NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
TABLE OF CONTENTS.
Subject of Report...
Result of enquiries
Cause of delay in submission of Report...
Dr. Leith's Abstract of the conclusions of the Cholera Conference should be reprinted
Arrangement of topics considered by the " Conference"
Scope of the Report
The enforcement of the recommendations of the Conference requires the authority of Government
The questions considered, and the conclusions arrived at, by the Conference
Method adopted by the Committee to verify the correctness of these conclusions
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Abstract Return shewing various points regarding the origination and propagation of Epidemic Cholera in
Southern India
Considerations preliminary to the present enquiry
Different modes of origination of epidemics
Endemicity of Cholera in India
Conclusions of the Conference and the importance of these
Alleged endemicity of Cholera at certain stations
The enquiries of the Committee do not confirm the foregoing opinion
Cholera not considered as endemic in any part of this Presidency.
Cholera not endemic in Madras
Arrangement of subject of enquiry
Method of enquiry proposed in the present report
Origination of epidemics due chiefly to contagion from pilgrimages
The subject of pilgrimages has been sufficiently discussed
Additional subjects to be considered
The results of experience regarding the transmission of Cholera claim especial attention
Various conditions under which epidemic Cholera is most usually observed
General considerations equally apply to all the foregoing conditions
General principles of prevention widely applicable
Conclusions of the Conference on the foregoing
How these views should be carried out
How to maintain the purity of air in cities
Water supply how to be protected from contamination
The foregoing subjects need not be reiterated
Several of the measures recommended are not novel
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2G
I. OUTLINE OF MEASURES OF SANITATION FOR THE PREVENTION AND CHECK OF EPIDEMIC CHOLERA IN CITIES,
VILLAGES AND TOWNS.
General principles of conservancy of Towns
The probable results of the adoption of these principles
Epidemic disease in crowded towns, during famine and from want of European Medical advice
Institution of broad streets greatly required
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II.
MILITARY CANTONMENTS.
Hules for Military Cantonments
Rules for arresting Cholera among Troops in infected Barracks
Measures of a preventive and curative character necessary for troops on the march
Identity of recommendations for station and marching Cholera camps
Rules for Cholera Camps
Further suggestions ou same subject
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2S
£9
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OFFICE OF SANITARY COMMISSIONER,
Madras, June 23rd, 1868.
From
W. MACKENZIE, Esq,, C.B., C.S.I., President,
Colonel A. C. SILVER,
V Cholera Committee ;
Surgeon-Major J. L. RANKING, Members.
To
The Honorable R. S. ELLIS, C.B.,
Chief Secretary to Government,
Fort Saint George.
SIR,—In compliance with the instructions of Government as conveyed in
their Order No. 216, dated the 27th February 1867, the
Subject of Report.
subject of the arrangements which should be made for
giving practical effect in this Presidency to the recommen-
dations and suggestions of the International Sanitary Conference, has received our
careful attention, and we have the honor to submit the following observations thereon.
2. We may premise that the result of our enquiries leads us to believe that
it is possible, by the enforcement of such regulations as we
Result of enquiries.
propose, in some instances to prevent the origination, and
in others to check the dissemination, of epidemics of Cholera
similar to those which have, in past years, been such a fruitful source of the loss of
life among Civil and Military communities.
3. The very extended field of enquiry which presented itself to us will, we
trust, sufficiently excuse the unavoidable delay which has
Cause of delay.
occurred in the submission of the following remarks,
4. Before entering upon any considerations of the many circumstances
under which epidemic cholera is originated and caused to spread in India, we consider
it advisable to submit briefly to Government the various questions investigated by
the Constantinople International Sanitary Commission, as the conclusions arrived at are
the bases upon which our several recommendations are founded.
5. The catechetical abstract of the labors of the Cholera Commission given
below is copied almost verbatim from an abstract of their
Dr. Leith's Abstract
proceedings and reports, compiled by Dr. A. H. Leith, then
President of the Sanitary Commission, Bombay. "We gladly
avail ourselves of the opportunity of recording our high sense of the value of his work,
in which is contained, in a small compass, all the most valuable conclusions arrived at
by the Conference, with the principal arguments and statements of facts upon which
those conclusions are based.
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—should be reprinted.
6. Indeed, so much that is valuable is contained in this abstract, that we
would respectfully urge on the Government that the whole
volume might, with advantage, be reprinted in the Govern-
ment Printing Press for general distribution.
Arrangement of topics con-
sidered by the " Conference."
