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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:
Total for India
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, o'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 Widows 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 464 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 :
July, 20, 1830
June 26, 1831
Aug. 31, 1831
Oct. 24, 1831
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 Ĉ. 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.
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 :
Place or District.
[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.
III.-DISTRICTS IN WHICH THE MORT. FROM C. WAS LESS IN 1849 THAN IN 1832.
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.
In the C. epidemic in 1849, the deaths of 7436 females against 6701 males occurred in Lond. This led to an inference that C. might be more fatal to females than males-not a very unreasonable assumption, when their being confined within the close precincts of their houses, and hence exposed to the choleraic poison of their house-drains, is considered. But subsequent investigation has dispelled the belief. Various other facts bearing upon this point will be mentioned as we proceed.
A noticeable feature of the outbreak of 1849 occurred in the district of Church-lane, St. Giles's. While the mort. among the poor Irish families in the “rookery" there was very considerable, not a single case occurred among the larger pop. in buildings of the Metropolitan So. in that locality. A similar result was observed in other model blocks of labourers' and workmen's dwellings.
A very severe visitation of C. occurred in the district of Plympton St. Mary, Devonshire, in 1849. It first broke out on the 11th May; it had disappeared generally by the early part of Sept.; and by the end of Oct. had altogether disappeared. Mr. A. C. MacLaren was sent down by the Gov. Inspector of Cholera to watch the progress of this outbreak, which was regarded as "a most exquisite instance of epidemical severity." The result of Mr. MacLaren's obs. are given in vol. xiii. of Statis. Journ. [p. 103], On the Origin and Spread of Cholera in the 8th District of Plympton St. Mary, Devonshire,— a paper of great completeness of detail. We must be content with one passage only:
The periods of life most liable to attack and death were those under 10 years of age; next, between 30 and 40, and 50 and 60. The periods most liable to attack were those over 60, and between 10 and 20 years of age. The periods of least mort. in relation to attacks by diarrhoea and C. were those between 40 and 60, and 10 and 20 years of age. The periods of greatest mort. in ratio to attacks by diarrhoea and C. were those over 60 years of age; next, under 10; and next, between 30 and 40 years of age.
In 1849 Dr. John Snow, M.D., pub. a work, On the Mode of Communication of Cholera, which attracted a good deal of attention, and passed through several eds. The following is an outline of the theory promulgated :
The C. commences as an affection of the alimentary canal, and not with general illness; there is no evidence of poisoning of the blood in this disease, except in some cases where secondary fever occurs; there is conclusive evidence that C. may be communicated from person to person, and it follows, therefore, that the morbid matter which produces the disease is applied to the interior of the alimentary canal, where it increases and multiplies during the period of so-called incubation, and passes off during the attack, to cause fresh cases when suitable opportunities occur. Various circumstances connected with the propagation of C. seem in accordance with the above view of its pathology. Thus it was observed to pass frequently from person to person in crowded habitations of the poor, who eat, drink, cook and sleep in the same apartment, and pay little or no regard to cleanliness; who live, in fact, under circumstances where the sudden and copious evacuations of C.. . would not fail to contaminate. It occurred to me, as soon as I began to entertain the above opinion, that if the C. excreta could produce the disease in the way just mentioned, they might also do so when diffused in water taken as drink; and that, unless this wore the case, the whole of the phenomena of C., as an epidemic, could not be explained.
Subsequent investigation has confirmed this theory, which has now come to be admitted by nearly all the leading authorities. Cholera becomes epidemic through the medium of our water supply. Dr. Farr says:-"Dr. Snow's theory turned the current in the direction of water, and tended to divert attention from the atmospheric doctrine, which in Lond. has received little encouragement from experience."
In 1849 there was pub.: (1) Report on the Nature of the Microscopic Bodies found in the Intestinal Discharges of Cholera, by the Sub-Committee of the Royal College of Physicians; (2) Instructions Sanitaires sur les moyens préservatifs du Cholera Morbus (Paris); (3) Obs. on the Epidemic Cholera of 1848-9, chiefly as it prevailed in the 13th Medical District of the City Parish, Glasgow, by James Maxwell Adams.
