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In 1840 there appeared in the Journ. of the Statistical So. [vol. iii. p. 113], Report of a Committee of the Statistical So. of Lond. appointed to collect and inquire into Vital Statistics, upon the Sickness and Mort. among the European and Native Troops serving in the Madras Presidency, from the Year 1793 to 1838. From this we take the following:

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Cholera.-The Madras returns do not distinguish between epidemic and the milder disease of C. morbus; and it is stated, upon the best authority, that almost every sudden invasion of disease which proves fatal is classed under the head of C.-a fact which would tend to indicate a careless system of obs. similar to that which in this country so much swells the apparent mort. caused by apoplexy and consumption. It is therefore prob. that some portion of cases not belonging to this class are included under this head, and tend, in some degree, to invalidate the comparison between this Presidency and other countries. There can however be no doubt that this disease, in its most malignant form, is more general, and recurs more often, in the East Indies than in any other country occupied by Brit. troops. It attacks both Europeans and natives in greater numbers and with greater severity than in any other country, but not with equal force; for among the natives the admissions amount only to one-third and the deaths to one-half of those which prevailed among Europeans.

In several of the countries occupied by Brit. troops the C. is happily a stranger. Among those in which it has hitherto appeared it has prevailed to the extent exhibited in the following T.; but as it has been only a transient visitor, and its ravages during the short period of its prevalence have been calculated as extending over the whole period examined, during the greater part of which the disease was almost, or entirely, dormant, the statement does not give a correct view of the intensity of the disease during the time of its prevalence. In Nova Scotia and New Brunswick, for instance, the epidemic only prevailed in 1834, when it cut off nearly 39 p. 1000 of the force; but this mort. extended over a period of 20 years makes the ann. average ratio only 1'4 p. 1000. In Canada it prevailed in 1832 and 1834, and the ratio of mort. during the 2 years was 22 p. 1000 of the mean force, although on an average of the whole period it was only 2'1.

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It appears to have occurred [in Madras] in an epidemic form among the European troops at 3 several periods during the 12 years, and to have prevailed at the same time among both classes of troops. The greatest mort. which it occasioned among the European troops was 2'24 p. 1000 of the mean strength in 1832-3; and the greatest mort. among native troops occurred in the same years and amounted to 7'5 p. 1000. In some years it will be seen that the disease was almost entirely dormant.... Although the disease is much less prevalent, and causes a less amount of mort., among the native troops, it is greater in intensity, as among that class 1 in 2'2 of those attacked died, and among the Europeans only 1 in 3'6.

The latter, it may be remarked, is almost exactly the same ratio of intensity which has been found to prevail in all the European and American stations in which the disease has of late years made its appearance among the troops, as will be seen in the following extract from the official reports:

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In 1840 also Dr. Robert Cavan, M.D., read before the Brit. Asso. at Glasgow a paper: Vital Statis. of Glasgow, Illustrating the Sanitary Condition of the Pop., wherein he furnishes the statistics we have given under date 1832, and many others.

In the Second Report of a Committee of the Statis. So. of Lond. appointed to collect and inquire into Vital Statistics upon the Sickness among the European and Native Troops serving in the Madras Presidency, pub. in vol. iv. of the Journ. p. 137, occurs the following: Cholera appears to have been far less prevalent among both classes of troops at Moulmein than in Madras. As however this is a disease possessing somewhat of a periodical character, and the returns from the Tenasserim provinces do not extend over an equal number of years as those furnished from the Madras peninsula, the following results may be liable to modification. Among the Europeans the admissions into hospital] were 27, and the deaths 7'6 p. 1000, in Madras, and only 6 and 28 respectively in the Tenasserim provinces. Among the native troops the admissions and deaths were 9 and 4'04 p. 1000 respectively in Madras, and o'4 and 0'06 p. 1000 respectively at Moulmein.

