# Advice to Officers in India/Chapter 11

CHAPTER XI.
1. DISEASES IN GENERAL.—The principal diseases to which natives are liable,are Intermittent and Remittent fever. Cholera, Diarrhœa, Dysentery, and Small-pox. Many of them are so accustomed to ague, that they do not feel much inconvenience from it,they lie down for an hour or two till the paroxysm is over, and then get up and return to their occupation. In long continued cases of ague, the spleen becomes enormously enlarged, and so fragile, that a blow or a kick on the belly very often causes its rupture and death. In all such cases, the use of mercury is strictly forbidden.
Dysentery is probably the most fatal of all diseases, and carries off the largest portion of the population.
2. CATARRH.—This is a frequent complaint, and it is not uncommon during the hottest weather. Persons predispose themselves to it by undressing immediately on returning home after a visit during the heat of the day; leaving an out-door temperature of 102°, and sitting down in shirt and pyjamas ​in an in-door temperature of 82° without due precaution.
Colds are also frequently caught by the punkah-bearer going to sleep, till awoke by his master, bathed in perspiration. Anxious to make amends for his neglect he pulls with double vigour, and entails a cold upon the sleeper.
3. CALCULUS.—This was at one time thought to be a rare disease amongst natives but late experience shows it to be as prevalent as in temperate zones. Many civil surgeons have operated in hundreds of cases within their own districts, and with remarkable success. Even natives, uneducated at any school, ignorant of anatomy and self-taught, operate with a degree of success that surprises the educated practitioner.
4. GOITRE.—is frequent along the outer range of the Himalayan, especially on limestone formations, but it is not considered a very grievous evd further than the inconvenience of its size and weight. Both sexes seem equally liable to it. It is unknown in the plains.
5. ELEPHANTIASIS.—in one or both legs is almost peculiar to Bengal proper, and is more common in the male sex than the female, and in mature age rather than in youth. It also is looked upon as an inconvenience rather than as a serious evil. The disease is almost unknown in the north-west provinces.
​6. LEPROSY.—Cases of this horrid disease are common all over Hindostan,and in both sexes, but confined especially to those of low castes. It does not seem materially to shorten the span of life, but to confine its ravages to the extremities; lopping off joint after joint, toe after toe, and finger after finger, and eventually the entire hand or foot, while the outcast victims drag out a lengthened existence in loathsome misery. It is firmly believed by the natives to be hereditary as well as contagious; no one thinks of inter-marrying with a leper, and contact of any sort is abhorred.
7. CHOLERA.—Cholera is the most alarming disease, and when epidemic, its ravages are like those of a destroying angel. I am inclined to think that it is much less frequent now, than it was twenty or thirty-years ago, though not less virulent. Hence a visitation from it causes universal alarm. I have a theory of my own upon Cholera, which it may be well to mention here; it may not be new, and it may not be true, but by it I can account for most of its concomitant symptoms; and its adoption renders the numerous names used to express a supposed different type superfluous; such as Blue Cholera, Cholera Asiatica, Cholera Asphyxia, Cholera Spasmodia, &c., for I believe, all these are merely different stages of the same disease. I will not pretend to ​say, which is the first cause of Cholera, nor do I think we shall arrive at that knowledge till the analysis of the atmosphere is carried to infinitely greater perfection than it is at present; till we are able to separate the principles of small-pox, plague, and intermittent fever from the air we breathe, and bottle them up as we do oxygen, nitrogen, and carbonic acid gas. I consider cholera essentially a disease of secretion, of immoderate secretion of serum from the skin and the intestines. In the first few hours so much liquid is withdrawn from the blood, that it becomes too much inspissated to pass through the capillaries from the arterial into the venous system; the whole course of circulation is stopped nearly as effectually, as if the arteries were filled with treacle or tar, for the blood soon becomes of that consistence. Hence engorgement of the arterial system, suppression of all glandular secretion, of bile, of urine, of saliva; hence congestion of the lungs and asphyxia, imperfect oxidation of the blood, and lividity of countenance, cramps and spasms, clammy coldness and death. I believe, I am correct in stating, that during an experience of twenty-five years, I have not met with cholera in an epidemic form more than five times.
I do not intend to enter upon the questio vexata as the contagiousness of cholera, but shall merely ​give a slight sketch of its visits on three principal occasions when I had to contend with it.