7. The " Conference" divided the subjects of their enquiry into three
groups. 1st.—The origin and generation of Cholera, the
" endemicity" and the " epidemicity" of the disease in India.
2nd.—The transmissibility and the propagation of cholera.
3rd.—The prevention of Cholera.
Under this last group, the Conference have presented not only a report on the
sanitary measures to be taken for the prevention of Cholera ; but reports on quaran-
tine measures, on sanitary cordons and on Lazarets ; rules for quarantine and dis-
infection ; bills of health ; measures to be taken in the East are also considered, as are
the measures to be taken in India, and between India and Europe, against the importa-
tion of the disease by sea, and finally the measures to be taken against its importation
by land.
Scope of this Report.
8. In the remarks we are about to submit to the Government, we have
confined ourselves to such portions only of the reports of the
Conference as appear to us of importance in their direct appli-
cation to this Presidency, either in respect to observations
derived from local experience, confirmatory of conclusions arrived at by the Conference,
or subjects upon which it is desirable that information, not available to the Conference,
should hereafter be obtained from this part of India.
The enforcement of the re-
commendations of the Con-
ference requires the authority
of Government.
9. There are many recommendations made by the Conference, which are
peculiarly applicable to this Presidency, and upon which, in
our opinion, it is desirable that action should be taken by
the Government, either by means of legislative enactments,
or by orders iu the Civil or Military Departments of the
Administration.
10. The following are the questions considered and the conclusions arrived
at, regarding the chief points which indicate the necessity of laying down certain rules
for the prevention of this disease.
" Question 1st.—Whence comes Asiatic Cholera ? Is it indigenous ? In what
countries is it now endemic ?
"Answer.—The Asiatic Cholera, which has several times spread over the
world, is indigenous in India, where it had its birth, and where it exists permanently
as an endemic.
" Question 2nd.—Is Asiatic Cholera endemic anywhere out of India ?
" Answer.—Asiatic Cholera is never developed spontaneously, and has never
been found to be endemic in the countries of Europe, the Caucasian provinces, Turkey
in Asia, all the North of Africa, and the two Americas, into which it has come from
• without. As to the countries in the neighbourhood of India, while admitting the pro-
3
bability, that Cholera does not exist in them as an endemic, it cannot be formally
concluded that it does not.
" Question 3rd.—Is there not reason to fear that Cholera may become natura-
lized in our (European, &c.) countries ?
" Answer.—It appears likely that by repeated invasions, the principle of the
disease may in some manner be naturalized.
" Question 4th.—Is there in the Hijaz an original source of Cholera, either
permanent or periodic ?
" Answer.—Asiatic Cholera does not appear to have an original source in the
Hijaz, but it appears to have been hitherto always imported there.
" Question 5th.—Are there certain localities in India where alone Cholera is
engendered, or which are particularly favorable to its development? In other words,
is Cholera endemic in all parts of India, or only in certain districts, which it is possible
to circumscribe ?
" Answer.—There are in India certain localities, chiefly in the valley of the
Ganges, where Cholera is endemic, without its being possible to particularize all, or to
affirm that they exclusively give birth to the disease.
" Question 6th.—Do we know the concurrence of causes under which Cholera
has its spontaneous birth in India ; also the circumstances which make it take an
epidemic form ?
" Answer.—We do not know the special conditions under which Cholera has
its birth in India and reigns there endemically in certain localities.
" Question 7th,—What are the circumstances that conduce to the develop-
ment and propagation of epidemics of cholera in India ?
" Answer.—Pilgrimages are in India the most powerful of all the causes
which conduce to the development and to the propagation of epidemics of cholera.
" Question 8th.—Is the transmissibility of cholera now proved by facts that
admit of no other interpretation ?
"Answer.—All the facts hitherto ascertained demonstrate that Cholera is
propagated by man and with a speed proportioned to the amount and rapidity of his
emigrations. The transmissibility of Asiatic Cholera is incontestable, and is proved
by facts that admit of no other interpretation.
"Question 9th.—Are there any conclusive facts that constrain us to admit
that cholera can be spread to a distance by certain conditions of the atmosphere, by
winds, or any other change or modification of the air ?
" Answer.—Hitherto no fact has proved that cholera can spread to a dis-
tance by the atmosphere alone, whatever may be its condition.
" Question 10th.—How is cholera imported, and what are the agents in its
transmission ?
