or in other words put in confinement, to the great misery of his friends and often of himself ; and with all this no good comes of it, or oi the disinfection of these supposed innumerable germs. Such measures never checked an outbreak of cholera and never can, while the experience of attendants shows they are not wanted. Again, the believers in Practical Conclusions. 135 germs or other forms of contagion would defend th water-supply as being the medium specially liable t be contaminated by them, and specially likely to dis seminate them on a large scale. But sanitary im provements include a good water-supply, and wouk protect it not only from cholera germs but from ever form of pollution, and they would at the same tim provide for all the other requirements of health whic the doctrine of contagion proclaims to be unnecessary In practice, therefore, nothing comes of the contagion doctrine. The believers in it can base no practica action on it — nothing which does not already flow muc more logically and thoroughly from acceptance of th great truth that sanitary improvements are the bes and only antidote to cholera. It remains to consider what measures the State What the State ought ought not to take in the hope of Suldletquara"! preventing cholera. The answer to tine. . thi<3 nnpsHnn has hppn in orpat narr this question has been in great part already anticipated. First of all there ought to be no attempt at quarantine. On this point the experience of India and of all other countries is most valuable. As already stated, all attempts at quarantine in India have signally failed to afford protection. But it is urged that because land quarantine is an impossibility, it by no means follows that quarantine is impossible in the case of ships. What, then, has been the experience of those countries in which it has been tried for years ? Have they suffered less from cholera than those countries in which there has been no quarantine ? 136 Practical Conclusions. / Or what has been the experience of the present epidemic ? Was Mecca protected, or Egypt, or Prance, or Italy ? So far they have all suffered, while England without quarantine, and having of all countries the most direct and constant intercourse with the East so far as an epidemic is concerned, has hitherto escaped. And yet in spite of this experience, which all tells the consistent story of signal and utter failure, the same thing goes on, with all its worries and annoyances just as if it ever had done, or ever could do any good. The Sanitary Boards at Constantinople and Alexandria decide when quarantine is to be imposed and when it is to be taken off. Their action is extraordinary and past all understanding. It is impossible from day to day to predict what the next move will be. To begin with, they assume that a time of cholera prevalence at or near any Indian port is a time of special danger to Europe, although this assumption is opposed to experience. They ignore the fact that in nearly all the ships which they put in quarantine as sources of contamination, the complete immunity from cholera of the passengers and crew who have been in these ships for many days is itself ample evidence that there is no such danger as is imagined. To-day there is a quarantine against Bombay, tomorrow it is against Calcutta. In a few weeks it is withdrawn from one, or both, to be reimposed in just as arbitrary a way as before. They insisted on quarantine at Suez against Indian arrivals when the disease was already epidemic in Egypt. They insisted on arrivals from Practical Conclusions. 137 Sumatra being quarantined at Calcutta otherwise Calcutta would be compromised, although there was at the time far more cholera in Bengal than there was in Sumatra. They required quarantine at Busrah to protect Turkey in Asia against the importation o cholera, and yet, so far as is known, there has never been a sign of cholera on board a ship going from India to Busrah. They required quarantine at Indian ports against the importation of plague from the Persian Gulf, otherwise Indian ports would be compromised The so-called plague was a purely local outbreak, am as was foreseen, it never attempted to move by ship to any other part of the world. Indian pilgrims are sub jected to all the delays and extortions of quarantine on the Island of Camaran, while the demands for pass ports and visas and for more stringent bills of health are only so many measures of interference and annoyance all of which are based on merely theoretical doctrines The proceedings of these boards have in fact been so illogical that there seems to be no explanation of them except that it was necessary for them to appear to b doing something in order to justify their own existence In the second place, there should be no cordons. There should be no These are generally called sanitary cordons. rorr!rm«; hut they arp thf> wrw cordons, but they are the very reverse of sanitary. They are cruel and oppressive and do a vast amount of harm. If it be true — and a experience shows it is true — that cholera is a diseas of locality, nothing could well be more inhuman tha to force people to remain in a cholera locality. Ex 138 Practical Conclusions. / perience in Egypt showed what misery was entailed by this means. All endeavours of this kind have bee given up in India long ago. Avoid any locality wher cholera exists. Escape from that locality is the bes means of safety. This is the teaching of al! India experience. On this principle, if cholera exists at o near a place of pilgrimage people are advised not t go there, because it is a place of danger. If it break out at a fair or other gathering, the people are dispersec because the place is dangerous. But all attempts to ioerce the people — to prohibit their going here or going lere have been forbidden. The last correspondence n this subject took place with the Government of the forth-Western Provinces. They desired to issue sstrictive orders of this kind ; they pointed out that i 1879, in consequence, they believed, of the great urdwar fair, cholera had been very prevalent, and that was therefore most desirable to prevent the recur:nce of such a calamity. The reply was very simple. o doubt there had been considerable cholera prevance in the North- Western Provinces and Oudh during $79, and much attention had been directed to it on :count of its supposed connection with the Hurdwar ir, but in 1880 the Hurdwar fair had passed off withit any cholera. There was not the smallest suspicion that cholera had been diffused by that fair or any other gathering. The epidemic of 1880 had in consequence attracted no attention, and yet in the North-Western Provinces and Oudh it caused exactly double the mortality which the epidemic of 1879 had caused. Practical Conclusions. 139 Even among the troops and prisoners in India > There should be no there is no ground for supposin forced isolation of the , , . . . sick or disinfection. that isolation of the sick an< disinfection have done any good. They have, on the other hand, done harm, because they have causec alarm. Men and women and children have been carried off to hospital, have died and have been buried, without seeing those who were nearest am earest to them. The one duty inculcated by th ction taken has been the duty of avoiding infection far higher duty of husband to wife or of wife to msband, or of both of them to their children, — the duty mposed by ties of relationship and by ties of friend hip, — has been often practically ignored. In th owns and villages of India where any such system ha >een attempted, the results have been most unfortunate Even if the system were beneficial, the people have no means of carrying it out. An enthusiastic Sanitar Commissioner in one of the provinces, who was a firm believer in the contagion of cholera, recommended, in a set of rules which he issued, that if a case of cholera occurred, the discharges should all be carefully collect ed in an earthen pot and boiled over the fire, so tha the vitality of the germ they are supposed to contain might thereby be destroyed. The picture of a poor Indian villager boiling cholera discharges would be very ludicrous, if the promulgation of such impractica suggestions did not do much mischief, but fortunately the suggestion is so foreign to the habits of the natives that it never could have been acted on. The forcible Practical Conclusions. 