July 1,
CHOLEEA IN CALCUTTA.?BY C. MACNAMARA.
1872.]
Calcutta to escape from the influence of cholera, then spreading Calcutta, the home of over the lower part of Garden Beach. for those threatened by the retreat a become now has cholera, disease beyond the confines of the city. It is a great mistake to suppose that the lower classes of natives are incapable of these matters. I wrote an essay on the causes
ORIGINAL COMMUNICATIONS. CHOLERA IN CALCUTTA.
By Medical
Officer
C.
Macnamaba,
appreciating
in
charge of the Native Hospital; Surgeon Ophthalmic Hospital, Calcutta. (Continued from
to the
page 100J
Having briefly referred to the past and present circumstances Calcutta, noticing the defective nature of the municipal returns, and endeavouring to test their value by hospital statistics, we may best reason, as to the supposed influence of the Calcutta water-works in diminishing cholera amongst the inhabitants of the place,* by arguing according to the method of difference. Proceeding on this principle, we notice that the condition of the inhabitants of the densely-populated northern or native portion of Calcutta, is the same now as it has been for many years past; the people live in a crowded, filthy, oriental city ; its drainage is most imperfect, and in fact its sanitary condition about as bad as it possibly can be. The food, clothing, and general state of the native inhabitants of Calcutta are precisely similar to what they were years ago. There has been nothing peculiar in the seasons, nor has there been any deviation in the ordinary rise and fall of the sub-soil water of the place; and cases of Asiatic cholera have been constantly of cholera in
amongst us. The seeds of the disease, therefore, must have been present, and the soil, both human and terrestrial, in a similar state
receive it as they have been for many years. The condition of the city and its inhabitants, in a sanitary point of view, is at the present time absolutely identical to what it has been for years past. In May, 1871, the phenomenon (the municipal
to
water-supply) we wish to study with relation to its bearing cholera, was introduced simultaneously, and almost universally, throughout the city ; and from that very month up to the present time, there has been a continuous and marked decline in the mortality from cholera amongst the inhabitants of the place. It may be argued, that this diminution in the death-rate from cholera in Calcutta is due to the disease having been in abeyance throughout the country : if we refer, however, to cur returns, we find that, during the early part of the year 1870, cholera was mere fatal in Calcutta than in the corresponding months of 1867 : and the above argument cannot possibly hold good with reference to the circumstances of cholera in 1872, for the disease has been very virulent immediately round Calcutta during the past cold season, and we have ample evion
dence in the pages of the Indian Medical Gazette, since the commencement of the present year, as to the wide dissemination and the fatal character of cholera throughout Bengal; nevertheless the death-rate from the disease in this town has been considerably lower during the first five months of 1872 than it was
in 1870, or any previous seasons to that on record. And this reduced death-rate from cholera would have been more apparent than it now is, had we been able to exclude cases incorrectly
dying by cholera from appearing in our returns, prevented strangers carried off by the disease either hospitals, or brought for cremation or burial from the suburbs, being entered among the deaths from cholera in our municipal mortuary tables. The natives of the place are fully aware of the fact that Calcutta is now comparatively exempt from cholera. As an instance in point, the son of Nawab Ali Mukie Khan told me only a few days ago that his family had lately removed into reported
as
?nd to have within our
* Those interested in the matter should add the following figures to the table given at page 77 of the Indian Medical Gazette :? Number of deaths reported from cholera in Calcutta during the year
1872:
January. 80
February. 81
March. 61
145
April. 67
May., 65
of prevention of cholera early in the year 1871, to the comprehension of the poorer classes; these few most illiterate pages were translated into Bengalee such as the native could understand, and in the course of a few months 5,000 copies of this pamphlet were disposed of. One of the Bengalee local newspapers re-published the essay in its columns.
