6
PRECAUTIONARY MEASURES—REMOVAL.
or people. In India this is practicable for troops and prisoners, and it has been
frequently effected with the most marked advantage. It has also been carried
out in small villages by the inhabitants deserting their houses, and living in
the open air in the surrounding country. They prefer living under trees. This
is less practicable in large towns; but much may be done, besides conservancy
arrangements, in removing the sick from their houses to special hospitals, and
providing cover for some of the inhabitants of crowded places.
In India means of carrying out the removal of the troops are available.
The importance of this subject has attracted much attention of late years, and
its interest will be increased by the extension of the disease to Europe and
America, where it is to be expected cholera will continue a permanent resi-
dent as in India. Removal from barracks into tents has been occasionally
practised for many years. It was systematically carried out by me during seven
severe epidemics at Agra in 1851, 1856, 1860, 1861, 1862, 1863, and at Umballa in
1867. It was not recognized as an imperative measure till the report of the
Cholera Commission in 1862. Since that date removal has been carried out with
decided advantage as shown by the accompanying Table No. II, where the
admissions among the European Troops of the Bengal Presidency in the two
quinquennial periods before removal amounted, respectively, to 25.58 and 21.05
per mille, and only to 7.04 since 1863. The admissions in 20 stations attacked
in the three epidemics of 1856, 1860, and 1861 amounted to 123.17 per mille,
whilst in the three epidemics of 1862, 1863, and 1867 in 31 stations it only
amounted to 47.34 per mille. Table No. II shows a similar diminution since
1863 in the admissions among the Native Troops from 7.50 per mille to 4.57,
and among the Native prisoners from 31.16 to 22.38 per mille. Table No. III
shows the result of seven epidemic attacks in the central prison at Agra, where
I introduced removal in 1851, and gained experience in subsequent attacks.
During the first three attacks, the admissions were 392.29 per mille, and the
deaths 60.53 per mille. In the four subsequent attacks the admissions were
68.99 per mille, and the deaths 17.02 per mille after removal was fully organized.
As extensive sanitary improvements have been going on since 1862, the
diminution of the numbers attacked in each epidemic may be attributed to
these in part ; but there was clearly some other power in force to produce the
sudden improvement shown in the last period. The diminished sickness from
fevers, which doubtless depended on sanitary reforms, was steady and continu-
ous during the three periods, whilst in cholera there was but slight change
during the first two, and there was a sudden diminution to less than one-third
during the last period subsequent to the regulated use of Removal. Table
No. IV shows the immediate beneficial result of removal in averting the
attack in more than half of the instances in which it was carried out in 1867.
This measure has clearly not aggravated the number of attacks of other
diseases, as was anticipated. On the contrary, in several instances, the troops
that moved into camp had less subsequent sickness than those who remained
in cantonments. This is shown in Table No. V. The instances of injurious
effects from removal that have come to my knowledge have arisen from de-
fective arrangements, irregular habits, exposure to the sun, too long marches,
or the camp having been pitched in low marshy ground. There is much dis-
comfort and considerable expense to the Officers and Government; but to the
men in all the cases that have come under my observation it has been a relief,
and in some instances a source of much enjoyment. The want of dry ground
in the vicinity of the station during the rainy season will soon be obviated by
the extension of railways. The absence of fatigue and the facility of trans-
port by rail strongly advocate its use, when available. There is no point in
the treatment of the disease on which the opinions expressed in the reports
is more decided, or so unanimous. Removal is considered one of the most
efficacious means available for saving life during cholera epidemics. The
following are the practical measures best calculated to carry it into effect in
India. They are an extension of the valuable regulations laid down in the
report of the Sanitary Commission in 1861.
When epidemic cholera is prevailing in the neighbouring town or dis-
trict, or if the station be in the line of the progressing wave, moro especially
if cholera has prevailed at the same season in former years, special attention
should be paid to the sanitary and dietary regulations in cantonments; and.