" Answer.—From all that has been learnt, there are two things necessary to
the outbreak and the spread of Asiatic Cholera in a locality—an arrival from an infected
place and circumstances that favor the transmission. As regards the former, an am-
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val with cholera is a complex affair ; it includes man and his clothing, personal effects,
merchandise, animals, the ship which carries him, and, in short, all that accompanies
the man. Is all that constitutes an arrival equally capable of transmitting the disease ?
It was a long while believed that the lapse of a few days between the depar-
ture and arrival without appearance of cholera was a sufficient guarantee against the
importation of the disease. But well attested facts show that even a. long voyage,
without appreciable accidents, does not ensure against danger. On the other hand,
it is certain that the regular packet boats, that for many years have plied with India,
have never imported cholera into Suez. Without at present entering into particulars,
it may be concluded that, even if every arrival from a country affected with cholera
be not capable of propagating the disease, it is not the less prudent, pending fuller
information, to consider every arrival as suspicious.
" Question 11th.—What are the conditions in which man imports cholera ?
" Answer.—There is no doubt as to man being the principal agent in the
importation of the disease. The arrival of a great number suffering with cholera is
not necessary for the causing of a great epidemic. A few sick, or even a single case,
may suffice. There is no proportion between the amount of cholera imported and the
intensity of the ensuing epidemic. The intensity is influenced by the more or the less
favorable conditions of the locality, as a conflagration is not in proportion to the spark
that kindles it, but to the inflammability and the quantity of material that it meets
with. One person with cholera may occasion an epidemic.
" Question 12th.—Can an individual with only Choleraic Diarrhoea, commu-
nicate Cholera ?
" Answer.—A person coming from a source of Cholera, and although suffer-
ing only with Diarrhoea, may import the disease.
" Question 13th.—What is the length of the time of incubation ?
" Answer.—In nearly all cases the period of incubation, that is the time lapsed
between the moment when a person can have contracted the choleraic poisoning and
the beginning of the premonitory Diarrhoea, or confirmed Cholera, does not exceed a few
days ; all the cited facts of a longer incubation are referable to cases which are not con-
clusive, either because the premonitory Diarrhoea has been included in the period of
incubation, or because the infection may have occurred after leaving the infected place.
"Question 14th.—Can Cholera be imported and communicated by living
animals ?
" Answer.—There is no known fact that proves that Cholera may be import-
ed by living animals ; but it is reasonable to consider them in certain cases as suscep-
tible articles.
" Question 15th.—Can Cholera be imported and transmitted by linen cloth-
ing, and generally by things in personal use ?
" Answer.—Cholera can be transmitted by articles of personal property com-
ing from an infected place, and especially by those which have been used by sufferers
under Cholera ; and certain facts prove that the disease may be carried to a distance by
such articles, shut up from the access of fresh air.
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" Question 16th.—Can Cholera be imported and transmitted by merchandise %
" Answer.—Until fuller information be obtained, it will be prudent to consi-
der as suspicious, unless in particular and defined conditions, every arrival from a
centre of Cholera.
" Question 17th.—Can the bodies of those who have died of Cholera be the
means of importing and transmitting the disease ?
"Answer.—Although it is not proved by convincing facts, that Cholera can be
transmitted by means of such corpses, it is prudent to consider them to be dangerous.
" Question 18th.—What influence have the different modes of communication,
by land or by sea, on the propagation of Cholera ?
"Answer,—Communications by sea are from their nature the most dangerous;
it is they that most certainly spread Cholera ; and then come communications by Rail-
ways, as they in a very short time, can carry the disease to a great distance.
" Question 19th.—What is the influence of deserts on the propagation of
Cholera ?
" Answer.—Great deserts are a very effectual barrier to the propagation of
Cholera. There is no instance of that disease being, imported into Egypt or Syria by
caravans coming from Mecca.
" Question 20th.—What is the influence of assemblages or congregations (ag-
glomerations) of men on the intensity of epidemics of cholera ; also on the propaga-
tion of the disease ? and under what conditions does that influence operate ?
" Answer.—Every assemblage of men, in which Cholera appears, is a condition
favorable to the rapid extension of the disease, and, if the assemblage is in a bad sani-
tary condition, to the violence of the epidemic. In like circumstances the rapidity of
the extension is in proportion to the concentration of the congregated mass, while the
violence of the epidemic (all other things being equal) is the greater the less the indi-
viduals have already been under a choleraic influence, or if they remain uncontaminat-
ed by it ; that is to say in other words, those who have already been under the influ-
ence of a source of cholera have a kind of relative and temporary immunity that coun-
terbalances the grievous effects of the agglomeration. Lastly, in a congregated mass
the more rapidly the epidemic spreads the more quickly also does it cease ; unless new
healthy arrivals furnish fresh aliment to the disease, and so sustain it.