140 / taking away of the sick has caused much misery. But now everything of this kind is forbidden. The experience of Simla in 1875 is a very ex- Experience of Simla cellent illustration of the evil of one in l8 75- system and of the good which may be done by another system :—: — " When the disease first appeared, a cholera hospital wa established, and endeavours were made to remove to it every person that was attacked. This procedure was based on th idea that cholera is contagious, that the disease is spread by discharges, and that, therefore, the public safety would b best consulted by isolating all who are seized. But i altogether failed in practice. The people feared cholera, bu they feared the cholera hospital still more. It was bu natural that they should dread the removal of their friends o members of their family to a hospital to be tended by stran gers, especially when there was so little hope of ever seeing them again. The consequence was that every effort was liade to conceal the disease, and hence, instead of diminish lg the sources of supposed contagion, they were only in reased. After a time an altogether different system was dopted. The settlement was divided into districts, eacl istrict was provided with a supply of medicines and a hos pital 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 o look after them. When it was known that those attackec would not be carried off to the cholera hospital against the wishes of their friends, applications for medicine were numerus, and in this way many cases were checked in their early tage. The sick were attended in their own houses, anc measures were adopted for disinfection so far as they coulc c carried out. There is not the smallest ground to believe Practical Conclusions. 141 that treating the sick in this way in the least degree spreac the disease. The four medical officers at Simla who hay been brought in immediate contact with cases since the new system came into play, have all recorded that in the whole o 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 instanc spread the disease. The sick have, in fact, not acted a sources of contagion from which others have become affectec On the other hand, there can be no question of the advan age to those attacked in being left at their homes. Not only id they meet with care and comfort there, which they couk lave had nowhere else, but they were also spared the fatigu nd other depressing influences of removal to hospital whic re so full of danger to a cholera patient. As the attempt t emove cholera patients from their homes, which failed a Simla, has been tried elsewhere with the same want o success and the same distress to the people, it is most im portant that these facts should be known, not only throughou India, but also in other countries, where belief in the conta gion of cholera has gained much ground both with the pro fession and the public, and where compulsory measures o isolation have been advocated in order, as it is called, to 1 stamp out ' the disease, and that it may be seen how need less is the social misery which any such system must inevi tably entail." l The practical lessons to be learnt from this and Proper method of other outbreaks are that the great managing an out- , . J • ? , break. objects should be — (1) to quiet alarm by assuring the people that, if attacked, they will not be carried off to a 1 Eleventh Annual Report of the Sanitary Commissioner with the Government of India, for 1874, pages 19 and 20. Practical Conclusions. 142 / hospital against their will, but that they may be treated in their own homes, care being taken to avoid if possible, the room they occupied when attacked ; and if the house can be changed, so much the better : (2) to impress on all that the sick can be at- tended without the ss m allest danger : and (3) to have convenient places where people can procure medicines and medical attendance without delay. Let them practise isolation and disinfection if they like. These can do no harm so long as the sick are not dreaded and neglected, but anything in the shape of an enforcement of these measures on the part of the authorities is very much to be deprecated as calculatec greatly to increase the evil it is intended to mitigate. The relation of man to an outburst of cholera very The whole practical much resembles the relation of a question is summed up. ship to a cyclone. Cyclones are met with most frequently in the East, but they are not unknown in other seas. They are not carried by man, nor can they be prevented by man To meet them the ship must be well built, wel found, and well commanded ; and when in spite of al these advantages the storm is greater than she can well bear, she must endeavour to get away from the area which it covers. What a blessing it would be to the human race if those who are responsible woulc prepare to meet cholera in the same way as the intelligent Practical Conclusions. 143 commander of a ship is prepared to meet a cyclone ! All interference with liberty in this matter would then be at an end — all that tyranny and oppression which are so often perpetrated in the name o truth and science. To sum up the whole matter, the doctrine that cholera is communicable or transmissible from man to man leads to no practical benefit. On the other hand, it leads to all the evils of quarantine loss of personal liberty, worry and annoyance, socia misery and anxiety, with grievous injury to trade Panic is caused, the sick are not properly attended to and, what is most to be lamented, sanitary improve ments are neglected — the real evils of filth in every form remain, and money which might have been spen with so much profit to remove or remedy these evils has been more than wasted on the quarantine officials If all nations will not admit the truth of what has beei said, let Egypt and every other country take sucl measures as it may think proper to protect itself, le ships go through the Suez Canal in quarantine, anc then it will soon be seen which countries fare best There is no need for International Sanitary Board such as now sit at Constantinople and Alexandria nor indeed is there anything useful to be done by them Their proceedings have invariably led to evil, they have never led to good. Each country should have its own sanitary administration, which should be occupied en tirely with carrying out sanitary improvements within it own boundaries, and with collecting information to show where these are most wanted, and what results they Practical Conclusions. 