again observed over a larger area of the same suburbs and in some villages to the east of Calcutta in 1878. Dr. Payne alludes to it in his report for the third quarter of that year, and Drs. MacConnell and Harvey, who held the office of Civil Surgeon during the later months of the year, have reported on it. Dr. Cayley treated several cases in the Mayo Hospital in September. The disease appears to have broken out during the rains, and subsided as the cold weather advanced. The same disease prevailed in Dacca in January and February 1879, and appeared in Shillong in October' 1878. Dr. O'Brien, writing in the May (1879) number of the Indian Medical Gazette, states that 200 cases had occurred in that station, and that new cases were appearing daily. He believes that it was imported from Dacca, and records that it prevailed in Cacliar, Sylhet, the Khassia Hills, and some of the districts' of Assam Proper. His statement, as far as Sylhet " is concerned, is confii-med by a planter's doctor," Dr. Alexander Nairne of South Sylhet, who, writing to the British Medical Journal, mentions that it prevailed in August and
was
September. The present epidemic
made itself known towards the close of 1879. A fresh outbreak seems to have occurred in the southern and eastern suburbs, and Calcutta was invaded for the first time. The portions of the town where the disease has prevailed are continuous with, or contiguous to, those parts of the suburbs which were previously attacked, namely, the bustees belonging to Bhowanipore and Ballygunge policesections, situated immediately to the south*of the South Circular Road. The disease is more widely prevalent in the suburbs than in the town ; that the northerly sections of both are as yet exempt, and it has travelled further northwards in the easterly suburbs than in the town. I have visited all the localities in the town and one place in the suburbs where the disease prevails, and from and the information supplied by the police my own inquiries it is evident that it broke out almost simultaneously in the affected localities towards the latter end of November and beginning of December, about the time of the Mohurrum. The extent to which the disease has prevailed, and the mortality which it has caused, are represented in the following statement prepared from the police reports :? I.?Town Sections. F. Jorasanko J. Bow Bazar M. Fen wick Bazar N. Toltollah O. Colli ngah P. Park Street ... Q. Bamun Bustee
...
...
...
...
...
...
...
...
...
...
...
Total
...
Cases. 2 1 1 2 182 13 65
Chitpore
Manicktolla
...
...
...
...
Entally Baniapooker Ballygunge Bhowanipore Tallygunge Alipore and Doorgapore Watgunge Ekbalpore ...
...
...
...
...
...
...
Garden lieach
Total
u
EPIDEMIC DROPSY IN CALCUTTA. Report p.y Surgeon-Major K. McLeqd, Health Officer of Calcutta, dated 13th March 1880. The disease broke oat in the southern suburbs (Garden Reach and its neighbourhood) in the rains of 1877, and it
...
...
...
...
...
...
...
...
51
Cases. 2 8 6 22 20-1 33 1 54 2 33 2
Deaths. 2
4 107 16 1 6 2 25
370
163
In relation to the population of the suburbs, the prevalence and mortality have been slight, and still less so in the town. I had a special enquiry made in Short's Bazar, with the following results :? 60 Number of houses Ditto 390 inhabitants, say 10 Ditto houses attacked 65 Ditto inhabitants in these 15 Ditto attacked 10 Ditto died When limited areas where the disease has prevailed are taken, of course the incidence and mortality attain higher ...
#fftcial pnpcr.
...
...
...
1 35 3 12
266
II.?Suburban Sections. B. D. F. G. H. I. J. K. & T'M. N. O.
Deaths.
proportions. The rate of
...
...
...
...
...
...
...
...
...
...
...
...
...
...
mortality given by
the town
figures
is about
May 2,
MEDICAL NEWS.
1881.]
20 per cent., and by the suburban about 44. These figures not, however, entitled to more reliance than to indicate that the mortality is considerable in relation to cases, though slight in relation to population. The facts regarding the manner of outbreak which I have gathered are as follows (a.) It has attacked houses in a village in a promiscuous The affected homesteads are mostly scattered throughway. out the locality, and not necessarily contiguous. (b.) The rule has been that several or all the members of a household have been seized, and single cases in a family are
exceptional. (c.) Such seizures have taken place almost simultaneously in rapid succession, as if from the operation of a common
are or
cause.