and
means
adapted
careful study of all the facts before me, and from an personal knowledge of the place and people, I cannot believe that the introduction of a pure supply of water Calcutta has been the immediate and sole cause affecting the
From
a
intimate but into
marked diminution in the death-rate from cholera which has during the past two years amongst the inhabitants of the place. Those who have no faith in the water theory of cholera (as they call it) will ask for more time before committing them-
existed
selves to .an expression of opinion regarding the influences at work in reducing the death-rate from this disease among the people of Calcutta, and I can only hope that the facts I have endeavoured to bring to their notice respecting this city, will
incline them to regard the propagation of cholera by means of water as something more than a "mere hypothesis." They ask for facts: I reply?study the circumstances of cholera in Calcutta ; at any rate, abstain from expressions of opinion such as the following until you have done so :?"All our efforts to stay the ravages of cholera (in India) have hitherto been fruitless.
These ravages appear,
on each successive outbreak, to be on the frequency and virulence; and in the present state of our knowledge, our only safety consists in the withdrawal of as many of our troops as possible to the hills."f To persons holding views such as these I would remark?try the simple plan of protecting those committed to your care from consuming cholera-polluted water ^including milk), and rest assured that results similar to those effected by this means among the population of Calcutta will follow your efforts neglect these simple precautions, and you may well advise a flight to the hills or any other impracticable 6cheme; but neither this
increase,
both as to
any other means, however costly or elaborate, will suffice to you from the influences of epidemic cholera, if you allow contaminated water to be consumed, in the hills or any where else, by those whose well-being is committed to your care. In giving this as my deliberate opinion, I would affirm, as I nor
protect
frequently done before, that I do not hold that cholera propagated from man to man only through means of drinking water; I believe contaminated water and milk to be the most frequent means by which the disease spreads over India, especially in those instances of local outbreaks of cholera which we so frequently witness in this country amongst the inhabitants of our towns, villages, barracks, and prisons. In conclusion, I cannot help reiterating my views, expressed over and over again in the pages of this journal during the past two years, as to the necessity which exists for the local investigation of the circumstances of cholera in Calcutta. The Lancet is equally strong on this point, and has on several occasions expressed its opinion on the subject. I have now shown how imperfect our mortuary returns are, and that the local investigations of such remarkable outbreaks of cholera as those lately reported in the pages of the Indian Medical Gazette as occurring in Calcutta, have been left to men whose have can
be
heads and hands
are
overfull of the anxious work incident to
general practitioner. Nevertheless, the Government special staff of sanitary officers, who might be expected
the life of
a
has a to interest themselves in matters of the kind.
We have in this
t Dr. Muir, Inspector-General of Hospitals, H.M.'s British Troope, Army Medical Department Report, Vol. XI., p. 281.
THE INDIAN MEDICAL GAZETTE.
146
Imperial Sanitary Commissioner, a Sanitary two officers deputed specially by Government to enquire into the nature of cholera, and lastly a Health Officer in Calcutta ; and yet, so far as I know, not a single fact, or one single case bearing on an outbreak or the spread of cholera in Calcutta, has as yet formed the subject of investigation, or even of a passing inquiry, by the members of our sanitary staff. I cannot express my own sentiments on this gubject more precisely than by quoting from our leading medical journal The Lancet of the 4th of May, 1872, remarks : on this subject. "Attempts have lately been made (in India) to deduce the laws influencing the origin and spread of this disease (cholera) by observing and registering all the conditions present on
Presidency
an
Commissioner for Lower Bengal,
different occasions of its appearance. "We confess that we are sceptical of the practicability or value of an exhaustive enquiry of this kind. The very elaborate scheme for the scientific investigation of cholera in India, set going by the very
Army Sanitary Commission, for example, will probably defeat its objects by its wide scope and the multiplicity of details embraced by it. We have urged on several occasions the importance of instituting a thorough investigation, undertaken at the time by persons on the spot, into all the circumstances attending these outbreaks of a very limited extent that are so common in India; we urge the necessity that exists for making a thorough investigation into all the circumstances attending cases of cholera among natives and Europeans in Calcutta."
[July 1,
1872.