In 1841 a paper was read by Major A. M. Tulloch, before the Statis. So. of Lond. : Comparison of the Sickness, Mort., and prevailing Diseases among Seamen and Soldiers [in the Mediterranean] as shown by the Naval and Military Statistical Reports [Statis. Fourn. vol. iv. p. 1], in which, under "Epidemic Cholera," we find the following: The extent of sickness and mort. by this disease in the two forces is shown by the following T.: Naval Force.-Out of an aggregate strength of 55,709, attacked, 92; died, 22. Military Force.of 62,300, 459; 131. Although this epidemic prevailed to so great an extent among the troops at Gibraltar in 1834, and was common also throughout the peninsula in that and the preceding year, it will be observed that the navy suffered comparatively little. The facility of removing vessels from the quarter when the disease originated, so soon as cases began to appear, no doubt contributed greatly to this exemption, as all the attacks occurred in harbour, or in the immediate vicinity of the shore; and the prevalence of the disease was checked on putting to sea.

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From the above statement of the number of attacks and deaths by C. in the naval and military force respectively, the proportion of recoveries appears to have been greatest among the former, in the proportion of 1 in 42. to 1 in 3; but it seems rather doubtful whether 33 of the cases which occurred on board the Castor, when lying off Santaner, were of genuine Asiatic Cholera, as only 3 terminated fatally, and the symptoms were comparatively mild. Deducting these, the proportion of deaths to recoveries would be precisely the same in both services, viz. 1 in 35.

In a paper read before the Statis. So. in 1841 by Charles Barham, M.B. Cantab.,

Physician to the Cornwall Infirmary, etc., Remarks on the Abstract of the Parish Regis. of Tavistock, Devon, there occurs the following [vol. iv. p. 37]:

The Cholera, however, though twice or three times introduced, did not take root, nor spread beyond the person first attacked; an exemption the more remarkable, as the neighbouring town of Plymouth was most severely visited by this scourge; and as the situation of Tavistock, on a river which empties itself into Plymouth harbour, is such as has in other instances apparently favoured the spreading of the disease. The dreadful havoc caused by the Plague in 1626 serves to show that a similar immunity to that recently enjoyed cannot be counted on if another pestilence should occur.

A paper was read before the Statis. So. in 1844 [vol. viii. p. 83], by Dr. J. Graham Balfour, M.D., Comparison of the Sickness, Mort., and Prevailing Diseases among Seamen and Soldiers, as shown by the Naval and Military Statistical Reports. This was based upon a later Report of the Health of the Navy than that reviewed by Major Tulloch in 1841. This present report comprised: 1. The Cape of Good Hope, Western Africa, and the Mauritius. 2. The East India command. 3. The Home and various forces. His remarks and comparisons were confined to the second head, for reasons stated in the paper. Under "Epidemic Cholera," the following T. is given :

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The author says:

This disease has proved more prevalent and fatal among the military than among the sailors, and the proportion of deaths to cases has also been higher. Dr. Wilson, however, states his opinion that some cases of common C. have been included, which seems prob., as in 1835 we find 21 admissions recorded and no deaths. C. being an endemic disease in India, although prevailing occasionally as an epidemic, it was naturally to be expected that the troops would suffer more from it as being more exposed to endemic influences. In 1832 it raged with great violence at Colombo and Trincomalee, cutting off nearly one-fifth of the white troops at the latter station, while only 9 cases occurred among the sailors in the harbour there, of which three terminated fatally; and throughout the rest of the command there were but 15 attacks and 1 death recorded.

In 1845, the C. was epidemic at Cabul, which from 1839 to 1842 had been the seat of war, and the scene of great triumphs and disasters.

In the summer of 1846 a form of disease prevailed in Lond. which has been designated in the U.S. Bills of Mort. Cholera infantum. The disease here proved fatal to many old people. The Reg.-Gen. says adults died of attacks which could not in their symptoms be distinguished from Asiatic C. "It was, however, quite evident from the first, that the epidemic had not the character of that malady which broke out here in the winter of 1832, but was closely allied to the C. described by Sydenham." [See 1669.] The mort. of the year was very heavy; and the epidemic was apparently as fatal in inland towns as in ports. In Lond. 228 deaths were referred to C., and 2152 to diarrhoea.

În Bombay epidemic C. prevailed in the spring of the year, and a part of the army of Scinde, at Kurrachee, was assailed by the disease in its most fatal forms. It acquired great force about the Indus. From Affghanistan, the Punjaub, and Scinde, the epidemic extended later in the year over Persia and Syria.