(id.) Similarly, as I have already remarked, the seizure of different houses in a village appears to have been simultaneous ; indeed the disease seems to have broken out all over the infected area about the same time. (e.) Recent cases are rare, and, according to the latest information I have gathered, the disease would seem to be dying out. The symptoms of the disease are very definite, viz :? lower always, sometimes (a.) Swelling of the limbs?the the upper, and occasionally the body. (&.) Fever sometimes before and sometimes after the swelling, and in some cases altogether absent. (n.) Bowel complaint in many cases?diarrhoea most commonly, dysentery in a few. (d.) Burning and pain in the affected limbs at the commencement. (c.) Shortness of breathing and cough, and palpitation in all cases. (f.) Great emaciation, exhaustion, and anasmia in severe in all. cases, slighter but well marked (&?) The duration of the disease appears to be about two months in cases of average severity, but it leaves its victim greatly enfeebled. (A.) In fatal cases great disturbance of respiration and circulation have been described, and death has generally been sudden. As regards the nature of the disease, it is impossible as yet to write very definitely. The prevailing opinion apsame the that it is to be disease as lias bppn described pears and in Madras observers Ceylon under the term Beri-beri. by I am myself inclined to favour this view, but the point has not been definitely settled yet, and it Would be out of place to discuss it here. As regards causation, I am not able to pronounce a positive
opinion
:?
(a,Though it is most prevalent among the poorer classes of Malioinedans and Hindus, it is by no meaus confined to these. Eurasians, Armenians, and natives in good circum-
stances have also suffered. (?.)?I cannot attribute it to prov'erty of living, high price of food, or any dietetic condition or. consequent constitutional taint. Well-fed IVIahomedan accustomed to generous living and in excellent bodily condition, have been I have observed and although indications of anosmia seized, and scurvy in some cases, I am inclined to consider them secondary conditions due to the disease, and not the cause of it. (c.)?Nor have I observed any special insanitary conditions associated with its prevalence. The sanitary conditions of the households and villages in which the disease has broken out are certainly no worse than those of hundreds of others in town and suburbs, where 110 disease has prevailed. In short, I have been unable to fix upon any one condition or assemblage of conditions, personal or otherwise, peculiar to the affected places. (d.)?As regards infectiousness, the evidence is very conflicting. Dr. O'Brien considers the disease to be very infectious, and gives good reasons for his belief. Facts have come to my knowledge which favour the impression that the disease is communicable, while others have opposed teat view. If it is infectious (and lam not prepared to deny this), it is so under conditions, seasonal and otherwise, which strongly modify its manner of transfer from man to man. The gradual spread northwards, the pronounced localization, and the seizure of whole families are the most remarkable circumstances in the natural history of the malady considered from an epidemiological point of view.
butchers,
was
September. The present epidemic
made itself known towards the close of 1879. A fresh outbreak seems to have occurred in the southern and eastern suburbs, and Calcutta was invaded for the first time. The portions of the town where the disease has prevailed are continuous with, or contiguous to, those parts of the suburbs which were previously attacked, namely, the bustees belonging to Bhowanipore and Ballygunge policesections, situated immediately to the south*of the South Circular Road. The disease is more widely prevalent in the suburbs than in the town ; that the northerly sections of both are as yet exempt, and it has travelled further northwards in the easterly suburbs than in the town. I have visited all the localities in the town and one place in the suburbs where the disease prevails, and from and the information supplied by the police my own inquiries it is evident that it broke out almost simultaneously in the affected localities towards the latter end of November and beginning of December, about the time of the Mohurrum. The extent to which the disease has prevailed, and the mortality which it has caused, are represented in the following statement prepared from the police reports :? I.?Town Sections. F. Jorasanko J. Bow Bazar M. Fen wick Bazar N. Toltollah O. Colli ngah P. Park Street ... Q. Bamun Bustee
...
...
...
...
...
...
...
...
...
...
...
Total
...
Cases. 2 1 1 2 182 13 65
Chitpore
Manicktolla
...
...
...
...
Entally Baniapooker Ballygunge Bhowanipore Tallygunge Alipore and Doorgapore Watgunge Ekbalpore ...
...
...
...
...
...
...
Garden lieach
Total
u
EPIDEMIC DROPSY IN CALCUTTA. Report p.y Surgeon-Major K. McLeqd, Health Officer of Calcutta, dated 13th March 1880. The disease broke oat in the southern suburbs (Garden Reach and its neighbourhood) in the rains of 1877, and it
...