The first time I saw Cholera as an epidemic, was in the campaign against the Coles, in 1832. Soon after leaving Barrackpore, in November, it showed itself in the camp to which I was attached. For nearly a month it assumed the sporadic form, selecting for its victims the camp followers, and the weaker Sepoys only. Though a good many of those attacked were carried off, still it did not excite much alarm; and we hoped,by constant change of ground, and the cold weather increasing, to leave it somewhere behind. However, after we had penetrated about twelve marches into the interior of the enemy's country, it burst out at Luckipore with all the violence of an epidemic, and raged for several days with most appalling mortality. The hospital became crowded to excess;two, three, or four poor fellows were carried in every hour; and so rapid was the progress of the disease, that many died a few hours after they were attacked. Many of the followers, rather than run the risk of living longer in camp, fled into the forests, and attempted to find their way home;running the risk of meeting upon their path the numerous beasts of prey, and the enemy, as savage as merciless, and still more dangerous than the wild beasts, through many a ​weary mile. The retching of those attacked—the groans of the dying, and the lamentations for the dead, occupied the ear incessantly night and day; graves were seen a digging in every direction, and funeral piles smoking all around, tainting the very atmosphere with human empyreumatic odour, flocks of kites and vultures hovered over the dismal scene, screaming to be deprived of their expected prey, troops of jackals prowled about at night, tearing open and robbing the newly-tenanted graves of the Mussulmen; and the short hoarse bark of the hyena, like a knell from a death's head, grated upon the startled ear; warning us of our mortality, and of his, perhaps, groping for our bones before another day's dawn. Public religious processions were frequently performed by the natives, each caste separate by itself, with all the noisy solemnity characteristic of Hindoo and Mussulman rites, the one trying to out-do the other in their supplications to their favourite deities, to abate the dreadful calamity; and, to complete the tragical scene, the savage enemy, apparently exempt from the disease, looked on composedly, from the skirts of the jungle ready to empale with their arrows any one who ventured beyond the picquets, and anticipated our extermination without any efforts of theirs to assist.
When things were in this condition, we broke ground, marched two days in succession, and ​halted at Boonga. We had not a case of cholera after leaving Luckipore. It is pretty well ascertained, though not easily accounted for, that if cholera break out in camp, and if that camp be broken up into parties, the chances are, that the greater number of parties will be exempt. This was strikingly exemplified in two companies of the 34th native infantry, that were detached: they had not a case of cholera after, though it continued with the head-quarters. The number of deaths on this occasion amounted to about seventy: about three-fourths of these were camp-followers. Most providentially, not a European officer was attacked: such is the caprice of this awful disorder.
The second time it was my fortune to meet with epidemic cholera, was in May and June, 1834, while in medical charge of the civil station of Goalpara, in Assam. Its progress up the Brahmapootra was very wed marked, but slow. I first heard of it at Dacca, some time after at Jumalpore, next it reached Goalpara, then it proceeded to Gohatti, thence to Bishnauth, and all in regular succession. Several weeks elapsed during its progress from Dacca to Bishnauth. In the town of Goalpara, with about 4,000 inhabitants, about 300 died of it. It continued to rage for six weeks. Its virulence seemed to have abated at Bishnauth, where only a few died.
The last time I saw cholera as an epidemic, ​was after the capture of Rangoon, in April, 1852. At the great pagoda, within the stockade, in the field hospital, and on board the shipping, it raged with appalling mortality. I have never seen it in so aggravated a form, and of thirty-three European artillery men attacked, I lost nine, most of them the finest and strongest men of the battalion.
Though cholera so rarely assumes the epidemic form, an occasional case happens at all seasons.
8. SCURVY.—Scurvy has of late years become much more prevalent in India than formerly, or rather I am inclined to think that that disease has previously existed under some other names. On my assuming medical charge of the civil station of Gohatti, 1836, I found it prevalent amongst the prisoners, under the name of gangrene, and that many of them had, previous to that time, died of it. The mouth was the chief seat of the disease. It manifested itself by a pale sponginess of the gums, and looseness of the teeth; or by a foul ulcer inside the cheek. All the symptoms of profuse salivation rapidly ensued; the gums became a mass of suppurating matter, the teeth dropped out, the ulcer spread over the mouth, the cheeks sloughed away, the patient sank exhausted—or, if he recovered, he was frightfully deformed. The hospital stores contained almost no anti-scorbutic. Oranges and lemons, indigenous to the neighbouring hills, were ​then plentiful in the bazaar. I bought them in basket-suds, prescribed them ad libitum in every case, and found them a perfect specific. I was fortunate in losing only one or two cases, and they were far advanced before they came under my care. No symptom of this disease showed itself amongst the Europeans at the station.
