NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
5
The soil on which Calcutta has been built has been formed at a compara-
tively recent date by the alluvial deposit of the Gangetic delta; excavations
made for tanks and foundations disclose alternate layers of sand and clay.
The climate is hot and moist. The mean temperature averages 79° F., the
mean maximum being 102° F. in May, and the mean minimum 48° F. in Janu-
ary. The average temperature in the hot season is 85° F., in the rains 83° F.,
.and in the cold season 72° F. Humidity averages 78 per cent. of saturation,
ranging from 69 per cent. in March to 89 per cent. in August. The annual
rainfall averages 60 inches, and the average number of rainy days in the
year is 118. The population of Calcutta in 1901 was 847,796, the mean den-
sity being 41 persons per acre for the whole city, and 68 in Calcutta proper.
.Judged by European standards the city is seriously overcrowded : more than
half the population have less than half a room per head, and 90 per cent. have
three-quarters of a room or less.
In the whole population there are only half as many women as men.
This is due to the large number of immigrants, among whom there are only
279 females to 1,000 males; the majority of these are temporary settlers who
leave their families at home. Another result of the large volume of immi-
gration is that 44 per cent. of the entire population are adult males, which
is double the proportion of the whole of Bengal.
Nearly a third of the inhabitants of Calcutta are engaged in manufac-
tures and nearly a fourth in trade, while personal service accounts for a
sixth.
The city has been divided into four municipal districts, each with its
own staff for conservancy, roads, and buildings.
The drinking water supply is derived from the Hooghly river at Palta,
17 miles north of Calcutta, where it is pumped up into settling tanks and
filtered. The pure water is conveyed by gravitation through iron mains to
masonry reservoirs at the north end of the city. Thence it is pumped into
distributing mains and three other reservoirs in different quarters of the city,
and from these it is again pumped into distributing pipes. The scheme was
inaugurated in 1860, and it was then intended to supply 6,000,000 gallons
per diem or 15 gallons per head. In recent years the works have been greatly
extended, and the Corporation has now three pumping stations at Palta and
four in the city ; there are 1,997 standposts and 5,904 ground hydrants, and
the number of filtered water connections exceeds 26,000. These give to
Calcutta and the adjacent towns of Barrackpore, Dum-Dum, Cossipore Chit-
pore, Maniktala, and Garden Reach a daily supply of over 7,624,000,000
gallons of filtered water, or 21½ gallons per head.
6
The streets are watered and the drains flushed with unfiltered water
pumped up in Calcutta, and for these purposes there are more than 3,500
connections.
The scheme of underground drainage, by which the city is freed of sur-
plus water and of filth, which water will carry, was inaugurated half a cen-
tury ago. The drainage is carried eastwards by a series of five parallel
conduits which discharge into an intercepting sewer, and thence into a large
well at Tangra in the eastern suburbs. There it is raised by steam pumps
into a high level sewer, which carries it to the salt water lakes east of the city,
there to undergo oxidation. The original project was commenced in 1859
and took sixteen years to complete; but meanwhile fresh additions had been
found necessary, these are still incomplete so far as the " added area " is
concerned.
(i) Method of collecting: Information regarding the Epidemic in Calcutta.
As the cases of Epidemic Dropsy were not notified to the Health Depart-
ment, Calcutta, it was necessary to seek out as many of these cases as possible
and make full enquiry regarding them. From the inspection of bodies at the
burning Ghaut, Calcutta, a rough estimate of the cause of death is made, and
the name and address of the deceased is taken. From this source, informa-
tion regarding the deaths stated to be due to Epidemic Dropsy was obtained,
and formed the starting point for further investigations at the house of the
deceased, where it was found, as a rule, that other cases of Epidemic Dropsy
were present among the family, or there was a history of previous cases or
deaths. From the Health Officer, Calcutta, I obtained a complete list of the
names and addresses of all fatal cases of Epidemic Dropsy reported from the
burning Ghaut, and the houses and inhabitants were carefully investigated
by myself or my assistants and the information obtained was recorded on
two forms which I had prepared specially for the purpose, see appendix to
my first report1 o n E p i d e m i c D r o p s y i n C a l c u t t a .