144 / have produced. If it is to be of any value, the whol practical action must be based on the great truth tha the measures which will confer protection from choler are measures directed not against the freedom of th person, but against the insanitary conditions of th place in which he lives. Such measures will not onl diminish cholera, but they will also diminish the many other diseases which, though less alarming, are by thei constant drain on the population in reality much mor destructive than cholera. Once accept the grea jrinciple that the improvement of local conditions i he one and only principle on which the State can ac with advantage in matters of public health, and the solution of the whole question will be comparatively easy. Sanitary administration will then no longer at empt to accomplish impossibilities, but will be directec o those great practical reforms which cannot fail to mprove the health, and thereby add to the happiness nd prosperity of the people. Appendix A — Statement I. "45 Appendix A. Statements shewing the Distribution by Months of the Deaths Registered from Cholera in India during No. I. Districts forming the central portion of the Endemic Area. Number of Deaths from Cholera registered in each Month. xf" al ™ Average Num. District. Population. ' . ber< January. February. March. April. May. June- July. August. c e P ter n" October. Novem' 1 24-Pergunnahs and Calcutta with its Suburbs . 2,480,363 9,441 7,778 11,148 10,291 6,627 3> 20 5 1,447 1,377 2,298 6,35 2 Howrah . . . 683,219 1,969 1,674 2,066 1,594 1,181 709 405 370 596 79° 1,43 3 Serampore and Hooghly . 885,133 799 861 1,421 2,058 818 399 298 358 406 501 88 4 Nuddea . . * . 1,915,321 5,222 3,869 10,301 13,119 5>95° 997 439 162 291 I>28 7 7 fit 5 Jessore .... 1,826,135 8,872 3,358 6.957 12,373 6,007 1,682 702 265 295 2,097 9 , 9 ( 6 Burdwan . . . 1,713,284 2,346 2,447 5>°59 5> 82 3 3>59 2 2 ,3 2 3 i, 247 2 47 880 524 468 61 7 Dacca .... 1,984,672 5,691 2,068 2,786 7,813 3,263 867 398 745 858 2,095 9,2. 8 Furreedpore . . . 1,322,161 3,193 1,240 4,098 9,057 2,678 475 190 338 301 2,612 7,3! 9 Backergunge . . . 2,139,161 14,692 4,877 5,760 8,848 7,601 2,152 694 312 203 736 2,3 10 Mymensingh . . . 2,700,942 3,993 2,204 1,507 3,265 3,790 1,860 619 393 449 1,963 6,6 11 Moorshedabad . . 1,290,208 1,403 1,727 3,656 5,495 3,131 1,232 391 213 276 897 2,4 12 Dinagepore . . . 1,508,135 1,210 517 847 2,111 2,016 801 680 241 207 145 5 13 Maldah .... 693,437 7°i 422 1,254 3,884 2,584 561 288 177 69 416 1,6 14 Rajshahai . . . 1,324,684 850 377 1,198 6,465 3,221 493 106 96 118 1,156 2,6 15 Rungpore . . . 2,123,968 2,168 869 1,289 3,310 3,960 1,884 1,265 886 435 1,078 2,8 16 Bogra .... 711,912 456 140 356 1,502 819 226 189 67 296 1,083 2,8 17 Pubna .... 1,261,661 1,027 322 1,016 4,394 1,726 301 91 53 230 2,366 6,4 18 Purneah . . . 1,781,741 228 740 4,171 12,562 5,265 1,009 459 341 429 755 1,7 19 Noakhally . . . 767,3537 6 7,353 12,460 7,317 3,084 1,957 977 267 108 190 95 139 5,6 20 Tipperah . . . .1,526,635 3,537 2,242 2,761 3,168 1,935 534 177 10 4 525 2 2 4 2 1,9 Total . 30,640,125 80,258 45,049 70,735 H9>° 8 9 67,141 21,977 10,193 7,5 68 7-593 23,124 81,; Average Death-rate of each Month per 10,000 of Population 2*lB 122 1*92 3-24 1-83 -59 '28 '21 '21 '63 v\ Percentage of Deaths in each Month . . 121 6*B 107 17-9 101 3-3 I*s I'l ri 3-5 12 X I 145 Appendix A. ? Distribution by Months of the Deaths Registered from Cholera in India during the 12 years 18J1-82. No. I. Districts forming the central portion of the Endemic Area. Number of Deaths from Cholera registered in each Month. Average Maximum Minimum urn er . ° — . , annual number of number of 1 . T ° tal , death-rate deaths in deaths in J h ' c , h th « Wpm n " mb " Of per io,oooany one of any one of death " ra t e ruary. March. April. May. June. July. August. b F er October. November. December. aeatns - o f popu . t h e 12 the 12 exceeded lation. years. years. -J^lj. ,778 11,148 10,291 6,627 3,205 1,447 1,377 1*463 2,298 6,351 13,628 75>°54 25-22 10,934 794 12 ,674 2,066 1,594 1,181 709 405 370 59 6 79° 1.439 2>825 2 > 82 5 15,618 i9"°s J>B93 J > 8 93 393 I 2 861 1,421 2,058 818 399 298 358 406 501 883 1,538 10,340 974 1,473 454 12 ,869 10,301 13,119 5,95° 997 439 *626 2 291 1,287 7,668 9,877 59,182 2575 11,020 528 12 ,35 8 6,957 12,373 6,007 1,682 702 265 295 2,097 9,902 16,737 69,247 3-" 6° 6 ° 14,822 1,906 12 1,447 5,059 5,823 3,592 2,323 1,247 880 524 468 680 2,189 27,578 13-41 5,276 144 11 :,068 2,786 7,813 3,263 867 398 745 858 8 5 8 2,095 9> 2 5 J '3,734 49,569 20-81 11,257 427 12 ,240 4,098 9,057 2,678 475 190 338 301 2,612 7,386 8,309 39,877 25-r 3 14,135 303 12 1,877 5,760 8,848 7,601 2,152 694 312 203 736 2,328 14,238 62,441 24-32 19,177 291 12 !,204 1,507 3,265 3,790 1,860 619 393 449 1,963 6,636 9,214 35,893 11-07 7,979 250 12 ,727 3,656 5,495 3,i3 r 1,232 39i 213 276 897 2,490 2,652 23,563 15-22 4,063 539 12 517 847 2,111 _,oi6 801 680 241 207 145 572 1,605 10,952 6-05 2,306 214 12 422 1,254 3,884 2,584 561 288 177 69 416 1,626 1,752 13,734 16*50 4,401 52 11 377 1,198 6,465 3,221 493 106 96 118 1,156 2,649 2,887 19,616 12-34 3,330 161 12 869 1,289 3,310 3,960 1,884 1,265 886 435 1,078 2,802 4,735 24,681 9-68 5,664 49 11 140 356 1,502 819 226 189 67 296 1,083 2,851 1,498 9,483 ii'io 1,888 104 12 322 1,016 4,394 1,726 301 91 53 230 2,366 6,403 4,807 22,736 15-02 3,937 312 12 740 4,171 12,562 5,265 1,009 459 341 429 755 1,701 963 28,623 13-39 8,870 117 10 ,317 3,084 1,957 977 267 108 190 95 139 5,685 13,312 45>59 X 49*5* 21,858 75 11 ,242 2,761 3,168 1,935 534 177 104 52 242 1,936 4,331 21,019 Ji'47 3.488 359 12 . ___________ 1 ,049 70,735 119,089 67,141 21,977 10,193 7,5 68 7,593 23,124 81,239 130,831 664,797 22 1-92 3*24 1-83 -59 "28 "21 -21 '63 221 3-56 =1808 6-8 107 17-9 101 3-3 1/5 ri I'l 3*5 12-2 197 =100 V No. II Districts situated towards the margin of the Endemic Area £ Number of Deaths from Cholera registered in each Month. | ¦ , — 3 _ Average * District. Population. "rt January. February. March. April. May. June. July. , August. Septem- Octobe; *jj " ber. in 21 Bancoorah . . . 784,262 440 767 1,163 825 1,236 1,158 968 580 224 91 22 Beerbhoom . . . 745» 1 75 800 1,445 2,859 M 62M 62 J ' 6 5 T i,5 8 ° 67* 6 7* 69° 6 9° 2 5° J 4 ( 23 Midnapore . . . 2,529,382 2,478 4,3 21 4,849 2,962 2,181 2,852 2,731 1,014 474 56(5 6( 24 Balasore . . . 857,756 1,601 1,845 4,120 4,493 5,866 6,944 5> X 95 1.041 457 74< 25 Cuttack . . . 1,616,474 1,617 1,914 4,547 4,852 5,173 5,918 6,225 3,101 2,510 2,51, 26 Pooree . . . 829,081 856 1,711 4,551 3,080 3,570 5,119 5,526 2,103 8 9* 7I(7 I( 27 Rajmahal and Deogarh . 1,413,690 191 194 884 1,137 i»6" I »75 I *,99 8 Z»3 X S 697 6 97 37< Total . 8,775,820 7,983 12,197 22,973 19,311 21,288 35,322 23,315 9,844 5,503 5,13; Average Death-rate of each Month per 10,000 of Population .... 76 ri6 n8 I*B3 2*02 2*41 2*21 '94 '52 '49 Percentage of Deaths in each Month . . 4*6 7*o 13*1 in 12*2 14*5 13*3 5"6 3*2 2*9 Appendix A — Statement 11. 146 No. 11. Districts situated towards the margin of the Endemic Area. ' . .... Number of H.». OK DEATHS »> C-OLEKA KEO.STEBED » EACH _.„_ Average MM = ™ *mj»m — > 1 T ? tal .death-rate deaths in deaths in death-rate ni Sath r , P er lO '°° C any u°" e ° f ai Yu° ne ° f exceeded U- February. March. April. May. June. July . August. Septem- October. November. December. ' crfpopu- £» £» 440 7 6 7 ?,6 3 8258 25 W6 1,158 968 580 224 96 208 497 8,16. 