308 EPIDEMIC CHOLERA OF INDIA OF 1875 AND 1376. [Section IV.
CHAPTER VI.
GENERAL CONCLUSIONS SUGGESTED BY THE STUDY OF THE CHOLERA OF 1875 AND 1876.
Fifteen districts of the Punjab registered between them 13 deaths in 1875, in a year when
cholera was epidemic over half the province, less than one death
to each district. It is in an area so divided that the question
of the importation of cholera can be fairly worked out. Cholera.
is imported and then it spreads, is the assertion; and it is easy,
with some show of truth, to assert that cholera has sprung from such a focus when it is seen
blazing up subsequent to the arrival of passengers from infected tracts. The assertion really
amounts to this: the Punjab is divided into 32 districts; cholera was introduced into 17 of
these districts in 1875, and therefore it spread; cholera was not introduced in 15 districts, and
therefore did not appear, or if it was introduced influences of which we know nothing stopped
its propagation in these districts. Unknown causes prevailing in the one-half of the area, are
presumed to influence the human system so that it is capable of receiving cholera, and in the
other to act universally as an antidote even to a cholera poison when introduced. This is what
is offered as antagonistic to the theory which asserts that cholera is air-borne and is as far-
flying as are the limits of natural areas. Primarily, these theories cannot be reconciled; the one
or the other is false. If cholera is spread only by the human being, the theory which shows
cholera to be air-conveyed is untrue; if cholera is spread solely as an aerial miasm, then the
theory which recognises only the effects of human intercourse is unfounded.
The most that is admitted by the advocates of the human theory is, that the subjection of
cholera to meteorological agencies is absolute, and that these influences can and do operate so as
to do away altogether with the effects of the poison, although imported.
They do not recognise the entity minus the human being.
The antagonistic theory, while holding as opposed to demonstrable fact the statement that
cholera moves only by human agency, may, if necessary, be extended in its scope so as to em-
brace the other; that is to say, the enquiry is left open as to whether or not the cholera entity,
after being aerially distributed, may be subsequently propagated or spread by man.
In the theory which connects cholera solely with man there is no such extensibility.
Human intercourse must explain every fact of spread and propagation, and nothing is left to
the play of natural agencies.
Human intercourse, giving the widest scope to the signification of the term, cannot
pretend to account for any fundamental phenomenon displayed during the progress of epidemic
cholera; and, therefore, I assert the theory to be radically untrue as applied to the behaviour
of cholera in India.
I do not say that the above statement will hold true all over the world; and, even as
applied to India, the theory does not preclude the possibility that cholera may be conveyed by
the human being.
Naturally, the recoil is to the opposite extreme. The bold statement that cholera is never
spread over an area unless human agency intervene, is apt to be met by the equally dogmatic
statement that cholera is as pure a miasm as malaria, and as little amenable to the control
of man.
Such a history as that which I have been writing, gives great scope for such dogmatism,
and it should be our earnest endeavour to throw into the scale against it whatever may be
advanced as proving incontestably that man can and does disseminate and propagate cholera.
I should leave a very false impression on the reader were it to be inferred that I under-
rated the influence of sanitation in arresting the progress of
cholera in communities, or making its effects less felt.
The same causes which have reduced the general death-
rate have equally influenced the cholera-rate. The fact may be
appreciated from these statements:—
Deaths per 1,000.
Excluding cholera.
Cholera rate.
European Army of Bengal
1860—69
2 0 . 7 4
9 2 4
1870—76
15.92
3.21
Jails of Bengal Presidency—18 years, 1859 to 1876.
N i n e y e a r s , 1 8 5 9 — 6 7 .
Per 1,000.
Bengal Proper. Oudh. Central Provs. N.-W. Provs. Punjab. Presidency.
Death-rate excluding cholera
70.90
76.l0
52.51
64.93
44.27
62.68
Death-rate from cholera
19.40
7.40
11.27
7.59
2.19
10.77
Nine years, 1868—76.
Death-rate excluding cholera
43.60
20.86
36.22
34.89
32.12
35.39
Death-rate from cholera
7.85
.82
2.73
1.45
.82
3.28
Question of the importation of
cholera in this epidemic and its
spread by human agency.
The effects of sanitary conditions
as influencing the propagation of
cholera.