...
...
...
...
...
...
...
51
Cases. 2 8 6 22 20-1 33 1 54 2 33 2
Deaths. 2
4 107 16 1 6 2 25
370
163
In relation to the population of the suburbs, the prevalence and mortality have been slight, and still less so in the town. I had a special enquiry made in Short's Bazar, with the following results :? 60 Number of houses Ditto 390 inhabitants, say 10 Ditto houses attacked 65 Ditto inhabitants in these 15 Ditto attacked 10 Ditto died When limited areas where the disease has prevailed are taken, of course the incidence and mortality attain higher ...
#fftcial pnpcr.
...
...
...
1 35 3 12
266
II.?Suburban Sections. B. D. F. G. H. I. J. K. & T'M. N. O.
Deaths.
proportions. The rate of
...
...
...
...
...
...
...
...
...
...
...
...
...
...
mortality given by
the town
figures
is about
May 2,
MEDICAL NEWS.
1881.]
20 per cent., and by the suburban about 44. These figures not, however, entitled to more reliance than to indicate that the mortality is considerable in relation to cases, though slight in relation to population. The facts regarding the manner of outbreak which I have gathered are as follows (a.) It has attacked houses in a village in a promiscuous The affected homesteads are mostly scattered throughway. out the locality, and not necessarily contiguous. (b.) The rule has been that several or all the members of a household have been seized, and single cases in a family are
exceptional. (c.) Such seizures have taken place almost simultaneously in rapid succession, as if from the operation of a common
are or
cause.
(id.) Similarly, as I have already remarked, the seizure of different houses in a village appears to have been simultaneous ; indeed the disease seems to have broken out all over the infected area about the same time. (e.) Recent cases are rare, and, according to the latest information I have gathered, the disease would seem to be dying out. The symptoms of the disease are very definite, viz :? lower always, sometimes (a.) Swelling of the limbs?the the upper, and occasionally the body. (&.) Fever sometimes before and sometimes after the swelling, and in some cases altogether absent. (n.) Bowel complaint in many cases?diarrhoea most commonly, dysentery in a few. (d.) Burning and pain in the affected limbs at the commencement. (c.) Shortness of breathing and cough, and palpitation in all cases. (f.) Great emaciation, exhaustion, and anasmia in severe in all. cases, slighter but well marked (&?) The duration of the disease appears to be about two months in cases of average severity, but it leaves its victim greatly enfeebled. (A.) In fatal cases great disturbance of respiration and circulation have been described, and death has generally been sudden. As regards the nature of the disease, it is impossible as yet to write very definitely. The prevailing opinion apsame the that it is to be disease as lias bppn described pears and in Madras observers Ceylon under the term Beri-beri. by I am myself inclined to favour this view, but the point has not been definitely settled yet, and it Would be out of place to discuss it here. As regards causation, I am not able to pronounce a positive
opinion
:?
(a,Though it is most prevalent among the poorer classes of Malioinedans and Hindus, it is by no meaus confined to these. Eurasians, Armenians, and natives in good circum-
stances have also suffered. (?.)?I cannot attribute it to prov'erty of living, high price of food, or any dietetic condition or. consequent constitutional taint. Well-fed IVIahomedan accustomed to generous living and in excellent bodily condition, have been I have observed and although indications of anosmia seized, and scurvy in some cases, I am inclined to consider them secondary conditions due to the disease, and not the cause of it. (c.)?Nor have I observed any special insanitary conditions associated with its prevalence. The sanitary conditions of the households and villages in which the disease has broken out are certainly no worse than those of hundreds of others in town and suburbs, where 110 disease has prevailed. In short, I have been unable to fix upon any one condition or assemblage of conditions, personal or otherwise, peculiar to the affected places. (d.)?As regards infectiousness, the evidence is very conflicting. Dr. O'Brien considers the disease to be very infectious, and gives good reasons for his belief. Facts have come to my knowledge which favour the impression that the disease is communicable, while others have opposed teat view. If it is infectious (and lam not prepared to deny this), it is so under conditions, seasonal and otherwise, which strongly modify its manner of transfer from man to man. The gradual spread northwards, the pronounced localization, and the seizure of whole families are the most remarkable circumstances in the natural history of the malady considered from an epidemiological point of view.
butchers,