CHOLEEA IN CALCUTTA.?BY C. MACNAMARA.
1872.]
Calcutta to escape from the influence of cholera, then spreading Calcutta, the home of over the lower part of Garden Beach. for those threatened by the retreat a become now has cholera, disease beyond the confines of the city. It is a great mistake to suppose that the lower classes of natives are incapable of these matters. I wrote an essay on the causes
ORIGINAL COMMUNICATIONS. CHOLERA IN CALCUTTA.
By Medical
Officer
C.
Macnamaba,
appreciating
in
charge of the Native Hospital; Surgeon Ophthalmic Hospital, Calcutta. (Continued from
to the
page 100J
Having briefly referred to the past and present circumstances Calcutta, noticing the defective nature of the municipal returns, and endeavouring to test their value by hospital statistics, we may best reason, as to the supposed influence of the Calcutta water-works in diminishing cholera amongst the inhabitants of the place,* by arguing according to the method of difference. Proceeding on this principle, we notice that the condition of the inhabitants of the densely-populated northern or native portion of Calcutta, is the same now as it has been for many years past; the people live in a crowded, filthy, oriental city ; its drainage is most imperfect, and in fact its sanitary condition about as bad as it possibly can be. The food, clothing, and general state of the native inhabitants of Calcutta are precisely similar to what they were years ago. There has been nothing peculiar in the seasons, nor has there been any deviation in the ordinary rise and fall of the sub-soil water of the place; and cases of Asiatic cholera have been constantly of cholera in
amongst us. The seeds of the disease, therefore, must have been present, and the soil, both human and terrestrial, in a similar state
receive it as they have been for many years. The condition of the city and its inhabitants, in a sanitary point of view, is at the present time absolutely identical to what it has been for years past. In May, 1871, the phenomenon (the municipal
to
water-supply) we wish to study with relation to its bearing cholera, was introduced simultaneously, and almost universally, throughout the city ; and from that very month up to the present time, there has been a continuous and marked decline in the mortality from cholera amongst the inhabitants of the place. It may be argued, that this diminution in the death-rate from cholera in Calcutta is due to the disease having been in abeyance throughout the country : if we refer, however, to cur returns, we find that, during the early part of the year 1870, cholera was mere fatal in Calcutta than in the corresponding months of 1867 : and the above argument cannot possibly hold good with reference to the circumstances of cholera in 1872, for the disease has been very virulent immediately round Calcutta during the past cold season, and we have ample evion
dence in the pages of the Indian Medical Gazette, since the commencement of the present year, as to the wide dissemination and the fatal character of cholera throughout Bengal; nevertheless the death-rate from the disease in this town has been considerably lower during the first five months of 1872 than it was
in 1870, or any previous seasons to that on record. And this reduced death-rate from cholera would have been more apparent than it now is, had we been able to exclude cases incorrectly
dying by cholera from appearing in our returns, prevented strangers carried off by the disease either hospitals, or brought for cremation or burial from the suburbs, being entered among the deaths from cholera in our municipal mortuary tables. The natives of the place are fully aware of the fact that Calcutta is now comparatively exempt from cholera. As an instance in point, the son of Nawab Ali Mukie Khan told me only a few days ago that his family had lately removed into reported
as
?nd to have within our
* Those interested in the matter should add the following figures to the table given at page 77 of the Indian Medical Gazette :? Number of deaths reported from cholera in Calcutta during the year
1872:
January. 80
February. 81
March. 61
145
April. 67
May., 65
of prevention of cholera early in the year 1871, to the comprehension of the poorer classes; these few most illiterate pages were translated into Bengalee such as the native could understand, and in the course of a few months 5,000 copies of this pamphlet were disposed of. One of the Bengalee local newspapers re-published the essay in its columns.