8'6 7 1,954 38 3 8 800 1,445 2,859 1,962 1,651 1,580 6726 72 6906 9 o 250 146 400 Q 5 4 13,409 15-00 3,996 80 2 , 47 8 4,321 4) 8 49 2,962 f,lBl 2,852 2,731 1,014 474 560 1,190 2,476 28,088 9-25 5,627 68 1,601 1,845 4,1*0 4,493 5,866 6, 944 9 44 5,^95 1,041 457 740 ifiu *,3™ l^z 35*7 7,56 i 49 1,617 1,914 4,547 4,852 5,i73 5,9i8 6,225 3,101 2,510 2,513 3,494 3,506 45,37° 23*39 7,296 IH " 856 1,711 4,551 3,080 3,570 5,119 5,526 2,103 891 710 1,965 2,430 32,512 32-68 7,569 9 » ,9, ,94, 94 884 i,i37 1,611 i,75i i,3i5 6976 97 370 578 194 10,920 6-44 2,096 114 10 7,983 12,197 22,973 19,311 21,288 35,322 23,315 9,844 5,503 5,135 9,447 12,445 174,763 — _ — — — _____ — _— — — 1 _______ — 1 ~ 7 6 n6 _'i 8 1-83 2-02 2«4i 2-2 i -94 '525 2 '49 '9° riB =16-60 4-6 7-0 13-1 tZ'l 122 14*5 i 3"3 5" 6 3"2 2*9 5-4 7'i =100 Appendix A— Statement 111. '47 No. 111. Districts of Bengal and the North-West Provinces situated between the Endemic and Epidemic Areas, Number of Deaths from Cholera registered in each Month. N S, District. p Aver a ? e ~ Number. Population. January. February. March. April. May. June. July. August. September. October. November. Dec 28 Manbhoom . . . 1,026,899 48 205 433 750 2,141 3,249 2,198 867 145 90 52 29 Hazaribagh . . . 938,308 2 30 213 312 356 907 1,856 1,962 831 270 41 30 Ranchee . . . . 1,423,184 18 23 66 184 617 1,707 3,633 4,545 1,420 173 51 31 Chybassa .... 488,493 32 75 196 173 113 821 808 258 82 46 48 32 Monghyr .... 1,891,380 16 24 453 3,044 6,991 7,699 3,920 2,175 74 2 734 494 33 Bhaugulpur . . . 1,896,224 32 106 2,579 8,185 5,119 2,922 3,530 3,216 1,618 1,242 7" 34 Gya .... 2,037,216 28 38 326 1,684 4,383 8,177 10,914 6,595 2>297 2 > 2 97 8 7° 3213 21 35 Patna .... 1,658,080 53 33 508 2,729 4,432 5,993 6,910 4,059 816 381 260 36 Shahabad .... 1,844,441 129 no 169 1,254 4,781 6,319 6,482 4,915 1,529 881 227 37 Sarun .... 2,172,121 24 45 49 466 1,698 3,356 4,274 5,154 2,478 689 239 38 Tirhoot and Darbhanga . 4,800,107 71 65 269 4,540 15,545 21,313 13,915 10,561 4.004 1,517 470 39 Chumparun . . . 1,581,211 24 3 H3 1./5 8 2 » 8 4° 3.9 6 5 4,505 9,341 4,939 812 102 I 40 Ghazipur and Ballia* . • 1,635,633 32 90 154 1,184 2,919 3,721 3,911 2,875 l>ll9 l > l 19 s°° *4° I 41 Benares* .... 842,980 301 365 1,073 2,649 2,000 1,818 1,774 1,493 695 420 161 I 42 Mirzapur* . . . 1,095,605 81 85 771 2,733 3,004 3,786 2,719 1,442 665 176 52 M 43 Azamgarh* . . . 1,495,263 37 65 421 3,393 3,566 3,349 3,237 3,018 1,613 1,098 207 I Total . 26,827,145 928 1,362 7,793 35,038 60,505 79,102 74,5 86 62,476 25053 9,899 3,576 ¦ Average Death-rate of each Month per 10,000 I of Population 03 -04 -24 I*o9 rBB 2-46 2*32 1*94 78 '31 ¦ Percentage of Deaths in each Month '3 *4 2*l 97 167 218 20*6 17*3 6*9 27 10 H m * In the North-Western Provinces. ¦ No. 111. cts of Bengal and the North-West Provinces situated between the Endemic and Epidemic Areas. Number of Deaths from Cholera registered in each Month. Average an- Maximum Minimum Number of __^______ Total nual death- number of number of years in number of rate per deaths in deaths in which the Heaths 10,000 of any one of any one of death-rate y. March. April. May. June. July- August. September. October. November. December. ' popula- the 12 the 12 exceeded 1 tion. years. years. per 10,000. 433 75° 2,141 3,249 2,198 867 145 90 52 64 10,242 8-31 2,936 51 10 213 312 356 907 1,856 1,962 831 270 41 3 6,783 6-02 2,444 61 11 66 184 617 1,707 3,633 4,545 1420 173 51 37 .2,474 7*3° 5.566 28 6 196 173 113 821 808 258 82 46 48 39 2,691 4-59 1,476 5 9 453 3»°44 6,991 7,699 3,920 2,175 742 734 494 349 26,641 1174 6,999 177 11 2,579 8,185 5,119 2,922 3,530 3,216 1,618 1,242 711 221 29.481 12-96 7,719 196 12 326 1,684 4,383 8,177 10,914 6,595 2,297 870 321 119 35.752 14-62 10,107 785 12 508 2,729 4,432 5,993 6,910 4,059 816 381 260 168 26,342 13-24 5,078 288 12 169 1,254 4,781 6,319 6,482 4,915 1,529 881 227 184 26,980 12-19 6,619 62 11 49 466 1,698 3,356 4,274 5,154 2,478 689 239 TO7 18,579 7"i3 ?>534 222 12 ; 269 4,540 15,545 21,313 13,915 10,561 4,004 1,517 470 113 72,383 12-57 23,025 85 11 1 113 1./58 2,840 -3,965 4,505 9,341 4,939 812 102 ... 28,402 14-97 5,362 30 11 > 154 1,184 2,919 3,721 3,911 2,875 M 79 500 140 83 16,788 8-55 5,647 126 11 ; 1,073 2,649 2,000 1,818 1,774 i>493 695 420 161 154 12,903 12-76 2,125 251 12 5 77 1 2,733 3,004 3,786 2,719 1,442 665 176 52 29 i5»543 H'B2 3,612 . 109 12 5 421 3,393 3,566 3,349 3,237 3,018 1,613 1,098 207 45 20,049 11-17 3,673 224 12 2 7.793 35,038 60,505 79,102 74,586 62,476 25053 9,899 3,576 1,715 362,033 4 '24 1-09 i«88 2-46 2*32 i"94 -78 '31 'ii '05 = 11-25 2-i 97 167 218 20-6 17-3 6-9 2-7 10 *5 =100 * In the North-Western Provinces, No. IV Eastern Districts of the North-Western Provinces and Oudh {excluding the Districts of the North-Wester £ Number of Deaths from Cholera registered in each Month. District Average " "~ z District. Population. Se tgm _ |g January. February. March. April. May. June. July* August. P ' Octobe ol 2 > 01 55 Gonda .... 1,219,371 36 59 1,048 6,820 7,751 5,677 2,823 M 34 1,169 989 8 56 Bahraich .¦•¦- . . 826,243 1 13 176 3,884 2,696 2,309 1,445 1,745 1,199 I >° l 57 Kumaon • . . 439,715 89 249 311 J>955 3784 2,805 596 154 36 4 58 Dehra .... 123,451 ... 1 ... 230 668 105 64 175 11 59 Garhwal .... 327,788 10 2 3 597 1,720 1,436 852 104 18 Total . 15,733,856 1,529 1,772 12,680 74,773 56>5335 6 >533 43>9 2i 2 i 20,851 i 4,3 T 4 9>5*4 14,44 Average Death-rate of each month per ¦ 10,000 of Population . . -09 -09 "67 3*96 2*99 2*33 I'll 76 "50 76 Percentage of Deaths in each Month . "6 7 47 277 20*9 163 77 5"3 3*5 Appendix A — Statement IV. 148 No. IV. tricts of the North-Wtslern Provinces and Oudh (excluding the Districts of the North-Western Provinces contained in No. III). ,_= " NaM.SK ? Deaths prom C«»» mmm ? EACH Mo™. Average M™ Minjmun, NunjWof — . ¦ ¦ : T ° tal , death-rate deaths in deaths in which the n « mberof perio.ooo anyone anyone death-rate ¦vary. February. March. April. May. June. July. August. *£¦, O ctobe, November. December. of popula- of£» oHhe^ fl exceeded^ "5 134 1,716 8,803 2,210 1,079 610 555 440 " 263 73 2 5 l 6 . 02 3 12>o1 8 8 ' 25i 2 5i J S IO 19 48 745 10,764 6,449 4,54 i 2,713 2 -i3 2 2,686 3,714 945 l6 ° 34,9i6 12-65 8,314 61 11 31 41 2)4 6 4 15,730 10,738 7,011 2,384 624 187 850 1,112 677 41,849 22-60 9,537 49 IO 301 203 701 3,205 3,271 2,650 960 761 322 198 87 24 12,683 Tl7 3.615 15 ir 33 53 27 93 631 1,452 700 630 316 179 22 6 4142 4 ' 142 5'° 6 9*7 4 8 194 221 1,635 5,153 2,158 1,086 667 253 2 1,786 1,287 356 15,448 14-44 6,129 ... 10 147 44 '142 525 4,367 6,300 2,325 1,699 502 1,324 1,420 861 19,656 18-88 6,635 4 9 414 447 2,088 7,650 3,007 2,402 1,195 534 257 1,264 3,365 2,962 25,585 22-59 5.704 2 9 102 195 1,342 6,204 3,815 1,716 1,152 628 205 562 1,529 689 18,139 12*00 3»135 2 5 ll 2 6 13 820 1,196 1,785 1,023 i, o6 7 467 230 52 203 6,864 7-04 1,926 2 9 35 56 269 2,340 2,072 1,567 1,342 1,819 1,047 2,015 2,004 602 15,168 13-29 4,612 8 9 36 59 1,048 6,820 7,751 5.677 2,823 1,434 1,169 9859 8 5 387 162 28,351 19-38 6,122 ... 10 1 13 176 3,884 2,696 2,309 1,445 i,745 1,199 r.°lB r .° l8 2 93 67 14,846 14-97 3.376 1 9 89 249 311 1,955 3,784 2,805 596 154 36 43 m 221 10 >354 i 9' 62 6' 6 ' 8 94 1 6 1 ... 230 668 105 64 175 n 9 ... ... 1,263 8-53 636 ... 3 10 2 3 597 1,720 1,436 852 104 18 ... 6 15 4,763 i2-ii 3.473 •¦• 3 ,529 1,772 12,680 74,773 56,533 43.921 20,851 i4,3H 9.5H i 4,440 12,693 7,030 270,050 09 -09 "67 3-96 2-99 2-33 rii -76 -50 76 67 '37 =14-30 •6 -7 47 27-7 20-9 163 77 5-3 3-5 47 2 6 =100 Appendix A — Statement V. 149 Western Districts of the North- West Provinces and Oudh {excluding Agra and Muttra), Number of Deaths from Cholera registered in each Month. Serial District. ' Avera ? e January. February. March. April, May. June. July. August. September. October. November. .Decem! 60 Cawnpore ... 1,185,129 20 15 26 263 897 1,261 877 1,528 1,381 934 83 61 Lucknow . . . 833,725 20 13 80 692 859 1,372 1,268 2,082 795 519 743 4 62 Hardoi . . . 959,303 2I 2 J 4 166 z66 J >396 2,302 5,109 2,090 1,609 218 63 Sitapur . . . 944,238 47 61 4*5 1.76° i, 68 4 1,121 2,035 5,091 3,105 1,864 596 64 Kheri . . . 784,827 ... 7 62 1.013 1,184 388 596 2,508 2,478 3,504 1< 6 94 t 65 Fatehgarh . . . 