EPIDEMIC OR ENDEMIC.
The has
recent outbreak of cholera iii
raised
the very
whether the disease
difficult
can ever
Calcutta
question
be said to be
as
to
epide-
mic iu the so-called endemic area, and more particularly in the centre and capital of this area. The of a
question has been raised in consequence very practical issue depending on the use
of one
other term. Some years ago a Medical consisting of the Principal of the Medical
or
Board,
Surgeon Superintendent of the Hospital, and the Health Officer of the was appointed by Government for the
College,
the
General town,
purpose of considering the weekly statistics of the town, and declaring whether or not any disease prevailed epidemically during the week
When the cholera attained the dimensions indicated iu the preceding article, the Board considered it right to apply to under
report.
the disease
the
epithet epidemic.
This term
had to be entered iu the bills of health of vessels
leaving
the
port aud communicated
to
nationalities, the consequence of which
other was
THE INDIAN MEDICAL GAZETTE.
370
that Calcutta became the world and that rendered liable
a
source
ships leaving
of
danger
its
restrictions and
to
port
[Dec,,
to Goitre.
Small-pox.
were
detentions
quarantine regulations existing in Merchants and shippers Egypt rebelled against the use of a term, which they contended was not justified by the circumstances, and therefore imposed on them an unneces-
material flucUndergoes tuation in incidence.
Appears after an interval of absence, waxes, prevails, wanes, and again disappears.
Does not present the feature of movement within or beyond the area.
Progresses from country
Affects
Affects persons and
no
under the
and elsewhere.
with
sary interference
money. Dictionaries, have been searched, aud the
of
propriety
circumstances any canvassed. The issue is
calling
time
at any
has
under
sons
otherwise,
and
Calcutta epidemic
cholera in
loss of
aud
business
medical
been
or
keenly
unquestionably
1886
a
to town to town, to hamlet, and
hamlet house to house.
simultaneously perresiding in different
parts of the
places
successively.
area.
Not transferable from to
country,
place.
Not contagious, tious.
nor
Portable
place
by
persons and
of
means
things.
Infectious.
infec-
serious one, for, on the one hand, unnecessary interference with the commerce of the world is a
Due to causes appertaining to the locality.
Due to causes appertaining to persons and populations.
very grave mistake, while on the other, the duty of preventing by any possible and reasonable
Bulk influenced by seasonal circumstances.
Prevalence subject to sonal conditions.
means
is
spread of a fatal disease pressing obligation.
the
a
very
obvious and
thing is quite certain, namely, that it is by a study of etiology rather than etymology, the question has to be solved. ExperiBut
one
and
ence
bularies,
research, are
the
and not lexicons and
by
means
which the
of
propriety cholera in
applying the term epidemic to Calcutta ought to be determined. words
voca-
A
war
of
be of no avail in
can
and the real
question
settling this matter, is not whether cholera is
at any time endemic or
epidemic in Calcutta, any danger of the elsewhere disease being conveyed by means of ships. It is easier to express the meaning of the words endemic and epidemic by illustrabut whether there is
tions than as a
type
by definitions.
of
and
an
we
have noted the
epidemic,
these diseases
Goitre may be taken
endemic disease, and
an
of
standpoint
ever
in the
small-pox following scheme
principal aspects of each of viewed from au epidemiological
in contrast:?
Eestricted within certain circumscribed areas.
Liable to
Prevalent perennially these areas.
Appears
in
Never prevalent outside of them.
signification of the terms endemic and epidemic is very clear when thus exhibited, and diseases presenting one or other of the aspects thus tabulated may, with propriety, be designated by one or other of these terms ; but the difficulty as regards cholera i>, that it cannot be The
other of these
categories. when it always presents, places in it and others an epidemic facies, appears, presents habitually the features of an endemic. Is it the case that it may in the same locality
relegated o
to
one
or
present the aspect of and of
an
0
it
In certain
epidemic
this looms another
an
endemic at
at another?
question,
one
time
And behind
does this altered
facies betoken any change in the causation of the disease? A mere increase of bulk or inten-
sity does not designation.
of itself
justify the change may simply be due to
These
increased evolution of the material
locally generated its
operation
or
an
enhanced
or
of an
influence
potency of
under certain seasonal and other
conditions. Nor does the circumstance of waxi ng,
locality.
prevail
and intervals.
and waning prove epidemicity. Malarious fevers present both of these features and they are held to be strictly endemic. The
persisting
Small-pox.