In a paper read before the Brit. Asso. in 1846 by the late Col. Sykes: Statistics of the Gov. Charitable Dispensaries of India, chiefly in the Bengal and North-Western Provinces, a letter by Dr. S. Davis respecting the inhabitants of Patna is quoted, and the passage contains the following:

During the 8 yearsof my residence I have seen several severe visitations of C. and remittent fever, the former usually making its appearance at the commencement of the hot winds. There is often in April and May an indescribable but well-understood state of the atmosphere, accompanied with variations in the wind, and a hazy and sultry appearance that is favourable to the production of the former very frightful disease. During such weather you find vegetation blighted by impalpably small animalculæ, which elude the perception of the naked eye, but are easily discerned by the aid of microscopic instruments.

I have long thought that C. and some other diseases have their origin in animalculine blight, and late writers have brought together so many facts bearing on the subject, that this opinion gains ground with me daily, nor is the circumstance of diseases spreading more in crowded cities than in smaller localities at all contrary to this theory, since there are so many more points of attraction or deposit. In 1846 Dr. Allan Webb pub. in Calcutta, Pathologia Indica; or, the Anatomy of Indian Diseases, based upon Morbid Specimens in the Museum of the Calcutta Medical College, in which work much information is given concerning the early hist. of C. in India. In June, 1847, the C. prevailed at Astrakhan, at the mouth of the Volga, on the Caspian Sea. By Sept. in that year it had reached Moscow.

The Reg.-Gen. in his report on the public health for the third quarter of 1847 said : The great historical epidemics have diminished in intensity; and there appears to be no reason why they should not be ultimately suppressed with the advance of the pop. amongst which they take their rise. Their origin is obscure, but influenza appears generally to have become first epidemic in Russia, C. in India. It is in India that the source of the latter disease must be attacked. If the health of

India become sound, Europe might be safe and hear no more of the epidemic which is now traversing Russia. The attention of the Indian authorities has been for some time directed to the subject.. Asiatic Cholera has taught us that the lives of thousands in England may depend on the condition of the Pariahs of Jessore.

In 1847 the late Col. Sykes communicated to the Statis. So. of Lond. a paper, Vital Statistics of the East India Co.'s Troops in India, European and Native, and the same is printed in vol. x. of its Journ., p. 100. The subject is treated under three divisions. 1. The Vital Statis. of the Bombay Native Army at every age from 20 to 52 for the years 1842, 3, and 4. 2. The Vital Statis. of the Indian Army, European and Native, from 1825 to 1844, both inclusive. 3. The Vital Statis. of the Prison Estab. of the Native Armies of the three Presidencies. All the more material facts, as deduced from these returns, are presented in tables prepared by Mr. F. G. P. Neison. The author of the paper, reviewing the results of the Tables, says:

Another important result from the compilation of this paper is the necessary removal of all rationa grounds for the panic terror which has hitherto obtained respecting the intensity and extent of that assuredly very shocking malady Asiatic Cholera. In consequence of the unexpectedness with which the disease appears in certain localities, the devastations it commits, sparing neither age nor sex, the robust nor the feeble, the daring nor the timid, the unthinking and the alarmist are led to characterize these local manifestations as types of the general operation of this appalling disease; but when we calmly cast our eyes over the mort. T. of the whole Indian army, whose ann. average strength for 20 years was 12,028 Europeans, and 194,082 natives, we find that the ann, average loss from C. for 20 years was: Europeans. Natives.

Bengal
Madras
Bombay

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51

22

14

87

Bengal
Madras

Bombay

Total for India

224

348

90

662

The European troops losing in fact only o'724 p.c. p.a., and the native troops only o'342 p.c. p.a. The maximum intensity of the C. was only 2'13 p.c. in 1843 in 20 years; and amongst the native soldiery during that period the maximum intensity scarcely exceeded the half of that amount.

Another fallacy which these T. dissipate is the asserted superiority of the European over the native soldier in the power of rallying from its effects when attacked. The European, it is said, is a robuster man than a native; his fibre is more rigid, and his stamina stronger; the native being comparatively feeble and washy from his habits of life, and from the insufficient nourishment of his farinaceous or vegetable food. Now the T. show the very reverse to be the case. In no year whatever, under the Bengal Presidency, has the per-centage rate of mort. from C. of the native troops approached that of the Europeans; nearly the same may be said of the Bombay C. mort. At Madras there is a difference, the mean mort. of the natives from C. being rather more than a half p.c. p.a., and that of the Europeans rather less than a half p.c. p.a. This I shall endeavour to account for when speaking of the prob. causes operating upon the health of the troops of the three Presidencies, European and Native. The final results of C. mort. as already shown are, for the European troops of all India, 0'724 p.c.; and for the natives, o'342 p.c. p.a. [INDIA.]