and
means
adapted
careful study of all the facts before me, and from an personal knowledge of the place and people, I cannot believe that the introduction of a pure supply of water Calcutta has been the immediate and sole cause affecting the
From
a
intimate but into
marked diminution in the death-rate from cholera which has during the past two years amongst the inhabitants of the place. Those who have no faith in the water theory of cholera (as they call it) will ask for more time before committing them-
existed
selves to .an expression of opinion regarding the influences at work in reducing the death-rate from this disease among the people of Calcutta, and I can only hope that the facts I have endeavoured to bring to their notice respecting this city, will
incline them to regard the propagation of cholera by means of water as something more than a "mere hypothesis." They ask for facts: I reply?study the circumstances of cholera in Calcutta ; at any rate, abstain from expressions of opinion such as the following until you have done so :?"All our efforts to stay the ravages of cholera (in India) have hitherto been fruitless.
These ravages appear,
on each successive outbreak, to be on the frequency and virulence; and in the present state of our knowledge, our only safety consists in the withdrawal of as many of our troops as possible to the hills."f To persons holding views such as these I would remark?try the simple plan of protecting those committed to your care from consuming cholera-polluted water ^including milk), and rest assured that results similar to those effected by this means among the population of Calcutta will follow your efforts neglect these simple precautions, and you may well advise a flight to the hills or any other impracticable 6cheme; but neither this
increase,
both as to
any other means, however costly or elaborate, will suffice to you from the influences of epidemic cholera, if you allow contaminated water to be consumed, in the hills or any where else, by those whose well-being is committed to your care. In giving this as my deliberate opinion, I would affirm, as I nor
protect
frequently done before, that I do not hold that cholera propagated from man to man only through means of drinking water; I believe contaminated water and milk to be the most frequent means by which the disease spreads over India, especially in those instances of local outbreaks of cholera which we so frequently witness in this country amongst the inhabitants of our towns, villages, barracks, and prisons. In conclusion, I cannot help reiterating my views, expressed over and over again in the pages of this journal during the past two years, as to the necessity which exists for the local investigation of the circumstances of cholera in Calcutta. The Lancet is equally strong on this point, and has on several occasions expressed its opinion on the subject. I have now shown how imperfect our mortuary returns are, and that the local investigations of such remarkable outbreaks of cholera as those lately reported in the pages of the Indian Medical Gazette as occurring in Calcutta, have been left to men whose have can
be
heads and hands
are
overfull of the anxious work incident to
general practitioner. Nevertheless, the Government special staff of sanitary officers, who might be expected
the life of
a
has a to interest themselves in matters of the kind.
We have in this
t Dr. Muir, Inspector-General of Hospitals, H.M.'s British Troope, Army Medical Department Report, Vol. XI., p. 281.
THE INDIAN MEDICAL GAZETTE.
146
Imperial Sanitary Commissioner, a Sanitary two officers deputed specially by Government to enquire into the nature of cholera, and lastly a Health Officer in Calcutta ; and yet, so far as I know, not a single fact, or one single case bearing on an outbreak or the spread of cholera in Calcutta, has as yet formed the subject of investigation, or even of a passing inquiry, by the members of our sanitary staff. I cannot express my own sentiments on this gubject more precisely than by quoting from our leading medical journal The Lancet of the 4th of May, 1872, remarks : on this subject. "Attempts have lately been made (in India) to deduce the laws influencing the origin and spread of this disease (cholera) by observing and registering all the conditions present on
Presidency
an
Commissioner for Lower Bengal,
different occasions of its appearance. "We confess that we are sceptical of the practicability or value of an exhaustive enquiry of this kind. The very elaborate scheme for the scientific investigation of cholera in India, set going by the very
Army Sanitary Commission, for example, will probably defeat its objects by its wide scope and the multiplicity of details embraced by it. We have urged on several occasions the importance of instituting a thorough investigation, undertaken at the time by persons on the spot, into all the circumstances attending these outbreaks of a very limited extent that are so common in India; we urge the necessity that exists for making a thorough investigation into all the circumstances attending cases of cholera among natives and Europeans in Calcutta."
[July 1,
1872.