During the year, 1909-10, I was engaged on the enquiry at Calcutta, I
investigated 321 houses with a total of 4,637 inhabitants among whom were
1,581 cases of Epidemic Dropsy. In this way a large amount of valuable
information regarding the epidemic was recorded. In my first report 1 s o m e
of the facts obtained were dealt with and in this report the remainder are
given in full. In dealing with the information collected it has been divided
into Epidemiological, Symptomatological, and Dietetic.
1 First Report on Epidemic Dropsy in Calcutta by Major E. D. W. Greig, M.D., D.Sc., I.M.S., Scientific Memoir
No. 45.
CHART SHOWING THE MONTHLY INCIDENCE OF EPIDEMIC DROPSY DURING 1909.
NUMBER OF CASES OF EPIDEMIC DROPSY.
B y B . L . D A S . A R T I S T .
7
(ii) Epidemiological Investigations.
The following table shows the number of cases of Epidemic Dropsy in-
vestigated which occurred in Calcutta in 1907-08-09-10 :—
Number of cases of Epidemic Dropsy in
1907.
1908.
1909.
1910.
6
30
1,528
17
2. Monthly Incidence of Epidemic Dropsy in 1909.
The following table shows the number of cases of Epidemic Dropsy
which occurred in each month in 1909 :—
J a n u a r y .
F e b r u a r y .
M a r c h .
A p r i l .
M a y .
J u n e .
J u l y . A u g u s t .
S e p t e m b e r .
O c t o b e r .
N o v e m b e r .
D e c e m b e r .
6
8
7
18
41
129
214
481
289
199
90
46
From this it will be seen that in the present outbreak the majority of
cases occurred in the monsoon period of the year, but in the previous epidemic
in Calcutta, 1878-79, the disease was most prevalent in the cold season and
died down in the hot weather. It cannot, therefore, be stated that the occur-
rence of Epidemic Dropsy is limited to a particular period of the year.
The chart No. I at the end of this report shows in graphic form the
monthly incidence of Epidemic Dropsy in Calcutta for the year 1909.
3. Geographical Distribution of Cases of Epidemic Dropsy in Calcutta.
As has been already mentioned, Calcutta is divided into four districts,
and these are again subdivided into Wards. In my first report¹ a map of Cal-
cutta was given showing the distribution of the fatal cases of Epidemic
Dropsy up to date.
The following table shows the number of houses investigated in which
cases were ascertained to have occurred in the four districts of Calcutta in
1909 :—
NUMBER OF HOUSES INVESTIGATED IN WHICH CASES OF EPIDEMIC DROPSY OCCURRED.
District I.
District II.
District III.
District IV.
143
108
27
43
8
The following table shows the number of houses investigated in which
cases of Epidemic Dropsy were ascertained to have occurred in the various
Wards in Calcutta in 1909 :—
NUMBER OF HOUSES INVESTIGATED IN WHICH EPIDEMIC DROPSY OCCURRED.
Ward 1.
Ward 2.
Ward 3.
Ward 4.
Ward 5.
Ward 6.
Ward 7.
Ward 8.
Ward 9.
45
24
13
41
19
10
36
4
33
Ward 10.
Ward 11.
Ward 12.
Ward 13.
Ward 14.
Ward 15.
Ward 16. Ward 17.
7
19
0
3
9
0
0
0
Ward 18.
Ward 19.
Ward 20.
Ward 21.
Ward 22.
Ward 23.
Ward 24. Ward 25.
0
11
4
17
11
3
1
11
The significance of the geographical distribution has been considered
in my previous report.¹ It may be mentioned that the noteworthy features
were the small number of cases in Wards 5 and 7, inhabited chiefly by Mar-
waris, as compared with Wards adjoining 6 and 8, inhabited chiefly by Ben-
galis, and further the fatal cases of Epidemic Dropsy recorded in these Wards,
5, and 7, did not occur among the Marwaris, but among the Bengalis, who
inhabit these Wards in small numbers; and further, Wards 15, 16, 17 popu-
lated by the better class European community did not show any fatal cases of
Epidemic Dropsy. It will be thus seen that the distribution of the disease in
Calcutta afforded important information.