In the Edin. Medical Journal for Jan. 1847 there was pub. by Dr. Begbie, a Report embracing 30 years' mort. experience of the Scottish Widow's Fund, in which some details as to deaths from C. are given; but as some subsequent Reports were pub., we shall speak of them all under date 1860.

In 1848 Surgeon F. P. Strong, of the Bengal Army, prepared a Report to the Bengal Gov. On the Mort. in the Fails of 24 Pergunnahs, Calcutta. An abstract of this report was read before the Statistical So. of Lond. in 1848 by Col. Sykes; and this abstract is pub. in vol. xii. of the Journ., p. 48. Therein we find the following:

The second return of Asiatic Cholera to our shores, after an absence of 16 years, gives considerable interest to the most complete T. of C. statistics for 31 years from 1817, the date of its first record in Calcutta, to 1847, inclusive, that has hitherto been compiled. . . . The return embraces the number of prisoners, the number of C. sick, and the number of C. deaths, for every month of every year from 1817 to 1847, both inclusive. The first striking feature of the T. is that there is not any one year of the whole series in which there was not C. in the jails; and, what is equally remarkable, with exceptions to be mentioned, there was not any one month of any year in which the C. was not present among the prisoners. The disease therefore took its place with the ordinary diseases to which man is subject in India at all times-dysentery, fevers, liver, spleen, and all the ills flesh is heir to, and yet the average mort. from C. to the strength, for 31 years, was exactly 1 p.c.; the average mort. from all causes for 27 years being 7'11 p.c. in the jails of the 24 Pergunnahs, while the mort. in Calcutta for the same period was 4'64 p.c. Here we have a most important and consolatory fact, the disease permanently located within the walls of prisons, under the most favourable circumstances for its development and spread, from the constrained juxtaposition of parties, produced only 6531 cases in 31 years to an ann. average strength of 1863, or about 11 p.c.; so that, whether the C. be contagious or be not contagious, only 1 in 9 persons was susceptible of taking the disease, when constantly exposed to its influence, and only one-eleventh of those who took the disease died; the average loss of those treated for 31 years being 8.86 p.c.

The following Reports were also pub. in 1848: (1) Reports on Asiatic C. in Regiments of the Madras Army, 1828-44, with Summary of its Treatment in India, by Samuel Rogers; (2) Report of the Sanitary Committee of N. Y. on the Asiatic C. at Staten Island (N. Y.). In June, 1848, C. prevailed in St. Petersburg and Berlin; by Sept. it had reached Hamburg; in Oct. it was at Edinburgh. It is thus seen to have followed much the same course as in 1830-31. The Board of Health showed this clearly by the following simple diagram:

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June, 1847
Sept. 18, 1847

July, 20, 1830
Sept., 1830

June 26, 1831

June, 1848

Aug. 31, 1831

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Oct., 1831

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Oct. 24, 1831

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Jan. 22, 1832

Oct. I,

1848

34

The Reg.-Gen. in his first quarterly report for 1848 pointed out that there was "a very remarkable improvement in the state of the public health." In his second report, "There is as yet no trace of the epidemic of C. which is ravaging Russia from Moscow to St. Petersburg, and is ascending the Danube." In the 3rd quarter of the year the mort. was declared to be below the average, "the improvement in the public health is considerable in all the divisions except Lond." For the 4th quarter the mort. was "below the average." Yet in Oct. the presence of Asiatic C. made itself distinctly known, and during the year no less than 1934 deaths were referred to C.; 829 in the first nine months, and 1105 in the last three. Dr. Farr says [Report on Mort. of Cholera in England, 1848-9]: The former were generally considered cases of common English C.; many of them were universally held to be "Asiatic" C. The two forms are often not distinguished in the returns. The cases separately considered run so insensibly into each other, that the attempt at distinction would have been fruitless. They differ perhaps in fact no more than distinct and confluent smallpox, simple and malignant scarlatina, simple and phlegmonous erysipelas, which are properly held to be varieties of the same maladies. Without entering into any disquisition in pathology, it is also necessary to notice here the connexion of diarrhoea and sporadic C. with Asiatic C. [See DIARRHEA.]