911,776 14 9 20 38 235 411 716 1,859 1402 723 31 66 Jalaun . . . 411,707 2 9 5 « 19 87 236 399 577 109 67 Etawah . . . 674,407 5 3 8 30 29 606 761 844 522 150 6 68 Jhansi . . . 322,500 ... ... ... 2 1 13 66 510 222 12 ... 69 Lalitpur . . . 248,617 ~ ... 11 14 26 137 261 46 35 148 8 70 Mainpuri . . . 750,718 2 1 1 10 69 566 877 619 734 116 24 71 Etah .... 685,437 9 7 12 22 107 222 413 671 825 389 49 72 Shahjehanpur . . 887,898 7 " 16 26 67 69 423 6,074 3,736 4,844 9°5 1 73 Budaon .... 898,131 17 23 46 65 114 65 262 772 2,735 3,183 274 74 Bareilly and Philibheet . 1,473,368 27 19 32 141 3103 10 2 37 353 3.784 6,608 6,362 809 75 Moradabad . . . 1,125,239 26 47 56 173 124 101 147 1,256 2,176 1,394 79 76 Aligarh . . . 973,363 22 6 37 93 37* 1,025 754 1,339 i> 2 46 179 39 77 Bulandshahr . . . 862,651 « 6 27 57 264 465 195 1,310 1,941 191 9 78 Meerut .... 1,256,365 5 15 23 136 269 359 227 596 1,323 81 13 79 Bijnor .... 706,213 21 21 41 482 238 61 38 46 672 1,057 176 80 Muzaffernagar . . 720,316 " 17 24 211 134 92 70 204 347 51 2 81 Saharanpur . . . 923,0i49 2 3,oi4 26 15 41 644 235 174 73 868 812 145 . 22 82 Terai Pergunnahs . . 171,55° - 2 S 5^ 2 49 139 76 8 314 796 532 237 Total . 18,710,492 313 332 1,053 6,298 7,648 10,304 12,958 37,829 36,558 28,096 6,017 1, Average Death-rate of each Month per . £ , 10,000 of Population § oi 'oi -05 '28 -34 '46 '58 1*69 1-63 1*25 '27 •< Percentage of Deaths in each Month '2 '2 7 4" 2 52 6-9 87 25-5 24-6 18-9 4-1 ) No. V Testern Districts of the North-West Provinces and Oudh {excluding Agra and Muttra). Number of Deaths from Cholera registered in each Month. Average an- Maximum Minimum Number of . Total nua ' death- number of number of years in number of ra ' e P er deaths in deaths in which the deaths io.ooo of any one of any one of death-rate March. April. May. June. July. August. September. October. November. December. ' popula- the 12 the 12 exceeded 1 tion. years. years. per 10,000. 26 263 897 1,26 l 877 1,528 1,381 934 83 7 7,292 5-13 1,609 23 9 80 692 859 1,372 1,268 2,082 795 519 743 439 8,882 8-88 i,795 6 11 14 166 266 1,396 2,302 5,109 2,090 1,609 218 26 13,219 11-48 5>997 1 4 415 1,760 1,684 1,121 2,035 5,091 3,105 1,864 596 96 17,875 1578 9,180 10 7 62 1,013 1,184 388 59 6 2,508 2,478 3,5°4 L 694 171 13.605 14-45 4,68 i 1 9 20 38 235 411 716 1,859 14°2 723 31 14 5>472 s*oo 2,538 2 3 5 11 19 87 2 36 399 577 10 9 ••• — i>454 2-94 499 2 7 8 30 29 606 76i7 6 i 844 522 150 0 3 2,967 3-67 1,450 I 4 2 1 13 66 510 222 12 ... ... 826 2-13 353 ••• 3 11 14 26 137 261 46 35 148 8 ... 686 2*30 502 ... 2 1 10 69 566 877 619 734 116 24 2 3,021 3-35 1,771 .- 4 12 22 107 222 413 671 825 389 49 5 2,731 3-32 1,861 6 4 16 26 67 69 423 6,074 3,736 4.844 9°5 17° 16,348 1534 5,738 2 7 46 65 114 65 262 772 2,735 3.!83 274 61 7,617 7-07 3,552 22 9 32 141 310 237 353 3.784 6,608 6,362 809 76 18,758 io-6i 10,393 i° 7 56 173 124 101 147 1,256 2,176 1,394 79 17 5,596 4-14 1,131 18 9 37 93 37S 1,025 754 1,339 J>246 J > 2 46 179 39 22 5,140 4-40 2,372 18 5 27 57 264 465 195 i,3i° T >94i 191 9 9 4,485 4*33 2,381 4 5 23 136 269 359 227 596 1,323 81 13 6 3,053 2-02 1,574 3 4 41 482 238 61 38 46 672 1,057 176 32 2,885 3*40 i,3° G 7 6 24 211 134 92 7° 204 347 51 2 6 1,169 135 561 1 4 41 644 235 174 73 868 812 145 . 22 30 3,085 279 1,351 1 4 56 249 139 "76 8 314 796 532 237 a 6 2,458 11-94 669 ... 9 1,053 6,298 7,648 10,304 12,958 37,829 36,558 28,096 6,017 1,218 148,624 •05 '28 -34 '46 "58 1*69 1-63 1*25 "27 -05 =6-62 7 4-2 5-2 6-9 87 25-5 24-6 18-9 4-1 *8 == 100 «s<> No. VI. Districts of Agra, Muttra and the Eastern portion of the Punjab. £ Number op Deaths from Cholera registered in each Month. x> — j ' Total ni § Average b e r 55 District. Population. P.i,.,,. „ ? T T , . . Septem- Octo- Novenv Decetn- deaths. F January. ™ U March. April. May. June. July. August. £ er ber> ber ber _ *C w . .83 "Agra 1,001,600 7 *4 37 239 3« 603 648 691 768 297 48 M 3,6^ .84 Muttra 736,006 15 13 68 Z zz 260 684 414 33* 37* 197 I3S 20 *,8 3 .85 Gurgaon .... 666,185 1 1 6 97 396 57;* »°9 3^6 272 25 28 » x, 73 86 Delhi 626,182 4 2 1 81 216 427 Ho 128 158 18 29 27 1,23 878 7 Rohtak 545.284 3 3 3 333 1,485 302 144 7 1 3 9 2 2,29 SB Hissar 494,432 2 ... I 994 2,302 414 45 56 17 1 - 3^9 £9 Sirsa 232,035 J 75 680 249 86 31 3 1 1 - »»" 90 Ferozepore .... 591,967 * 4 395 W4 292 138 147 43 5 - 2,29 91 Karnal . . . . . 616,774 ••• 2 4 214 1,552 7*3 101 187 142 3 3 - 2,92 92 Umballa .... 1,038,108 6 7 8 234 733 5<50 156 284 318 55 3 3 2,36 Total . . 6,548,573 38 42 129 2,693 8,341 5>597 2,235 2,180 2,198 709 262 66 24,49' Average Death-rate of each Month per 10,000 of Population ! oo *oi '02 -34 ro6 71 '29 " 2 8 '28 -08 "04 01 Percentage of Deaths in each Month "i *2 '5 IX'O 34*1 22-8 9-1 89 9*o 2-9 vt '3 Appendix A — Statement VI. 's<> No. VI. Districts of Agra, Muttra and the Eastern portion of the Punjab. — — — . Number op Deaths from Cholera registered in each Month. a Maximum Number of ¦ " T b Ot cr nU "f raTe pS ber of deaths ber of deaths S££t£2 erage _ . . be r ot rate per in one of m any one o f , , ilat^n , , a * Septem- Octo- Novetn- Decem- deaths. io,ooo of .. J the I 2 years . exceeaea January. F «J ru ' March. April. May. June. July. August. ber> faer ber< population, the 12 years. year per IO)OOO . ,0i,600 7 14 37 *39 3" 603 648 691 768 a 97 48 M 3,686 3^7 86 9 13 6 ¦36,006 15 13 68 322 260 684 414 332 372 197 135 20 2,832 3-21 733 4 7 66,185 1 1 6 97 396 37i 2°9 326 272 25 28 2 1,734 2-17 753 - 5 26,182 4 2 1 81 216 427 Ho 128 158 18 29 27 1,231 1-64 4i6 ... 4 45,284 3 3 3 333 1.485 302 M 4 7 1 3 9 2,295 y V 2,020 ,94,432 2 ... 1 994 2,302 4i4 45 56 17 67 1 ... 3,899 6-57 3.674 ... 3 32,035 175 680 249 86 31 3 I * - 1>226 I > 226 4-4O 1,088 .., 3 191,967 1 4 395 1-274 292 138 147 43 5 - 2,299 13-24 W7 - 2 ?6,774 ... 2 4 214 1,552 7*3 W l8 7 U* 3 3 - 2,921 3-95 1,606 ... 4 ,38,108 6 7 8 234 733 560 156 284 318 55 3 3 2,367 1-90 i.m I 4 148,573 38 42 129 2,693 8,341 5.597 2,235 2,180 2,198 709 262 66 24,490 000 OF „ . . -oo -oi -02 '34 ro6 71 "29 -28 -28 # o8 -04 '01 •1 -2 -5 iro 34-1 22-8 9-1 8-9 9-0 2-9 n *3 =100 Appendix A — Statement VIL 151 No. VII. The Western Districts of the Punjab. $3 Number of Deaths from Cholera registered in each Month. •§ ' - § Dis R c Average Total num 1 ""' P ° PUlatiOn - J-a ry . *%- March. Apri,. May. June. J_-. Au^t. *g^ *£• "_JT (U 09 93 Simla 38,559 J 4 14 6 181 55 4 2 94 Jullundur .... 786,288 ... 1 2 39 32 11 31 762 474 76 3 3 1,4 95 Ludhiana .... 601,140 4 4 3 27 56 132 120 521 228 3 2 1 i,i< 96 Hoshiarpur .... 920,135 ... 3 5 27 40 58 37 409 636 172 4 ••• 1,3 97 Kangra .... 737,504 5 10 4 108 65 76 293 1,669 63° 6 3° 12 5 l 6 3 3,0 98 Gurdaspur . . . . 864,910 13 14 8 19 24 17 83 443 1,283 754 99 4 2,7 99 Sialkot 1,003,303 7 2 2 14 13 X 3 2 9 91 92<59 2<5 3 IQ 7 l 1,4 100 Amritsar .... 863,008 254 200 219 127 189 740 1,096 393 12 5 2,9 101 Gujranwala .... 583,734 1 2 1 5 64 93 189 317 589 75 2 2 1,3 102 Gujrat 652,731 3 1 2 5 93 224 85 268 356 51 2 5 1,0 103 Lahore 849,828 5 10 7 29 368 728 763 1,926 995 174 22 10 5,0 104 Montgomery .... 392,983 2 16 22 41 27 6 1 1 105 Mooltan . . . . 505,872 1 ... 2 ... 1 33 106 Muzaffargarh .... 317,076 ... ... ... ... 1 ... ... 3 1 1 JO7 Dera Ghazi Khan . . . 336,093 125 ... 4 108 Dera Ismail Khan . . . 418,257 ... 11... 1294 48 141 81 16 3 109 Jhang 371,661 ... 1 1 7 144 85 6 6 2 no Shahpur .... 395,152 8 254 348 92 30 7 in Jhelum .... 545,180 1 124 548 820 291 537 213 58 ... 2 2,5 112 Hazara .... 387,147 2 1 1 4 160 240 232 130 224 116 7 ... 1,1 113 Eawal Pindi .... 760,080 2 50 535 1,165 97 2 641 348 75 26 1 3,* 114 Peshawar .... 546,558 ... 