At Lahore, in 1848, I had no less than 425 cases of scurvy amongst the Sepoys of the 31st regiment native infantry. The ulcers generally began by a thickening swelling and engorgement of the cellular substance, soon after assuming the nature of an irritable bod, which, when cut into presented a spongy mass of cells infiltrated with pus. These sometimes remained in a chronic state, covered with a hard raised horny crust, or they ran into a phagydenic ulcer extending rapidly on all sides, dividing muscles and tendons, and laying bare the very bones. No part of the body was free from them, though they were chiefly confined to the lower extremities. When most prevalent every open sore took on the same ulcerative character, and a bubo, an abrasion, or a blister, as in hospital gangrene was speedily changed into a phagydenic ulcer, threatening to involve the whole limb in mortification. Such ulcers generally went by the vague name of Scinde boils, but I came to the conclusion, that all such sores so common along the course of the ​Indus, were merely types of scurvy, and treated them as scurvy with the greatest success. In 1849, I had medical charge of the 2nd European Fusiliers at Lahore, and found about one-third of the regiment afflicted with scurvy. In them it was not of an ulcerative character, but marked particularly in the gums with swelled legs, and general anemia; and when diarrhœa set in upon such a constitution,it was of a very intractable and fatal character. My impression was that the general scantiness of vegetable diet so common in the Punjaub and Scinde, was the cause of this scorbutic diathesis. As the best means of improving the tone of health of the regiment, and eradicating the disease, I recommended that half a pound of fresh vegetables should be added to the daily rations of the soldiers, and it was sanctioned by government,and the same concession has since been extended to all European troops in the presidency with the best effects.
Scrofula is a rare disease amongst the natives, as is also phthisis; and it is generally allowed that India is very favourable to Europeans affected with these diseases. Elephantiasis,leprosy, hydrocele, are common; syphilis and gonorrhæa are prevalent every where.
9. MAHAMURRY.—It is very remarkable, that in the Himmalayah mountains, especially in Kumaon, at elevations of from five to seven ​thousand feet, a disease frequently becomes epidemic with most of the characteristics,and all the fatality of plague, and known there by the name of Mahamurry, or the Great Mortality. As soon as the disease manifests itself, the people leave the place, and take up their temporary abode a considerable distance from the infected village; the dead are left unburied where they fall, the sick deserted where they lie, nor do the survivors venture back to their homes for months and years, when decomposition and time is supposed to have purified the infected spot. So strong is their conviction of the Mahamurry being contagious, that acordon is immediately made round a community suffering from the disease, and if one of their number were to venture beyond the boundary, he would be stoned to death.
10. PREDISPOSING CAUSES OF DISEASE.—A sound mind in a sound body,has long been known to be the best prophylactic against disease; a man in good health and of a cheerful train of mind, may be many times exposed to contagion or malaria with impunity, whereas one labouring under any bodily ailment, or depressing passion, is very liable to catch infection. Hence poor diet, bad water, scanty clothing, wretched houses, famine, fatigue, misfortune, melancholy, prepare the body for the seeds of fever; and the weak and inanimate are more frequently its victims than the ​strong and the active. Hence the propriety of a more generous diet, and an extra glass of wine during the prevalence of an epidemic, especially cholera.
11. MALARIA.—It is a generally received opinion that the greater proportion of the diseases of India is the consequence of malaria generated in the decomposition of animal or vegetable matter: that a certain ethereal essence, whether a gas or a vapour, a film or an aroma, is evolved by such substances, when exposed to putrefaction in moist high temperatures, which has the property of causing fever when inhaled, or absorbed externally. The germs of disease are so ethereal, that they have hitherto baffled all art and all science to identify them, either in air, earth, or water. We can separate the component parts of all three, and bottle them up like May-dew; we can handle electricity, galvanism, and magnetism as we would material agents; we can divide the light of day into its constituent elements, and convert the red, and the yellow, ray into peculiar uses,—and the violet ray into a photographic pencil, far surpassing in truth, the paintings of the most able artists. But who can analyze a cubic foot of air, and be able to ascertain whether it be good or wholesome, or contain the essence of small-pox or cholera, or plague, or intermittent fever? Yet our belief is that these must exist as distinct ​elements in the atmosphere; and till chemistry attains to that extreme perfection, we must be content to use the old fashioned terms malaria and contagion to explain our meaning; and our theories without meaning. This miasma is generated more readily in Autumn than during other seasons of the year; is more potent at full and new moon than at other periods of lunation;and more active between sunset and ten o'clock, than during the rest of the day. Miasma seems to possess gravity; soldiers that sleep on the ground-floor are more sickly than those that sleep on the second or third story. European settlers preserve their health in the Sunderbands of the Gangesby living in lofty houses; and in the forests of Malacca, some wild tribes actually roost upon lofty trees; indeed, the distribution of miasma is directed by the same laws that are applicable to smoke or fog.