The year 1849 opened with severe epidemic C. too firmly implanted in Gt. Brit. The deaths in England in Jan. were 658; in Feb., 371; in March, 302. The circumstances were equally remarkable with those of the preceding year. The Reg.-Gen. said in his first quarterly return, "Although epidemic C. has been in England since Oct. 1848, and has prevailed more or less up to the present time in parts of the country, the general mort. has been and is considerably below the average. This is encouraging, and should stimulate all sanatory improvements; for summer is the season in which the epidemic is to be most dreaded." In April the epidemic very much subsided, and only 107 deaths were referred to C. in England. In May the deaths were 327; but the fatal period set in during that month in Liverpool, and went on through June, during which month the deaths were 2046 in all England. South Wales was now suffering, and the epidemic had greatly increased in Lond. With the advance of the heat of summer, the epidemic increased alarmingly, until, in the month of Sept., the deaths reached 20,379. It reached its highest point on the 5th and 6th of that month, when the mort. was respectively 1120 and 1121. It had sensibly decreased by the 11th Sept. The maximum day in South Wales was 11th Aug.; in Lond. 4th Sept. The decline of the mort. was very rapid. The mort. in Oct. was very much confined to the S. and N. Western Divisions of England. D. was more fatal than C. in the early months of the year. In the middle and autumn of the year it was the reverse. At the close, D. was again in the ascendant. The following T. of the monthly progress of these almost twin diseases will be useful for future reference: Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Cholera ...658 371 302 107 327 2046 7570 15,872 20,379 4654 844 163 Diarrhoea...810 698 708 666 721 926 2124 3599 4928 2244 871 592

C. and D. 1468 1069 1010 773 1048 2972 9694 19,471 25,307 6898 1715 755 The following T. compares the intensity of the mort. month by month during the visitations of 1831-2 and 1848-9; but it must be always remembered that the returns for the former period were prob. defective, as already pointed out.

DEATHS IN ENGLAND FROM CHOLERA DURING EACH MONTH THE EPIDEMIC REIGNED IN ITS TWO EARLY VISITATIONS.

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The following Tables present some points of interest:

I.-DISTRICTS AND TOWNS WHICH SUFFERED MOST SEVERELY FROM THE CHOLERA EPIDEMIC OF 1849, ARRANGED IN ORDER OF THE RATE OF MORT. EXPERIENCED :

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1832.

Place or District.

Pop. 1831.

[These numbers will be found to differ in some respects from the figures given in the Special C. Report pub. 1852-the calculations in that Report having been made prior to the Census of 1851.]

II.-DISTRICTS IN WHICH THE CHOLERA WAS GREATER IN 1849 THAN IN 1832.

1849.

Deaths from
Cholera 1849.

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III.-DISTRICTS IN WHICH THE MORT. FROM C. WAS LESS IN 1849 THAN IN 1832.

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It is important to bear in mind that in abstracting the cases of 1849 for the purposes of Dr. Farr's special Report on the Mort. of Cholera in England in 1848-9, all cases returned as "Cholera" (whether English or Asiatic), cholerine, "bowel complaint," and diarrhoea simply, or as a complication of other diseases, were transcribed. All the cases in which the term "Cholera" or "Choleraic Diarrhoea" occurred were referred tc Cholera. About 300 cases, in which diarrhoea was evidently a symptom of consumption, or some other disease, were struck out; the residue of the cases was classed under Diarrhoea.

The small general mort. of the year 1849 led, perhaps not unreasonably, to a surmise that the mort. from C. did not over a series of years disturb the average rate of deaths in the pop. In other words, it was thought prob. that those who were attacked by C. were debilitated lives, that would have died from some other cause within a very short period. Further obs. has shown that this theory cannot be upheld in its entirety. It does, however, appear that the deaths from C. do not augment the deaths of the entire pop. to the extent of those ascribed to C. itself; hence there is a set-off somewhere. This is prob. found in the increased care taken by a large number of persons. The subject will be rendered more clear by reference to a T. given under DEATH RATE.

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