114 384 219 264 84 126 929 198 ... 2, 115 Kohat 163,480 ... 1 ... 1 24 323 103 205 313 33 l 9 \ 2 i>' 116 Bannu 310,062 1 1 536 100 24 417 95 ... 1, Total . 13,350,741 43 57 45 673 2,670 4,543 4,94 i 9> ir 3 8,556 3,943 595 55 35, Average Death-rate of each Month per 10,000 of Population *oo - oo -oo -04 '17 '28 -31 "57 '54 '25 "04 -oo Percentage of Deaths in each Month *i '2 'i I*9 7"6 12*9 14-0 25-8 24*3 ira 17 '2 __________________________________________________________ No. VII The Western Districts of the Punjab. Number of Deaths from Cholera registered in each Month. Average an- Number of T .. .p. p nual death- Maximum num- Minimum num. in which Total number rate ber of deaths ber of deaths [ he death . rate A ., „ T .. A Reptem- Octo- Novem- Decem- of deaths « 10,000 of in any one of in any one of exceeded , per March. April. May. June. July. August. ber> ber# ber> population. the I 2 y ears - the 12 y ears - 10,000. 14 14 6 181 55 4 274 5"9 2 ijB ... 3 1 2 39 32 11 31 762 474 767 6 3 3 1,434 i's 2 865 ... 3 4 3 27 56 132 120 521 228 3 2 1 1,101 1-53 717 ... 3 3 5 27 40 58 37 409 636 172 4 ••• 1,391 1*26 724 ... 3 0 4 108 65 76 293 1,669 63° 6 3° 12 5 l 6 3 3>°°4 3*39 2,048 ... 3 .4 8 19 24 17 83 443 1,283 754 99 4 2,761 2-66 1,482 1 3 2 2 14 13 13 29 91 926 310 7 1 1,415 i'iB 463 ... 4 5 4 200 219 127 189 740 1,096 393 12 5 2,992 2*89 1,269 ... 4 2 1 5 64 93 189 317 589 75 2 2 1,340 1-91 430 ... 4 1 2 5 93 224 85 268 356 51 2 5 1,095 r 4O 572 ... 3 10 7 29 368 728 763 1,926 995 174 22 10 5,037 4"94 1,673 1 5 2 16 22 41 27 6 1 115 '24 101 ... 1 1 ... 2 ... 1 33 37 '06 32 1 ... ... 3 1 1 ... ... 6 *O2 3 '.'. '.'.'. 1 2 5 ... 4 I 2 "03 5 1 1 ... 1 2 9 4 48 141 81 16 304 # 6i 240 ... 1 1 1 7 144 85 6 6 250 '56 242 ... 1 8 254 348 92 30 73 2 i"54 5°4 ... 3 1 124 548 820 291 537 213 58 ... 2 2,594 3-97 1,962 ... 3 1 1 4 160 240 232 130 224 116 7 ... 1,117 2-40 781 ... 3 2 50 535 1,165 972 641 348 75 26 1 3,815 4*lB 2,914 ... 4 1 1 4 384 219 264 84 126 929 198 ... 2,210 3-37 1,002 ... 4 1 ... 1 24 323 103 205 313 33 J 9 2 1 ,° 2 4 5' 22 642 ... 3 1 536 100 24 417 95 ••• i,i74 3' 16 998 ... 2 57 45 673 2,670 4,543 4,94 i 9»"3 8»556 8 »55 6 3,943 595 55 35> 2 34 •oo 'oo *04 '17 '28 *3i *57 '54 '25 '04 -oo =2*20 •2 'i i*9 j'6 12*9 i4 - o 25*8 24*3 nn # 2 17 '2 =100 I No. VIII. Districts of Thur, Parkur and Sind. jj Number of Deaths from Cholera registered in each Month. ja ' I District. D Ave . r^ c . I P January. F _b- March. April. May. June. July. August. *£- Octo- Novem- Decem-6 w 117 Thur and Parkur* . , . 214,172 7 19 l 9 * 21 3° J 118 Shikarpurf . . . . 814,606 .... 204 673 133 37 95 184 33 119 Kurrachee* .... 451,091 ••• ••• ••• ¦•• 219 607 323 26 i ... 17 25 120 Hyderabad* .... 738,285 380 909 144 121 Upper Sind* .... 111,700 - 8 85 6 Total . 2,329,854 7 19 830 2,395 636 64 96 184 50 25 Average Death-rate of each Month per 10,000 of Population ....,,,.,.... '00 f oi '32 '93 '25 "03 '04 "07 '02 - oi Percentage of Deaths in each Month , , .... ... *i -4 19-3 55-6 i4 f 8 I*s 2#22 # 2 4-3 r» -6 * Statistics for 187 1 not available. t Statistics for 1871 and 1872 not available. Appendix A - Statement VIII. '52 No. VIII. Districts of Thur, Parkur and Sind. NUMBER OF DEATHS FKOM CHOLERA REGISTERED IN EACH MONTH. Avera« an- num . Mlaimum _.. Numberofveig 1 r " ' b6r regiS " ra a te de per" !>- of deaths ber of deaths ex-35,. IT I T1 . , Septem- Octo- NovenV Decfcm- *«*£*¦ JJe'S^ Se"l needed! per January. F ^ Fro" ro " March. April. May. June. July. August. £ er ber bef faer> v years. popu i a tion. the " ?eaTs'? eaT5 ' y ™ 10,000. 14,172 7 19 i 9 121 30 1 J 97 '84 88 "" 3 14,606 ... 204 673 133 37 95 184 33 - i,359 r6 7 J >359 — \ 51,091 219 607 323 26 1 ... 17 25 1,218 2-45 1.175 ••• 2 38,285 33 8 ° 9°9 144 M 33 V 76 J ,433 - l 11,700 8 85 6 99 -8i 99 - » 29,854 7 19 8 3° 2*395 636 64 969 6 l8 4 5° 2 5 4,3° 6 >OO OF •00 "oi "32 "93 '25 -03 '04 -07 '02 *oi =i'6B •i "4 19*3 55*6 14*8 i*s 2f22 f 2 4"3 i*2 -6 =100 * Statistics for 1871 not available. t Statistics for 1871 and 1872 not available. Appendix A — Statement IX. 153 No. IX. Districts forming the Eastern portion of the Central Provinces. S Number of Deaths from Cholera registered in each Month. § Average z District. Population. 804 1,925 3i7 18 38 41 16,127 21-96 8,040 ... 6 322 2,496 9,008 8,931 7,228 3,487 855 337 239 3,132 36,228 30-44 17,076 ... 8 12 169 1,042 684 442 494 151 " 42 20 3,097 8-32 1,695 6 43 314 973 1,109 854 683 282 54 39 - 4,472 8-65 1,697 ... 5 100 494 1,069 1,256 635 345 207 hi 19 12 4,297 8-o6 2,371 ... 5 29 180 338 256 187 166 112 ... ... ... 1,322 520 722 .» 5 50 66 711 1,061 808 1,005 256 57 115 12 4,223 9-31 i,976 .» 5 1,383 5,112 17,413 18,577 14,590 8,524 2,537 74i 515 3,244 73,464 •31 1-15 3-92 4-19 3' 2 9 r r 9 2 '57 #I 7 '" 73 I*9 7-0 23*7 25*3 19-9 n'6 3-4 i*o *7 4*4 =100 *5< No.X. Districts of the Western portion of the Central Provinces, Berar and. the Eastern portion of the 80-, Number of Deaths from Cholera registered in each Month. Serial ni9 24 2 4 559 488 138 Wardah . . . 365,245 ... ... ... ... 65 185 491 3.240 2,400 426 112 139 Wun .... 367.764 J 6 I ... 3° 131 748 1,342 3.880 2,186 376 159 140 Chanda .... 474,598 17 ... 122 279 1,294 1,810 1,692 1,737 826 117 152 141 Burhanpur . . . 98,403 ... ... 1 19 80 140 866 495 199 19 7 142 Bassim .... 3°9. 8 94 16 ... — 2.2 912 4.753 4.5 2 7 2,852 1,008 313 149 143 Akola .... 536,725 ... ... 29 34 270 3,199 4.89° 4.949 1*287 205 142 144 Buldana . . . 402,771 5 2 ... 33 1.370 1,808 6,783 4,651 1,149 12 7 22 145 Amraoti . . . 535.853 3 « 8 31 75 1,521 4,581 3,312 1,346 274 146 Ellichpur . . . 233,268 ... ... ... ... ... 136 1,682 1,457 262 71 7 147 Khandeish . . . 1,104,743 18 I 1 1 30 1,022 2,514 6,219 8,610 1,683 10 4 10 4 148 Nasik .... 726,997 55 124 110 585 1,628 1,467 1,835 2,669 J . 833 800 129 149 Ahmednagar . . . 762,644 9 6 53 241 1,008 2,678 4,988 4,015 2,474 9°4 X 54 150 Sholapore .... 577.155 180 195 85 307 1,830 1,804 5,161 2,714 761 344 225 151 Satara . . . . 1,051,271 38 70 414 2,383 3,213 5,566 5,258 3,048 1,554 982 143 Total . 10,753,877 866 872 1,113 5.5*9 15.091 3M-23 55.505 6o .504 26,084 7,843 2,958 Average Death-rate op each Month per *o6 *o» 12 '•• March. AprU. Ma y . Jme . ,„,,. Augo3l . *£»• Orto- W D,ce, v W 152 Ahmedabad .... 842,981 43 82 548 1,404 2,304 2,077 451 75 6 525 2 177 io< 153 Panch Mahals . . . 251,528 33 4 86 970 1,859 2,146 400 28 1 ... 117 5-154 Kaira 793,766 25 9 408 843 1,852 1,539 414 203 144 7§ 148 8 155 Broach .... 322,418 2 5 96 173 490 1,167 734 252 74 43 3° 156 Surat 553,441 115 152 152 339 975 2,238 1,666 1,204 777 673 6 73 2 i° 5< 157 Tanna 879,093 413 400 356 246 1,251 3,257 3,129 3,331 1,051 558 326 32; 158 Colaba .... 366,051 178 183 40 44 82 913 940 1,435 548 133 61 15; 159 Bombay City .... 708,801 261 298 433 4i7 684 1,069 1,262 998 487 3023 O2 *39 2 *< 160 Poona 875,029 656 166 217 700 3,029 4,930 4,020 2,743 1,199 441 3H 27 161 Ratnagiri .... 989,685 109 270 217 128 124 986 1,822 1,272 642 281 249 6 162 Kaladgi .... 698,504 677 950 1,898 3,246 4,262 2,472 1,699 1,552 766 443 295 22 163 Belgaum . . . 901,382 1,443 1,423 3> 02 7 4,53 2 5, 2 7 2 2,362 990 624 763 1,738 75° l > 2 l 164 Dharwar* .... 809,654 2,198 2,780 4,065 3,125 1,989 1,210 444 380 477 r r > 22 7 93^ i,3< Total . 8,992,333 6,153 6> 6 >7 22 2 2 n,543 16,167 24,173 26,366 17,971 14,778 7,092 5,969 3,752 4,0! Average Death-rate of each Month per 10,000 of Population -57-62 107 1-50 2*24 2-44 1*67 i' 37 " 66 '55 "35 '3 Percentage of Deaths in each Month . . 4-3 4*6 Bo 11 2 16-7 18*2 12-4 10-2 4*9 4*l 2-6 V * Statistics of 187 1 not available. 