" Question 21st.—What intensity and persistence have epidemics of cholera in
ships ?
" Answer.—The intensity of epidemics of Cholera on board ships, crowded with
men, is usually in proportion to the crowding, and is more violent when those on board
do not come from a residence in a centre of Cholera ; in crowded ships the progress of
epidemics is generally rapid ; lastly, the danger of importation by ships and of
giving rise to a severe epidemic, are not altogether dependent on the intensity, or even
the occurrence, of choleraic casualties that have happened during the voyage.
" Question 22nd.—What influence have assemblages in lazarets, of persons
coming from a source of Cholera, on the development of the disease among those in
quarantine, and those outside the lazarets ?
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of Cholera) does not exceed a few days. The observations cited as exceptional do not
prove that the cases of Diarrhoea which last longer are choleraic, and are capable of
transmitting the disease when the individual has been removed from, all cause of con-
tamination."
Method adopted by the
Committee to verify the cor-
rectness of these conclusions.
11. With a view to the verification of the accuracy of the conclusions noted
above, the Inspector General of the Indian Medical Depart-
ment, under date the 19th July 1867, circulated a tabular
form of Return to be filled up by Medical Officers in his
department, and Government issued instructions that all Collectors of Districts should
furnish similar information regarding the localities under their charge.
13, The following Abstract Return shewing various points regarding the Origina-
Dr. Montgomery, who
District or
Station.
1.
North Arcot
District.
Kurnool
District.
Names of places, villages or towns
Endemic.
2.
None.
Do.
Epidemic every year.
3.
Chittoor, Chendra-
gherry, Palmanair,
Vellore, Arcot, Polur.
Arnee, Calastry,
Maderpak and Tirutani
Talooks.
Cumbum, Atmakur,
Peapully, Koilkuntla,
Chapalmadagoo,
Nundikotkur,
Markapur, Patti-
kondah, Kurnool,
Calwa, Nundial and
Sirwell Talooks.
in which Cholera is
Epidemic at short
intervals, not exceed-
ing four or five years.
4.
Gudiattam, Palmanair,
Wallajah, Wandewash,
Vellore, Arcot, Polur,
Arnee, Punganur,
Narrainavanum,
Maderpak and
Tirutani Talooks.
Cumbum, Atmakur,
Peapully, Koilkuntla,
Chapalmadagoo,
Nundikotkur,
Markapur,
Pattikondah, Kurnool,
Calwa, Nundial and
Sirwell Talooks.
Places which are resorted to
by Pilgrims in large
numbers.
5.
Chittoor, Chendragherry,
Palmanair, Wallajah,
Wandewash, Vellore,
Arcot, Polur, Punganur,
Narrainavanum, Calastry,
Maderpak and Tirutani
Talooks.
Streesailem, Gundala,
Venkatadripoliem,
Nullamalla and Ahobulam
hills, Narsimbasawmy, and
at Kurnool during the
Mohorrum.
Is Cholera both
epidemic and
endemic at any
of the places
mentioned in
column 5 1
If so, mention
their names.
6.
No.
No.
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12. Considerable delay has occurred in the receipt of the information thus
sought for ; but it has been so far satisfactory as proving the general accuracy of the
conclusions arrived at by the International Sanitary Conference, and we are happy to
add that we have, in connection with the subject of pilgrimages, been able to satisfy
ourselves, not only that these conclusions are correct, but also that it is possible, by
acting upon the precepts suggested by them, to prevent the appearance of epidemic
cholera during those agglomerations of people which periodically occur in India at the
celebration of certain religious festivals, and during the holding of certain fairs.
lion and Propagation of Epidemic Cholera in Southern India, has been prepared by
kindly acted as our Secretary.
Mention the date of the
chief outbreaks of Cholera
which have occurred in
this District within
the last ten years.
1858 January, 1859 January,
February and December,
1860 April and May, 1861
June and July, 1863 April
and May, 1864 and 1865
April and May, 1866 July,
August, October and Nov.,
1867 March.
1859 March 2nd, April 26th,
June, July and September,
1862 April, June 9th, July
and September 7th, 1863
April, June, July 7th and
August 1st, 1864 April,
June 9th, July 17th and
August 11th, 1865 Feb-
ruary 1st, 26th March,
April 16th, June, July, and
August 27th, 1866 April,
May 23rd, June, July and
September 10th, 1867 March
24th, April 1st, June, July,
and September 10th.