Miasma is liable to be dissipated by heat; a moist atmosphere is more favourable for its action than a dry one, and a person may sleep in a marsh with impunity, if beside a watch fire. Miasma may be conveyed by the wind to a considerable distance, with its properties unimpaired. A ship may anchor, and a regiment may encamp a mile distant to windward of a marshy island without suffering; whereas,if so situated a mile to leeward, both would suffer from fever. An army may encamp with safety on the sea-shore of a ​pestilential island during one monsoon, when the wind is from the sea, but if the monsoon change, and blow from the interior, sickness invariably follows. Miasma loses its property of producing fever in its progress on the wind, as if it became too volatile to have effect. Localities within one mile of a marsh may be feverish, whereas others five miles distant may be healthy. People born and bred in a malarial country become inured to it, and enjoy comparatively good health, where new comers would suffer. The Garrows, one of the hill tribes, on the frontier of Assam, are the most powerful, athletic race I have seen in India, yet they inhabit a country, into the interior of which no European could penetrate without the certainty of a most dangerous fever. In some parts of South America, a slave escapes from bondage, and finds a safe asylum in some well-known deadly jungle, knowing that his master would follow him thither at the risk of his life. Landholders frequently take advantage of their being seasoned to marshy situations, renting their farms at a very low rate, when a succession of casualties to new coiners has prevented people in general from having anything to do with such supposed unlucky spots.
In most cantonments in India, there are certain marked houses,known from their unhealthiness, and waste; or only occupied for a month or two ​by strangers. There are in general good grounds, for the reputed character they bear, and though it be only a popular opinion, it is the safest plan to retain it.
The state of sleeping or waking materially affects the liability to miasma: a person may pass through an unhealthy country with safety if awake, whereas if asleep he will most likely be attacked; as if the vis medicatrix that protected the constitution when awake, went to sleep along with its master, leaving him unprotected.
It is also curious that miasma may be effectually shut out by tying up the head in a gauze veil, which acts like the wire-gauze of the safety lamp. Hence an advantage of the native mode of sleeping with the head and body wrapped up in a cloth,which no doubt saves them from many a fever. A belt of high trees intervening between a marsh and a town, is known to afford a similar exemption to the inhabitants. Numerous instances exist of towns becoming suddenly unhealthy after the cutting down of such high belts of trees, as well as other instances of towns being protected by having a grove of trees planted between them and the marsh. Miasma seems capable of accumulation in the soil, and the breaking in of old forest land is generally attended with much sickness. Hence cantonments suddenly established on the site of a cut down forest are at first very unhealthy, ​of which the new cantonment of Namean, on the Irrawaddy, is a noted example, and has been abandoned in consequence of its unhealthiness, yet Namean seemed to possess all the advantages desirable in a cantonment. It is ascertained that all the types of intermittent fever may be occasioned by the same exposure to miasma; four persons may pass through a jungle at the same time: one may get a quotidien fever; one a tertian, and one a quartan, and one may escape; and the one may be attacked an hour or two after the exposure;another a day or two; another a week or two, the seeds of fever lying dormant in the constitution.
12. MARSHES.—These are the principal sources of miasma or malaria, and hence the name of marsh—fever;and hence the propriety of draining marshy ground, and the impropriety of excess of irrigation, converting good soil into a nursery for fever. That Calcutta is so much more healthy now than it was in the olden time, when the survivors held a jubilee when the sickly season was over, is chiefly owing to the drainage of its marshes and jeels, and learing away jungle;and that cultivated lands may be depopulated even by marine inundation, was manifested in the awful mortality from fever that followed the irruption of the sea into the districts of Balasore, and the ​twenty-four pergannahs, sweeping away thousands and thousands of the population.
The stations of Hansi and Kurnaul, are good examples of the generation of fever from excess of irrigation;the country is naturally dry and unfertile, so as to give little crop if dependent on the scanty rains of the seasons. An abundant supply of water for cultivation was furnished by a canal,but without due discretion, this was allowed to overflow the country to excess,converting it into a hotbed of fever. The consequence was, that Kurnaul, one of the largest and finest cantonments, was abandoned;and its hundreds of elegant houses in ruins, and its endless ranges of barracks, not yet in ruins, are lasting monuments of the abuse of one of the most essential elements of life. The superintendents of the Great Ganges Canal, and of those of the Punjaub, have, therefore, good reason to be on their guard against similar abuse. But the abuse of the new canal by excess of irrigation is not the only evil to be apprehended; the bed of the old river must not be over drained so as to stop the current, and leave nothing but a chain of stagnant pools; for if this is done, great sickness is unavoidable, and the blessing intended to be conferred upon the country may turn out a public calamity.