4. General Incidence of Epidemic Dropsy in Inhabitants of Houses investigated.
The following table shows the total number of houses investigated in
which cases of Epidemic Dropsy occurred, the total number of inhabitants of
these houses and the total number of cases of Epidemic Dropsy amongst the
inhabitants of the houses :—
T o t a l n u m b e r o f
houses investigated
in which cases of
Epidemic Dropsy
occurred.
TOTAL NUMBER OF INHABITANTS OF
HOUSES.
TOTAL NUMBER OF CASES OF EPIDEMIC
DROPSY AMONGST INHABITANTS OF
HOUSES.
Adults.
Children.*
Servants.
Adults.
Children.*
Servants.
M.
F.
M.*
F.
M . F.
M .
F.
M.
F.
M.
F.
321
1,349 1,339
692
627
302
328
543
40·2%
621
46.4%
166
24%
115
18 . 5%
73
24%
63
19%
I b i d .
* Under 12 years.
9
5. General Mortality amongst Cases of Epidemic Dropsy investigated
The following table shows the total number of cases of Epidemic Dropsy
investigated and the total number of deaths amongst these cases :—
TOTAL NUMBER OF CASES OF EPIDEMIC DROPSY.
TOTAL NUMBER OF DEATHS AMONGST THESE CASES.
Adults.
Children.*
Adults.
Children.
*
Male.
Female.
Male.
Female.
Male.
Female.
Male.
Female.
616
6 8 4
166
115
102
223
19
24
16.5%
32. 6%
11.4%
20.8%
* Under 12 years.
6. Incidence of Epidemic Dropsy amongst Castes or Religions.
The following table shows the total number of cases of Epidemic Dropsy
investigated, the number of Hindus, Mohamedans, Indian Christians, Eura-
sians amongst them :—
Total cases of
Epidemic Dropsy
investigated.
HINDUS.
MOHAMEDANS.
INDIAN CHRISTIANS.
EURASIANS.
Bengalis.
Others.
Bengalis.
Others.
Bengalis.
Others.
630
534
4
5 6
4
27
...
5
From this table it will be seen that the large majority of cases of Epi-
demic Dropsy occurred amongst Hindus (Bengalis).
7. Age Incidence of Epidemic Dropsy amongst Cases investigated at Calcutta.
The following table shows the total number of cases of Epidemic Dropsy
investigated, and the number of cases which occurred at various age periods
amongst males and females :—
Total number o f
cases of Epidemic
Dropsy.
THE NUMBER OF CASES OF EPIDEMIC DROPSY IN EACH OF THE
FOLLOWING AGE PERIODS AMONGST MALES AND FEMALES.
Up to 1 2
years.
13—20. 21—30. 31—40. 41—50. 51—60. 61—70.
Over 70.
M.
F.
M. F. M. F. M. F. M. F. M. F. M. F.
M.
F.
630
25
24
47 60 75 90 50 70 57 48 25 27
8 14
6
4
10
8. Mortality from Epidemic Dropsy at different Age Periods.
The following table shows the total number of fatal cases of Epidemic
Dropsy investigated, the number of deaths from Epidemic Dropsy in each of
the following age periods amongst males and females :—
Total number of
fatal cases of
Epidemic Dropsy.
THE NUMBER OF DEATHS FROM EPIDEMIC DROPSY IN EACH OF THE
FOLLOWING AGE PERIODS AMONGST MALES AND FEMALES.
Up to
12 years.
13—20. 21—30. 31—40. 41—50. 51—60. 61—70.
Over 70.
M.
F.
M. F. M. F. M. F. M. F. M. F. M. F.
M.
F.
228
8
12
11 31 11 36
6 33 15 19 11 16
6
9
1
3
Chart No. 2 shows the age composition of the population of Calcutta.
Chart No. 3 shows the age incidence of cases of Epidemic Dropsy in the male
and female population of Calcutta. Chart No. 4 shows the mortality from
Epidemic Dropsy at different age periods amongst the male and female popu-
lation in Calcutta.
These Charts are of considerable interest. In the first place it will be
seen from the Chart showing the age distribution of the population of Cal-
cutta that the bulk of the inhabitants are between the ages of 20 and 40 years.