155 No. XI. The Western Districts of the Bombay Presidency. Number of Deaths from Cholera registered in each Month anrufa! Maximum Minimum Number of Total death number of number of years in P number rate per deaths 5 " deaths in hi i h \ he Febru- a-, M t ti A,, f Septem- Octo- Novem- Decem- of deaths. io,coo o f any One of a ? y ° ne death - ra . te l-ebru Marc h. April. May. June. July. August. £ . , , noDuia the I 2 of the t2 exceeded i ar y« " £j £ years. ' years. per io.ooo. 82 548 1,404 2,304 2,077 451 75 6 163 52 177 106 8,163 8-07 2,818 1 7 4 86 970 1,859 2^46 400 28 1 ... 117 54 5,698 18*88 4,13° ••• 5 9 408 843 1,852 1,539 414 203 144 78 148 81 5,744 6-03 2,104 ... 6 5 96 173 490 1,167 734 252 74 43 3° * 3.° 6 7 7*93 i>° 2 7 ••• 5 152 152 339 975 2,238 1,666 1,204 777 673 6 73 2l ° 54 8,555 12-88 2,751 4 7 400 356 246 1,251 3,257 3,129 3,331 1,051 558 326 327 14,645 i 3"88 5,969 ... 9 183 40 44 82 913 940 i,435 548 133 6l 157 4,7i4 1073 1,453 ... 9 298 433 417 684 1,069 J>262 J > 262 99 8 487 302 139 216 6,566 772 2,510 19 10 166 217 700 3,029 4,930 4,020 2,743 1,199 441 3X43 X 4 270 18,685 1779 4,649 ... 10 270 217 128 124 986 1,822 1,272 642 281 249 67 6,167 5-19 3,125 ... 6 950 1,898 3,246 4,262 2,472 1,699 1,552 766 443 2 95 222 18,482 22-05 7,124 ... 9 ' 1,423 3,027 4,532 5,272 2,362 990 624 763 1,738 75° J>232 J > 2 3 2 2 4,i5 6 22 "33 8.357 ... 7 12,780 4,065 3,125 1,989 1,210 444 380 477 x x > 22 7 936 1,294 20,125 20-71 8,779 ••• 5 i 6,722 n,543 16,167 24,173 26,366 17,971 14,778 7,092 5,969 3,752 4,081 144,767 i •62 107 1-50 2-24 2-44 1*67 1-37 -66 -55 -35 "38 —13*42 4-6 8-o IT2 16-7 18-2 12-4 10-2 4-9 4"i 2-6 2-8 =100 * Statistics of 187 1 not available. ¦56 No. XII. The Districts of the Madras Presidency. Number of Deaths from Cholera registered in each Month. i I- ¦ — c pr ; n i Average henai District, PonnlatTon Number. ropuiauon. j February March< April May> j une . j u i y . August. September. October. November. D 165 Ganjam .... 969,084 672 813 2,585 3,046 3,316 3436 3,079 MO5 565 299 1,196 166 Vizagapatam . . . 1,325,105 613 966 1,803 1,007 9 47 2,345 3J68 2,529 1,614 1,124 1,215 167 Godavery . . . 1,509,783 1,566 439 223 304 2,180 4,416 9,640 6,827 3>3™ 2,075 1,870 168 Kistna .... 1,449,659 3,677 3,354 2,133 838 1,150 2,325 4,226 4,967 3,626 941 551 T69 Nellore .... 1,231,132 10,038 5,430 1,807 778 493 549 973 2,942 3,053 1,141 1,352 170 Madras .... 389,739 1.9*4 M 93 853 610 1,158 625 711 853 611 320 401 171 Chingleput . . . 859,306 2,067 766 412 384 73* 554 1,128 1,019 560 466 442 172 South Arcot . . . 1,755,570 5,262 3,971 2,928 2,173 3,392 3,015 7,826 8,271 4,569 1,831 2,033 173 Trichinopoly . . . 1,102,991 4,874 1,9" M 42 1,530 2,507 2,458 5,047 4,425 2,938 1,228 1,500 174 Tanjore .... 1,845,044 11,306 5,281 1,802 939 3,315 8,004 10,939 4,335 2,668 1,483 941 175 Madura .... 1,238,581 3,004 1,696 1,461 1,273 2,710 1,830 1,679 2,973 2,979 3,939 5,278 176 Tinnevelly . . . 1,608,824 5,729 2,534 2,793 2,327 1,207 1,277 1,455 2,623 3,346 2,187 2,219 177 Kurnool . . . 842,545 2,051 1,550 2,324 2,703 2,485 1,846 2,083 1,627 947 394 1,068 178 Cuddapah . . . 1,247,863 10,192 8,430 3,781 2,852 3.603 3,970 5,226 5,303 3,586 1,212 1,335 179 Bellary .... 1,666,911 4,34* 7,652 8,569 5,985 5.856 6,590 4,869 2,681 1,219 1*023 1,701 180 North Arcot , . . 2,014,766 13,250 11,032 7,531 4,205 4,840 3,009 5,172 5.699 4.107 2,649 1.693 181 Salem . . ' . 1,966,679 9,686 9,549 10,280 9,846 9,129 3,585 2,790 3,083 4.014 2,510 3,161 182 Coimbatore . . . 1,762,976 4.099 4,7" 3439 4,154 6,489 4420 3,281 3,549 5,620 4,798 6,019 183 Neilgherries . . . 60,949 | 28 42 132 214 69 11 14 " 8 184 South Kanara. . . 918,202 j 432 272 203 332 176 338 367 370 388 537 7H 185 Malabar. . . . 2,244,739! 2,711 2,300 2,406 2,631 2,604 3,451 3,152 2,786 1,293 959 1,387 1 . — Il¦¦¦-¦ ' ' " ' ' ' Total . j 28,010,448 ' Appendix A — Statement XII. ¦56 No. XII. The Districts of the Madras Presidency. ? Averaee Maximum Minimum Number of Number of Deaths from Cholera registered in each Month. Total num " annnal number of numberof years in i . , — ber regis- death-rate deaths in deaths in which the tered in p er 10,000 any one of any one of death-rate ' l January. February. March. April. May. June. July. August. September. October. November. December. £_,'• ofpopula- JJj^l. *_» exceeded^ 1 67a 813 k_B!s 3,046 3,3^6 3436 3,079 W«S 565 M* W7 21,489 18-48 8,384 73 • 9 5 6:3 966 9 66 ?803 1,007 947 2,345 3,768 2,529 1,614 1,124 W 937 18,868 ir8 7 6,923 ... 6 3 1,566 439 223 304 2,180 44i6 9,640 6,827 3,3t0 2 ,0 7 5 1,870 i.4*> 34,270 18-92 9,548 ... 6 9 3,677 3,354 2,133 838 1,150 2,325 4,226 4,967 3,626 941 SSI ''395 29,183 1678 12,374 - ° 2 10,038 5430 ?807 778 493 549 973 2,942 3-053 W W 4,357 32,9*3 22-28 19,476 ... 6 9 1,964 1,493 853 610 1,158 625 7iT 853 611 320 401 714 i 0,313 22-05 6,246 ... 7 6 2,067 766 412 384 73i 554 1,128 1,019 560 466 442 591 9,120 8-84 4,39* - 5 0 5,262 3,971 2 , 92 8 2 ,i73 3,392 3,015 7,826 8,271 4,569 1,831 2,033 3,239 48,510 23-03 25,783 8 7 1 4,874 1,911 " 1,442 1,530 2,507 2,458 5,047 4,425 2,938 1,2.8 1,500 3,640 33,500 25-31 15,447 ... 8 4 11,306 5,281 1,802 939 3,315 8,004 10,939 4,335 2,668 1,483 94 1 4,6 49 55,662 25-14 18,125 23 8 1 3,004 1,696 1,461 1,273 2,710 1,830 1,679 2,973 2,979 3,939 5,278 5,265 34,087 22-93 15,647 - 7 4 5,729 2,534 2,793 2,327 1,207 1,277 i,455 2,623 3,346 2,187 2,219 6,539 34,236 1773 H,2i4 - 7 5 2,051 1,550 2,324 2,703 2,485 1,846 2,083 1,627 947 394 1,068 6,061 25,139 2486 11,758 ... 5 3 10,192 8,430 3,781 2,852 3.603 3,970 5,226 5,303 3,586 1,212 1.335 4,062 53,552 3576 33,102 ... 5 1 4,341 7,652 8,569 5,985 .5.856 6,590 4,869 2,681 1,219 1,02 a 1,701 3,126 53,6u 26-80 30,183 ... ¦ 4 6 13,250 11,032 7,551 4,205 4,840 3,009 5,i72 5,699 4,107 2,649 1.693 4,528 67,795 28-04 42,145 - 7 9 9,686 9,549 10,280 9,846 9,129 3,585 2,790 3,083 4.014 2,510 3,161 6,144 73,777 31*26 47,633 .- 8 6 4,099 4,712 3,439 4,154 6,489 4,420 3,281 3,549 5,620 4,798 6,019 6,578 57,158 2702 36,622 ... 7 g ... 28 42 132 214 69 11 14 11 8 ... 9 538 736 476 ... 5 2 j 432 272 203 332 176 338 367 370 388 537 714 712 4,841 4-39 2,900 ... 6 9 I 2,711 2,300 2,406 2,631 2,604 3,451 3,152 2,786 1,293 959 1,387 1,865 27,545 10-23 11,303 5 6 g I 726,107 1 Appendix A — Statement XIII. 157 No. XIII. The Districts of British Burma. SJ Number of Deaths from Cholera registered in each Month. M § ~ Averatre " 1 T Total nui 4 District. average reristerp, Z Population. -> , _ _. regi!>iere< •3 January. *f™' March. April. May. June. July. August. Septem- October Novem- Decem- the 12 ye o » w 186 Akyab 313,600 231 172 496 457 349 805 566 406 361 75 118 172 4,; 187 Kyaukpyu .... i4s>m 82 7l7 l 43 :34 : 34 101 229 576 415 330 350 144 «9 2,1 188 Sandoway .... 57,063 141 ... 12 49 86 221 81 •¦• j 189 Hanthawaddy .... 495,902 481 513 426 375 390 518 829 381 182 181 384 666 51 190 Thonegwa* .... 214,120 623 405 293 378 339 370 . 168 52 28 90 264 1,037 A 191 Bassein 343,929 372 384 774 1,007 55 8 463 278 200 121 89 295 494 5] 192 Henzada .... 376,700 209 351 308 338 299 311 1,021 1,052 462 175 299 175 5] 193 Tharrawaddyf • . . 255,704 80 10 i 36 46 22 348 397 162 227 362 170 i| 194 Prome ..... 280,141 222 129 339 427 206 163 1,388 1,046 548 579 531 299 M 195 Thayetmo .... 147,841 16 35 79 109 148 181 995 1,092 123 57 101 31 m 196 Amherst .... 298,308 167 328 521 417 608 268 100 48 14 47 114 188 M 197 Tavoy 78,241 193 118 35 ... 8 2 23 28 113 213 158 158 ¦ 198 Mergui ..... 50,660 92 136 74 28 29 21 54 59 52 96 107 100 ¦ 199 ShwegyinJ .... 156,887 287 124 80 82 61 52 99 83 60 ' 120 182 366 ¦ 200 Toungoo .... 103,627 42 2 71 58 12 6 69 34 53 178 101 57 I Total . 