All water, to remain wholesome must be in a ​continued state of circulation; agitation is not enough, and no one can taste water that has stood in a glass for a week unmoved and unchanged, especially in a hot climate without being convinced of the truth of the theory. Hence also the reason why the months of August,September, and October are so unhealthy. In these months the periodical floods are subsiding; the country is covered with a stratum of slime, and mud, and decaying vegetation: the inhabitants of many such districts abandon their houses at that time,nor venture to go back till the unhealthy season is over. The Tarai along the foot of the Himmalayan mountains; the Delta at the mouth of the Indus; the Sunderbunds of the Ganges, are in a great measure deserted at this season, few remaining exposed that can effect their escape. Many parts of the interior are, during these months, insulated by cordons of jungle, and no one who values his life would willingly pass through them.
13. RICE FIELDS.—The same laws that operate in rendering marshes miasmatic, also act, though perhaps in a less degree, in the rice fields of India. Towards the end of the rains and while the fields are still flowing with water, the ears are cropped and the straw is allowed to remain to ferment and form malaria. This is not a visionary idea, for so strong is this belief, that in many parts of the continent of Europe, far less favourable for ​the development of miasma than India, the laws of the realm prohibit the growth of rice contiguous to towns.
14. TANKS, POOLS AND DRAINS.—But marshes and rice fields are but two of the many sources of disease to be seen on every hand in India. Every native of rank has a nursery for fever in the immediate vicinity of his house called a tank, and every poor man a pool, from which he dug the mud to build his house,which seem as if made on purpose to supply them with malaria, as well as with muddy water. I do not mean to attribute any blame to tanks and ponds, if kept properly clean, they would then be both useful and ornamental, and the sod excavated in forming them would serve to raise the adjoining land and render it dry; but from the weeds and jungle that in most cases are allowed to infest them, they exert the most prejudicial effects on the health of the inhabitants. If the ditches of Fort William were allowed to remain filled with stagnant water, and become a field for the study of reeds and rushes, its present healthy character would soon leave it, and were the numerous tanks throughout Calcutta left to nature, the consequences on the public health would be calamitous.
Things are bad enough as they are. Calcutta is probably the worst drained city in the British dominions; its present drains are nothing better ​than elongated cesspools, indescribably filthy and offensive; without the necessary fall to give a current to the rain water when it falls, and absorption and percolation are the chief agents in checking the bad effects. Nor are the injurious effects confined to the most filthy parts of the native town, but they taint the health of the inhabitants of its palaces.
A considerable reservoir of river water, filled by a steam pump, stands upon the esplanade, with a canal extending into Chowringee; but it is useless as a detergent for the public sewers; the original object of it was to water the streets, and to fill the tanks;but the chief use made of it is by sweating natives and sweating horses to bathe with.
For the last twenty years, we have had one committee after another sitting upon the conservancy department of Calcutta, but bringing forth nothing vital. All of them have lamented the most unhealthy state of the public sewers; all have suggested something being done, but the original evils remain to this day unmitigated.
Nevertheless, the drains of Calcutta admit of being as well purified as any town in the world, the rise of the tide is from twenty to thirty feet; indeed, a great part of Calcutta is below the level of the spring tides, and it is only necessary to sink the present drains ten or twelve feet to have ​most perfect drainage, and have a rush of pure water twice a day. Tollys Nulla, the circular canal, and the river, are most conveniently situated for opening the necessary number of arteries.
15. FLOATING CORPSES.—These form another source of sickness. Though the Hindoos profess to burn the bodies of the dead, and throw the ashes into the sacred Ganges, or any of its million branches, yet the poorer classes either cannot afford fuel for this purpose, or do not incinerate. They are satisfied with singeing the body with a bundle of straw, and sinking it by means of an earthen pot filled with mud, and tied to the neck of the deceased. As soon as decomposition takes place, and the development of gas, the body rises to the surface, and drops down the stream for hundreds of miles, tainting the atmosphere as it floats along, till maceration and birds of prey strip the flesh from the bones, and cause it to sink to rise no more.
Not long ago this Hindoo practice became the subject of a public inquiry; but I believe the evil was thought to be too deeply rooted in native superstition to be put down by the order of the magistrate