Further, although, as we have seen, in the whole population of Calcutta there
are only half as many women as men, yet the number of fatal cases of Epi-
demic Dropsy is higher at each age period in females than in males. In my
first report¹ and in the present one this problem is discussed, and the explana-
tion of the greater mortality amongst female Hindus lies in the fact that
their diet, and especially amongst widows, is, in ordinary circumstances,
distinctly " One-sided," and, consequently, any factor which increases this
" One-sidedness " of diet, as rise in price of food grains, affects most severely
the adult female population.
9. Occupations of Persons attacked by Epidemic Dropsy.
1.— Males.
Total number
of Epidemic
Dropsy cases
investigated.
C l c r k s .
P e t t y t r a d e r s .
A r t i s a n s .
P r e s s h a n d s .
L a n d h o l d e r s .
M e r c h a n t s .
Me di c a l pr a c t i - t i one r s .
B r o k e r s .
M u s i c i a n s .
P r i e s t s .
T e a c h e r s .
P l e a d e r s .
E n g i n e e r s .
B a n k e r s .
M i l l - o w n e r s .
M e n i a l s , d o m e s t i c s e r v a n t s , e t c .
M i l l h a n d s .
L a s c a r s .
P e n s i o n e r s .
S t u d e n t s .
N o o c c u p a t i o n .
293
104 29 26 13 10
7 10
5
2
1
1
2
1 1 1
3 2 1 6 36 31
¹ Ibid.
II.
AGE DISTRIBUTION OF 1000 OF EACH SEX IN CALCUTTA
(CENSUS OF INDIA, 1901. Vol. VII. PART IV. )
PER THOUSAND.
II.
AGE DISTRIBUTION OF 1000 OF EACH SEX IN CALCUTTA
(CENSUS OF. INDIA, 1901. Vol. VII. PART IV.)
MALES. =—
FEMALES. = - - - - -
IlI.
AGE INCIDENCE OF EPIDEMIC DROPSY.
MALE AND FEMALE.
— MALE.
- - - - F E M A L E .
N U M B E R O F C A S E S O F E P I D E M I C D R O P S Y .
IV.
CHART SHOWING MORTALITY FROM EPIDEMIC DROPSY AT VARIOUS AGE PERIODS.
MALE AND FEMALE
N U M B E R O F F A T A L C A S E S . O F E P I D E M I C D R O P S Y .
— M A L E .
---- FEMALE.
V.
BY B. L DAS., CALCUTTA .
11
2.—Females.
Total number o
f
Epidemic
Dropsy cases
investigated.
WORKERS.
DEPENDENT ON
S c h o o l m i s t r e s s e s .
M a i d s e r v a n t s , e t c .
H a w k e r s e t c .
P r o s t i t u t e s .
C l e r k s .
T r a d e r s .
A r t i s a n s .
M e r c h a n t s .
L a n d h o l d e r s .
B r o k e r s .
P l e a d e r s .
Medi cal pract i -
tioners.
T e a c h e r s .
P r e s s h a n d s .
M e n i a l s .
P r i e s t s .
M u s i c i a n s .
C h r i s t i a n s c h o o l s .
337
3
6
14
10
15
32 24
10
29
6
5 11
5
4
6
1
1 11
Chart No. 5 shows in graphic form the occupations of 293 persons
attacked by Epidemic Dropsy.
From a study of the two tables and Chart it will be seen that of the 630
cases of Epidemic Dropsy investigated, 205 males and 215 female dependents
belonged to the Clerical, Artisan, Student, or Petty trader classes, that is to
say, they belonged to the classes with small fixed incomes. This is a very
important point because as I have shown in my first report¹ the factor which
determines the extensive outbreaks of Epidemic Dropsy is a sustained high
price of food grains, and, consequently, it is just those persons with small
fixed incomes who would be most severely affected. In times of prosperity
and low price of food grains these persons can purchase additional articles
of diet and so compensate the defects in their staple food, and in this way
maintain nutritional equilibrium, but when the price of their staple article
of food rises and remains high, then their power of purchasing additional
articles of food is gone, and their diet, accordingly, becomes more and more
" One-sided "; and the longer this condition lasts, the more severe will be the
manifestations of a nutritional breakdown : when the price of food grains
falls to normal and they are again able to supplement their dietary by addi-
tional articles of food the " One-sidedness " of their dietary ceases, and with
it the epidemic as occurred in Calcutta in 1879-80, and again in 1909-10.