It was in this year also that Dr. Budd, of Bristol, announced that he had discovered microscopic "fungi" in the water used for drinking when C. prevailed. About the same period Dr. Brittan and Dr. Swayne also pub. an account of certain " annular bodies," or "Cholera cells." While Prof. Mitchell, of Philadelphia, announced a similar theory. These discoveries are believed to have been all independently made; and they demonstrate the large amount of scientific investigation which was being bestowed upon the subject. The effect of C. visitations upon the mort. of insured lives is a subject which would naturally engage attention. The first return throwing any especial light upon the subject was, we believe, that of the Gotha So. Its report for 1838 contained an abstract of the causes of death for the ten years 1829-38, arranging the diseases according to a general and popular form of classification. The report of the same So. for 1848 contained a similar abstract for the 20 years 1829-48. The first report showed that during the period it embraced the deaths from C. were but 12; of which 2 occurred between the ages of 31 to 40; 5 between 41 and 50; and 5 between 51 and 60, all inclusive. The deaths from C. in the second period were 29; of which 4 occurred between the ages 31 to 40; 12 between 41 and 50; 9 between 51 and 60; and 5 between 61 and 70, all inclusive. Mr. F. G. P. Neison, in a paper read before the Brit. Asso. at its meeting in Edin. in 1850, Mort. of the Provident Classes in this Country, and on the Continent, deals with these reports, but also adds to them a return of 31 deaths from C. experienced by the same office in 1849. Placing all these deaths together-making 60 in the whole-and
viewing them in relation to the number of lives exposed to risk, of which he had obtained a return from the So., he constructed the following T.:
He remarks, "In reference to age, it will be seen that the largest number of deaths have taken place between ages 51 and 60, but the rate of mort. has gone on increasing from the youngest to the oldest age. A similar law has always been observed elsewhere, although within epidemic periods the mort. must of course be greater than shown in the above T. A few deaths have taken place at intervals throughout the whole period; but if the year of the principal epidemic be considered, viz. 1849, the rate of mort. will appear much increased." This is shown as follows:
This is found to be much under the rate for the whole of Paris in 1832, or for Lond. in 1849, as shown by the following T.
Hence the mort. of the Gotha within the ages 31-80 was 1 in 464; while in Paris it was I in 26, and in Lond. I in 104.
The Board of Health, in its Report dated 14th Aug., 1850, says, regarding the epidemic of 1848-9, "The late extended experience has shed no light on the primary or proximate cause of this pestilence; that remains involved in the same impenetrable mystery as ever." They affirm, however, that the "disease is not, in the common acceptation of the term, contagious, but spreads by an atmospheric influence; its progress consisting of a succession of local outbreaks."
occurred in the autumn This led to the pub.
In 1850 C. visited the Island of Jamaica for the first time. It of the year, and it was estimated that 50,000 persons died from it. (in 1853) of Report on the Cholera in Famaica, and the Sanitary Condition and Wants of that Island.
In 1850 there was pub. Reports of the Origin and Progress of the Pestilential Cholera in the West Yorkshire Lunatic Asylum, Autumn of 1849, by Dr. T. G. Wright; and in the same year, Hist. of the Cholera in Manchester in 1849, as reported to the Reg.-Gen. of Births and Deaths, etc., by John Leigh and N. Gardiner, Sup.-Regis. of Manchester.
In 1851 Dr. James Stark, M.D. [now medical officer in the department of the Reg.Gen. for Scotland], read before the Statis. So. of Lond. a paper, Contributions to the Vital Statistics of Scotland. This paper is printed in vol. xiv. p. 48 of the Journ. of the So. The author, after showing the mort. of the different towns of Scotland for a series of years, as deduced from the latest returns, says:
On the Continent it has generally been remarked that the C. more than doubled the ann. mort., and in every case caused the mort. of the year during which it prevailed to rise high above all previous