Goitre.
sea-
in any
disappears
at
Subsides in one place and appears in another.
elements of progress and successive visitation adjoining localities are more characteristic
of
indices of
epidemicity;
in Calcutta cholera
but these
at its worst.
are
wanting
DEFECTIVE VISION AND THE INDIAN SERVICE.
Dec., 1886.] Our
opinion
in Calcutta in the full
epidemic
been
never
of the
sense
in the above illustration.
represented designate such diseases
term
To
is that cholera has
as
cholera
by
the
same
small-pox
and
term may be
con-
as
generic
nosological purposes, but for purposes of practical sanitation, the proceeding is absurd, venient for
because it suppresses aud ignores differences in conditions of origin and spread which govern the selection and application of appropriate preventive
But
measures.
waiving
it is still
the
of
question
epi-
to argue in this wise.
possible The epidemic spread of cholera is usually, not always, preceded by unwonted activity
demicity
the disease in the endemic condition of vital
The bulk of
area.
the disease in the endemic
area
importance
if of
is, therefore,
a
with reference to
its power of locomotion. Endemic or epidemic it therefore appears reasonable aud proper to adopt precautions against its locomotion when it exhibits unusual It is difficult but
ment;
activity
in the endemic
resist the force of this
to
even
if
area.
arjxu-
accept it, it is still
we
necessary to settle what sort of precautious necessary to prevent spread in the presence For this purof unusual endemic intensity.
are
pose a study of the natural history of the disease is necessary, and from such a study it has become an accepted doctriue that the disease moves
by
and is
by
slow and
seldom,
steady steps
if ever, carried
the agency of vessels
country This is
to
country by
or
on
the
across
transported
means
laud,
the
sea
from
of merchandise.
the fundamental and
important question, and the use of the terms endemic and epidemic as warrants for practical action is plainly foolish, because it may lead to the adoption of measures
point
for the
really
with reference
to
the
of one disease included in the which are not suitable or category, necessary the for prevention of another.
prevention
371
The has
recent outbreak of cholera iii
raised
the very
whether the disease
difficult
can ever
Calcutta
question
be said to be
as
to
epide-
mic iu the so-called endemic area, and more particularly in the centre and capital of this area. The of a
question has been raised in consequence very practical issue depending on the use
of one
other term. Some years ago a Medical consisting of the Principal of the Medical
or
Board,
Surgeon Superintendent of the Hospital, and the Health Officer of the was appointed by Government for the
College,
the
General town,
purpose of considering the weekly statistics of the town, and declaring whether or not any disease prevailed epidemically during the week
When the cholera attained the dimensions indicated iu the preceding article, the Board considered it right to apply to under
report.
the disease
the
epithet epidemic.
This term
had to be entered iu the bills of health of vessels
leaving
the
port aud communicated
to
nationalities, the consequence of which
other was
THE INDIAN MEDICAL GAZETTE.
370
that Calcutta became the world and that rendered liable
a
source
ships leaving
of
danger
its
restrictions and
to
port
[Dec,,
to Goitre.
Small-pox.
were
detentions
quarantine regulations existing in Merchants and shippers Egypt rebelled against the use of a term, which they contended was not justified by the circumstances, and therefore imposed on them an unneces-
material flucUndergoes tuation in incidence.
Appears after an interval of absence, waxes, prevails, wanes, and again disappears.
Does not present the feature of movement within or beyond the area.
Progresses from country
Affects
Affects persons and
no
under the
and elsewhere.
with
sary interference
money. Dictionaries, have been searched, aud the
of
propriety
circumstances any canvassed. The issue is
calling
time
at any
has
under
sons
otherwise,
and
Calcutta epidemic
cholera in
loss of
aud
business
medical
been
or
keenly
unquestionably
1886
a
to town to town, to hamlet, and
hamlet house to house.
simultaneously perresiding in different
parts of the
places
successively.
area.
Not transferable from to
country,
place.
Not contagious, tious.
nor
Portable
place
by
persons and
of
means
things.
Infectious.
infec-
serious one, for, on the one hand, unnecessary interference with the commerce of the world is a
Due to causes appertaining to the locality.