10. Incidence of Epidemic Dropsy amongst Hindu Females (Married, Unmarried,.
and Widows).
The following table shows the total number of adult female inhabitants
in 130 houses investigated and the total number of cases of Epidemic Dropsy
amongst them :—
TOTAL NUMBER OF ADULT FEMALE INHABITANTS IN 130
HOUSES INVESTIGATED.
TOTAL NUMBER OF CASES OF EPIDEMIC DROPSY
AMONGST THEM.
Married and single.
Widows.
Married and single.
Widows.
398
151
201
85
50.5%
5 6 . 2 %
I b i d .
c2
12
11. Case Mortality amongst Hindu Females (Married, Unmarried, and Widows).
The following table shows the case mortality from Epidemic Dropsy
amongst female Hindus in Calcutta
TOTAL NUMBER OF CASES OF EPIDEMIC DROPSY AMONGST
ADULT FEMALE HINDUS IN 130 HOUSES.
TOTAL NUMBER OF DEATHS FROM EPIDEMIC DROPSY
AMONGST THESE CASES.
Married and single.
Widows.
Married and single.
Widows.
201
8 5
62
30.89 %
45
52.9 %
A study of these tables brings out the interesting fact which was dealt
wi t h i n my fi rst report , ¹ namel y, t hat t he mort al i t y from Epi demi c Dropsy i s
higher amongst female Hindus (Bengalis) than amongst male Hindus, and
particularly amongst widows. As I have already pointed out, this fact has
an important bearing in connection with the etiology of Epidemic Dropsy,
because female Hindus consume less fresh meat than adult male Hindus, and
widows, for religious reasons, do not partake of meat at all and are pure
rice-eaters. If this fact is examined in the light of the working hypothesis,
that Epidemic Dropsy is dependent on defects in dietary whereby it is ren-
dered " One-sided," is correct, then Hindu widows, whose diet is a typical
example of " One-sidedness," ought to have suffered most, and this is exactly
in accordance with the facts brought out in my reports of the investigation.
Incidence of Cases of Epidemic Dropsy in Families.
(1) Households of two families.
Total number of households
investigated.
NUMBER OF HOUSEHOLDS IN WHICH
One family attacked.
Two families attacked.
26
24
2
(
2
)
H o u s e h o l d s o f t h r e e f a m i l i e s .
Total number of house-
holds investigated.
NUMBER OF HOUSEHOLDS IN WHICH
One family attacked.
Two families attacked.
Three families attacked.
21
15
2
4
1 l b i d .
13
(3) Households of four families.
NUMBER OF HOUSEHOLDS IN WHICH
Total number of house-
holds investigated.
One family attacked.
Two families
attacked.
Three families
attacked.
Four families
attacked.
16
10
4
2
0
(4) Households of five families.
Total number
of households
investigated.
NUMBER OF HOUSEHOLDS IN WHICH
One family
attacked.
Two families
attacked.
Three families
attacked.
Four families
attacked.
0
Five families
attacked.
1
1
0
0
0
(5) Households of six families.
Total number
of households
investigated.
NUMBER OF HOUSEHOLDS IN WHICH
One family
attacked.
Two families
attacked.
Three families
attacked.
Four families Five families
attacked.
attacked.
Six familie
s attacked.
0
2
1
0
1
0
0
(6) Households of more thaw six families.
NUMBER OF HOUSEHOLDS IN WHICH
Number of families in
household.
Total number of such
households investigated.
One family attacked.
More than one attacked.
7
1
1
0
9
2 2
0
10
1
1
0
11
1
1
0
1 2
1
1
0
In the above tables some of the households investigated have been classi-
fied into those with 2, 3, 4, 5, and 6 families, and the results of the enquiry as
to the number of families in each household which was attacked by Epidemic
Dropsy stated. It is interesting to note that in the great majority of instances
14
1 family only in these various sized households was attacked. This limita-
tion of the disease to single families in households is important in regard to
the question of infectivity of the disease. That is to say, that amongst the
healthy inhabitants there were foci of persons attacked by Epidemic Dropsy
and the disease did not spread from these foci to the unaffected population.