Could any of these outbreaks
be traced to any particular
sources, such as arrivals
from another District ?
If so, mention them.
8.
Attributable to the passage
of pilgrims to and from the
seat of festivals in or near
the district, and to the
scarcity of food and conse-
quent high prices of grain.
Arrivals from Cuddapah, Bel-
lary and Secunderabad,
the Mohorrum festival, the
Streesailem festival, and the
passing of an Infantry Re-
giment in 1863, and the
2nd Cavalry in 1867, were
the chief causes of the out-
breaks of Cholera in the
district. The passing of
pilgrims.
What was the usual point
of departure of Cholera
from the District ?
9.
Not known.
Do.
Places that have the reputa-
tion of being free from
Cholera, with statement of
grounds upon which this
immunity is alleged.
10.
Certain villages in the Chen-
dragherry, Punganur, Pal-
manair, Tirutani, Wande-
wash, and Maderpak taluqs.
The grounds for this immu-
nity not generally ascer-
tained ; but the situation of
two villages in the Punganur
talook on high stony
ground is said to be the
cause of the non-appearance
of Cholera.
Chilkacherla—good water and
soil. Bollawarum, a well
whose water is very good ;
a plant called Nemallizutta
growing on the Fort walls
and a tree whose flowers are
of a white color, and whose
smell extends to about 10
chains. Seddapuram, no
grounds.
Gopolsingawa-
ram, contains temple of
Venkataswarlu. Bavapu-
ram, contains the tomb
of Shakangal Saheb. Mud-
dalate, no ground. Runga-
puram, no grounds. Aho-
balam, Yaparlapadu, Bo-
ganapully and Valavalsa,
on account of elevation.
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District or
Station.
1.
Trichinopoly
District.
Cuddapah
District.
Tinnevelly
District.
Nellore
District.
Tanjore
District.
Names of places, villages or towns in which Cholera is
Endemic.
2.
Trichinopoly,
Varagany,
Streerungum,
Moosory,
Tottiem,
Kultoopootur,
Alatodium-
putty,
Coottapolliem,
Marudy,
Chettycolum,
Kerramboor,
Toriore.
None.
Unknown.
Ongole and
Venkatagiri.
None.
Epidemic every year.
3.
Trichinopoly.
None.
None.
Rapur, Udayagiri,
Polur, Darisi.
Negapatam, Nannillam
Combaconum, Tanjore
Pottukottai,
Manargodi, Tritra-
pundi, Shealli and
Mayavaram Talooks.
Epidemic at short
intervals, not exceed-
ing four or five years.
4.
Trichinopoly.
Budwail, Cuddapah,
Sidhout, Pullumpett,
Junmalmadugu,
Poddatur,
Madanapully,
Voilpaud, Kudri,
Pulivaindla and
Koyachote Talooks.
Most of the towns and
villages.
Most of the towns and
villages.
, In only a few villages
in this district.
Places which are resorted to
by Pilgrims in large
numbers.
5.
Streerungum, Corasalem,
Tottiem, Sevoyem,
Veerappoor, Andavancovil,
Thondony Hills, Kadavoor
and Seroovachoor.
Kudri, Royachote, Culcudda
in the Voilpaud, Uottacota
in the Madanapully, and
Pooshpagiri, Daivoony,
Cuddapah, and Kottapata
in the Cuddapah Talooks.
Strivilliputur,
Sankarnainakovil,
Courtallum, Tenkasi,
Papanasern, Tinnevelly,
Strivycuntum,
Alwarterimagari, Trichendur,
Nanguneri, Tirukurungudi.
Runganaickaloopet,
Nursimulukondah,
Butchereddipalem, Sungum,
Penchalahkona,
Venkatighiri.
Negapatam, Nagore,
Valangunni, Trivalore,
Trivadi, Avadayarcoil,
Mayaveram, Vedarniem,
Muthearjunum,
Sawmy Mullay and
Manargudi are
resorted to every
year, whilst
Combaconum is
visited only once in
12 years.
[s Cholera both
epidemic and
endemic at any
of the places
mentioned in
column 5 ?
If so, mention
'their names.
6.
Streerungum
and Tottiem.
No.
No.
No.
No.