3»3 1 7>834 I * For 8 years, 1875 to 1882. t For 5 years, 1878 to 1882. H i 57 No. XIII. The Districts of British Burma. Number of Deaths from Cholera registered in each Month. Minimum Number of _ Tf I k Average annual Maximum num- number of years in ist nU d death-rate per ber of deaths deaths in which the i?. Qenfom m ..~.~ n „,»„•, re gis ere in 10 000 of po- in any one of any one of death-rate •ary. March. April. May. June. July. August. be P£ m - October N ° ve r m * De ™™' the 12 years. pulation> F the 12 years. the 12 exceeded, 1 •*' years. per 10,000. 31 172 496 457 349 805 566 406 361 75 u8 172 4,208 iriB 1,340 ... 8 82 71 43 J 34 101 229 576 415 330 350 144 29 2,504 14*38 73 2 ••• 5 141 ••• I 2 49 86 221 81 ... 455 6-64 285 ... 5 81 513 426 375 390 518 829 381 182 181 384 666 5,326 8-95 2,248 ... 10 2 3 405 293 378 339 370 . 168 52 28 90 264 1,037 4,047 23-63 1,083 206 8 72 384 774 1.007 55 8 463 278 200 121 89 295 494 5,035 12*20 1,393 8 11 °9 351 308 338 299 311 1,021 1,052 462 175 299 175 5,000 iro6 1,575 15 11 80 10 i 36 46 22 348 397 162 227 362 170 1,861 14*56 693 67 5 22 129 339 427 206 163 1,388 1,046 548 579 531 299 5,877 17*48 i,439 •-• 8 16 35 79 109 148 181 995 1,092 123 57 101 31 2,967 1672 1,187 ... 9 67 328 521 417 608 268 ioo 48 14 47 114 188 2,820 7*BB 764 5 8 93 118 35 ... 8 2 23 28 113 213 158 158 1,049 11*17 662 ... 8 92 136 74 28 29 21 54 59 52 96 107 100 848 13-95 423 ... 6 187 124 80 82 61 52 99 83 60 120 182 366 I >s9 f J 9*25 401 ... 8 42 2 71 58 12 6 ,69 34 53 178 101 57 683 5*49 3253 2 5 ••• 5 44,276 t For 5 years, 1878 to 1882. X Statistics of 187 1 not available. ¦58 No. XIV. Districts of Assam. c. Number of Deaths from Choirra rrgistered in each Month. £ ____ T( .g District. Population. Febru- »., t t i a * Septem- n , . Novem- Decem- * •g January. ™ v March. April. May. June. July. August. October. ber bef I C/ 3 , 201 Lakhimpur* . . 150,580 48 46 81 263 737 801 600 180 126 44 201 76 202 Sibsagar . . . 333,432 1,066 815 1,485 1,824 1,170 876 641 335 276 803 2,334 2,563 203 Nowgong . . . 283,484 355 173 479 1,520 2,434 3,594 2,454 773 641 1,049 1,488 1,222 204 Darrang . . . 254,670 166 263 1,084 2,394 3,087 2,868 1,788 699 236 329 352 561 205 Goaipara . . . 445,496 421 250 268 815 1,513 975 903 420 279 812 922 1,070 206 Cachar . . . 247,226 235 342 488 734 824 456 135 59 84 99 274 417 207 Sylhet . . . 1,844,274 2,534 1,567 2,067 3,525 3,425 i,3 2 4 438 350 476 1,514 2,974 4,188 208 Kamrup . . . 603,321 2,189 W* i,335 2,337 5,544 6,359 4,5*5 2 ,5 1 5 1,53° l^ 2 I » o8 4 li 7» Total . 4,162,483 * Statistics of 187 1 not available. «S8 Appendix A — Statement XIV. No. XIV. Districts of Assam. Number of Deaths from Cholera rrgistered in each Month. w,,-k_. « Total num- Avera g e an " Maximum Minimum INumt)er .of " . her reo-is nual death - number of number of y ?*? S J n July . August . Septem- Qctober No-em- Decem. ££__ th « 101 000 of any one of any one of ar y ocr# Der - Der - ' population. the 1 2 years. the 1 2 years exceeded i ' per io.ooo. 3 48 46 8l 263 737 801 600 180 126 44 201 76 3,203 19-34 855 22 II J 1,066 815 1,485 1,824 1,170 876 641 335 276 803 2,334 2,563 14,188 35-46 3,919 337 I 2 * 355 173 479 i,5 20 2,434 3,594 2,454 773 641 1,049 1,488 1,222 16,182 47-57 3,106 168 12 > 166 263 1,084 2,394 3,087 2,868 1,788 699 236 329 352 561 13,827 45-24 4,148 59 I 2 > 421 250 268 815 1,513 975 903 420 279 812 922 1,070 8,648 16-18 2,288 57 12 » 235 342 488 734 824 456 135 59 84 99 274 417 4)147 13 . 9 g 1>342 5 n I 2,534 1,567 2,067 3,525 3,425 1,324 438 350 476 i,SH 2,974 4,188 24,382 iro2 7,393 39 „ 2,189 1,072 1,335 ,337 5,544 6,359 4,515 2,515 1,530 1,062 1,084 *,7" 31,253 43-17 7,896 320 I 2 S 115,830 • Statistics of 1871 not available. ¦Statement XV. Appendix A 159 No. XV. Districts of Bengal, North-Western Provinces, Central Provinces, and Bombay not included in above retu S3 Number of Deaths from Cholera registered in each Month. •* Total » Average er 3 District. P °P ulati ° n - January . Febru- March April> May> June July< August> Septum- October Novem- Decen, 978 2,664 1,575 2,528 3,383 1,306 730 703 539 165 2,943 7,232 29, 212 Banda . . . 711,490 180 177 33 258 1,189 3,795 2,856 1,326 631 169 25 2 10, 213 Hamirpur . . . 514.. 139 34 20 3 16 349 2,158 4,244 2,820 502 159 3 6 10, 214 Mandla . . . 244729 ••• 13 9-8 79 59 274 575 661 394 16 1 ... 2, 215 Kanara* . . . 398,310 239 330 514 646 317 309 376 415 235 189 164 122 3 1 Total . 3,623,600 3 ! I___J * Returns for 1871 not available. No. XV , Noyth-Western Provinces, Central Provinces, and Bombay not included in above returns. ber of Deaths from Cholera registered in each Month. Average an- Maximum Minimum " m r °- , T .otal num- nual 6 death _ number of number o f £J£J th " npr rpais- • .< ¦ i ,1 • WHICH tne toed in the ratG pe ' deaths !.5 ! .5 deathS 4 death-rate Sentem- ~. , Novem- Decem- „"* 10,000 of any one of any one of PvrPP ApA t April. May. June. July. August. be g£ m October. faer ber 12 years. popu i ation . the I2 years. thei2years. 176 320 1,113 429 91 27 15 12 22 2,511 1675 1,734 ... 9 275 974 1,112 57° 2 57 153 2 42 287 404 4,450 7-41 1,353 IJ 7 2,528 3,383 1,306 730 703 539 l6 5 2,943 7,232 29,746 21-94 9,300 12 10 258 1,189 3,795 2,856 1,326 631 169 25 2 10,641 12-46 2 ;3 37 7 I 0 16 349 2,158 4,244 2,820 502 159 3 6 IO >3H i 6 72 5,655 ! I 0 79 59 274 575 661 394 16 1 ... 2,170 7-39 1,091 ... 6 646 317 309 376 415 235 189 164 122 3,856 8-8o 2,804 ... 4 63,688 i I A. STEPHEN, M.8., Surgeon- Major, Statistical Officer to the Government of India, * Returns for 1871 not available. in the Sanitary and Medical Departments II Appendix B. Statement showing the Mortality among Emigrants proceeding to Assam by Steamer during each of t) Number of De Year. Place of embarkation. Nu ™ each^lace!^ Total embarked - Percentage embarked. — Cholera. All other cau 1877-78 . Goalundo . . . . I7>3 66 6 6 ) 25,269 68 7] _ 2 97 :7 : 7 Dhubri .... 7,903 5 31*3) 10 12' , . ( 1878-79 . Goalundo .... 16,49,5 ) 2 . 400 707 0 " 2 ) 422 20: I *6Ay u > = 100 Dhubri .... 6,995 * 2 98) ? 1879-80 . Goalundo .... 6,333 ) ,, nTI 49" 1 > 40 2; f 1.4,911 c _ 100 1 Dhubri . ' . . 6,578 ) 509 ) ? ; 1880-81 . Goalundo .... 3> 2 94") m ofiS 32>13 2>I ) ... 3 C 10,205 C -— 100 Dhubri .... 6,974) 67-9) 12 j , ' 1 r 1881 . . Goalundo . . . . . 3>340 T ~ ~k a 2 7° ) ... 6 > I^>3°4 [ = 100 Dhubri .... 9,023 ) 73-0 ; 2 ie 1882 . . Goalundo . • . . . 3,689 ) fi 22-6 ) 21 6 . f 10 >3 2 5 > := 100 Dhubri .... 1^636 ; 774 J 65 14 1883 . . Goalundo .... 3,908 1 20,690 t8 ' 9 ) _ IO(1 X 3 2 Dhubri .... 16,782] Brij " l ' 62 5^ Government of India Central Printing Office.— No. 2 S. C. — 27-12-84. — 1,000. i6o Appendix B. Appendix B. t showing the MortaHty among Emigrants proceeding to Assam by Steamer during each of the seven years i8 77 - 7 8 to 1883. Number of Deaths. Death-rate per 1,000. Number embarked f oia \ embarked. Percentage embarked. '¦ at each place. Cholera. All other causes. Total. Cholera. All other causes. Total. • • '7,366 1 25)269 68 7] m 100 297 171 468 17-10 9-85 26-95 7,903 )J 3i'3J • 10 126 136 1-27 15-94 *7'2i • ' l6 >495 ) 23)49 o 7° 7 °' 2 ) = xoo 422 2 ° 2 624 25 " 58 12 " 25 37 " 83 6,995 j 2 9"8) ? ? 170 ? ? 24-30 • • 6,333 I2)9II 491 Ui00 4 ° 2? 6? &32 4 " 26 lO ' sB 6,578 ) 509 * ? ? 39 ? ? 593 • • 3,294] 10 , 268 32-I | =IO o - 3 3 •"• "9I" 9I ' 9I 6,974) 67-9) 12 8 I ¦ 20 172 I*ls 2-87 • • *34.} 13i364 2r °}= 100 - 6 6 ¦ - r8 ° l8 ° 9,023J 730 ) 2 10 12 '22 I'll 133 3,689) . 226> ioQ 21 6 27 5^9 163 732 12,636) 77-4) 65 14 79 5-14 rii . 6-25 3,908 1 2o6gQ lB '9] =100 13 3 16 3-32 -77 4-09 16,782) Bi-i) 62 57 "9 3*69 3*40 7-09 *o. 2 S. C— 27-12-84.— 1,000. ~~7^^-