Due to causes appertaining to persons and populations.
very grave mistake, while on the other, the duty of preventing by any possible and reasonable
Bulk influenced by seasonal circumstances.
Prevalence subject to sonal conditions.
means
is
spread of a fatal disease pressing obligation.
the
a
very
obvious and
thing is quite certain, namely, that it is by a study of etiology rather than etymology, the question has to be solved. ExperiBut
one
and
ence
bularies,
research, are
the
and not lexicons and
by
means
which the
of
propriety cholera in
applying the term epidemic to Calcutta ought to be determined. words
voca-
A
war
of
be of no avail in
can
and the real
question
settling this matter, is not whether cholera is
at any time endemic or
epidemic in Calcutta, any danger of the elsewhere disease being conveyed by means of ships. It is easier to express the meaning of the words endemic and epidemic by illustrabut whether there is
tions than as a
type
by definitions.
of
and
an
we
have noted the
epidemic,
these diseases
Goitre may be taken
endemic disease, and
an
of
standpoint
ever
in the
small-pox following scheme
principal aspects of each of viewed from au epidemiological
in contrast:?
Eestricted within certain circumscribed areas.
Liable to
Prevalent perennially these areas.
Appears
in
Never prevalent outside of them.
signification of the terms endemic and epidemic is very clear when thus exhibited, and diseases presenting one or other of the aspects thus tabulated may, with propriety, be designated by one or other of these terms ; but the difficulty as regards cholera i>, that it cannot be The
other of these
categories. when it always presents, places in it and others an epidemic facies, appears, presents habitually the features of an endemic. Is it the case that it may in the same locality
relegated o
to
one
or
present the aspect of and of
an
0
it
In certain
epidemic
this looms another
an
endemic at
at another?
question,
one
time
And behind
does this altered
facies betoken any change in the causation of the disease? A mere increase of bulk or inten-
sity does not designation.
of itself
justify the change may simply be due to
These
increased evolution of the material
locally generated its
operation
or
an
enhanced
or
of an
influence
potency of
under certain seasonal and other
conditions. Nor does the circumstance of waxi ng,
locality.
prevail
and intervals.
and waning prove epidemicity. Malarious fevers present both of these features and they are held to be strictly endemic. The
persisting
Small-pox.
Goitre.
sea-
in any
disappears
at
Subsides in one place and appears in another.
elements of progress and successive visitation adjoining localities are more characteristic
of
indices of
epidemicity;
in Calcutta cholera
but these
at its worst.
are
wanting
DEFECTIVE VISION AND THE INDIAN SERVICE.
Dec., 1886.] Our
opinion
in Calcutta in the full
epidemic
been
never
of the
sense
in the above illustration.
represented designate such diseases
term
To
is that cholera has
as
cholera
by
the
same
small-pox
and
term may be
con-
as
generic
nosological purposes, but for purposes of practical sanitation, the proceeding is absurd, venient for
because it suppresses aud ignores differences in conditions of origin and spread which govern the selection and application of appropriate preventive
But
measures.
waiving
it is still
the
of
question
epi-
to argue in this wise.
possible The epidemic spread of cholera is usually, not always, preceded by unwonted activity
demicity
the disease in the endemic condition of vital
The bulk of
area.
the disease in the endemic
area
importance
if of
is, therefore,
a
with reference to
its power of locomotion. Endemic or epidemic it therefore appears reasonable aud proper to adopt precautions against its locomotion when it exhibits unusual It is difficult but
ment;
activity
in the endemic
resist the force of this
to
even
if
area.
arjxu-
accept it, it is still
we
necessary to settle what sort of precautious necessary to prevent spread in the presence For this purof unusual endemic intensity.
are
pose a study of the natural history of the disease is necessary, and from such a study it has become an accepted doctriue that the disease moves
by
and is
by
slow and
seldom,
steady steps
if ever, carried
the agency of vessels
country This is
to
country by
or
on
the
across
transported
means
laud,
the
sea
from
of merchandise.
the fundamental and
important question, and the use of the terms endemic and epidemic as warrants for practical action is plainly foolish, because it may lead to the adoption of measures
point
for the
really
with reference
to
the
of one disease included in the which are not suitable or category, necessary the for prevention of another.
prevention
371