The question of the infectivity of Epidemic Dropsy has been discussed fully
in my previous report,¹ and reference to it should be made in this connection.
13. Degree of Communication between Families in Households affected by
Epidemic Dropsy.
The following table shows the degree of communication between families
in households affected by Epidemic Dropsy, the food and cooking arrange-
ments of these families, and the occurrence or non-occurrence of Epidemic
Dropsy in unaffected families :—
HOUSEHOLDS COMPOSED OF TWO OR MORE FAMILIES IN WHICH CASES OF EPIDEMIC
DROPSY OCCURRED.
Number of such
households
investigated.
NUMBER OF HOUSE-
HOLDS IN WHICH COM-
MUNICATION BETWEEN
FAMILIES WAS
NUMBER OF HOUSE-
HOLDS IN WHICH
COOKING ARRANGE-
MEETS ARE
NUMBER OF HOUSEHOLDS IN
WHICH EPIDEMIC DROPSY
Intimate.
Slight.
Same.
Different.
Occurred in
unaffected
families.
Did not occur
in unaffected
families.
72
3 3
39
72
0
0
66
In 6 households all the families were affected simultaneously.
In this table the interesting fact comes out that in 66 out of 72 house-
holds cases of Epidemic Dropsy were not recorded in the families originally
unaffected by the disease, and in the remaining 6 households all the families
were affected simultaneously. This is further evidence that the disease
remains limited to the family originally attacked although communication
may be intimate with other families of the household.
14. Movements of Families in Relation to Epidemic Dropsy.
The following table shows the number of households free from Epi-
demic Dropsy into which cases were imported and. the number of these house-
holds which recorded cases of Epidemic Dropsy after importation :—
Number of Epidemic Dropsy free households into
which cases were imported.
Number of these households which recorded cases
of Epidemic Dropsy after the importation.
3 1
2
¹ Ibid.
16
It is noteworthy that when single cases of Epidemic Dropsy were report-
ed from a house it was found, on investigation, that either the disease was
not Epidemic Dropsy, or that the case had been imported. It was rare for a
single individual to be attacked in a household; generally a whole family.
17. Sanitation of Houses in which Cases of Epidemic Dropsy occurred.
The following table shows the number of houses investigated, in which
cases of Epidemic Dropsy occurred, and the condition of the sanitation of
these houses :—
Number of houses investigated
in which cases of Epi-
demic Dropsy
occurred.
NUMBER OF HOUSES IN WHICH SANITATION WAS
Poor.
Fair.
Good.
Excellent.
321
66
(including 29
* k a c h c h a h u t s )
151
93
1
During the house to house enquiry a note was made of the general state
of the sanitation and the above table sets forth the results. It Will be ob-
served that in the majority of cases the sanitation is reported to be fair.
( i i i ) S y m p t o m a t o l o g y o f E p i d e m i c D r o p s y .
In this section the frequency of the various signs and symptoms asso-
ciated with Epidemic Dropsy are set forth. As most of the cases were seen
in their houses it was not possible to enter into an elaborate clinical study of
the phenomena of each case. The detailed results of the examination of the
blood, excreta, etc., of such cases as were seen by me in hospitals have been
recorded in my first report.¹ In the present report the histories of a large
number of cases have been analysed and the signs and symptoms classified.
1. Duration of Illness.
The following table shows the total number of cases of Epidemic Dropsy
examined and the duration of illness of these cases :—
Total number
of cases
of Epidemic
Dropsy
investigated.
DURATION OF ILLNESS OF THESE CASES OF EPIDEMIC DROPSY.
Under 1
month.
1—2
months.
3—4
months.
5—6
months.
7—8
months.
9—10
months.
11—12
months.
13—14
months.
15—16
months.
17—18
months.
19 and
over.
630
21
88
2 5 5
157
63
24
9
7
1
2
3
3 . 3%
14%
40 .4%
24. 9%
10%
3.8 %
1.4%
1.1%
.1%
.3%
.4%
1 Ibid.