Jan. 8, 1880] 



NATURE 



231 



And it can be shown from the same source (Bryden) that 

 there is a similar reduction in the death-rate among native 

 troops ; and that, during the great cholera epidemic that 

 prevailed in 1876, the death-rate among the civil popula- 

 tion being 12-12 per !,ooo (it was the famine yen 1 , that 

 of the European troops was 175 and of the native army 

 2'2 per 1,000. Also that in the death-rate of that great 

 scourge of India— fever— there has been an equally happy 

 result, as shown bv the death-rate of a period of nine 

 year3 _f rom !S6S to 1S77— in the Bengal and N.W. 

 Provinces gaols, as against a mean, in nine years ending 

 1867, of 22-41.' 



Mean ... 22-41 Mean ... 3-29 



In India, as elsewhere, the purpose of epidemiological 

 study is to observe accurately and to interpret the import 

 of the facts — i.e. if possible, to elucidate the laws of which 

 they are the expression, — and thus to form a scientific 

 basis on which to direct sanitary work, which itself is the 

 practical outcome of such observation, and concerns itself 

 but little with theories. Those who have to do with it 

 know how difficult it sometimes is to obtain reliable ob- 

 servations, such is the difficulty of excluding the bias of 

 preconceived theory of the nature of the subject under 

 investigation. Our Society, however, must hold the 

 balance, and deal with theories as well as facts. No 

 doubt the explanations sometimes are conflicting. 

 Happily, in the practical mode of dealing with the ques- 

 tion, there is not much conflict, and it is remarkable how 

 little different is the action of those who hold opposite 

 opinions on the causation of disease. As to the different 

 views that are held in regard to fundamental questions 

 regarding the genesis and diffusion of disease let us hope 

 that we may, perhaps, here contribute something towards 

 their adjustment. 



In illustration of the state and progress of epidemio- 

 logy in India I might select the history of any of the 

 great epidemics that have occurred of late years, but it 

 would be impossible, in the short space of time at my 

 disposal, to do this completely. I shall, therefore, confine 

 myself to a few remarks on cholera, as it, though far from 

 being the most destructive, is the epidemic to which most 

 interest attaches. 



The theory that cholera is purely of Indian origin, and 

 that wherever it may appear it is to be traced back ultimately 

 to the delta of the Ganges, is disputed by some who sec 

 in history evidence that it had long been existing in other 

 parts of the world, and that it was described by the earliest 

 writers — Sanscrit, Greek, and Arabian. I may here just 

 remark that the name " haida," or " haiza," used by 

 Rhazes nearly 1000 years ago in describing the symptoms 

 of cholera, is the same as that applied to it now by every 

 Hindustanee-speaking native of India. As to its presence 

 in India, from earlier periods we have descriptions by 

 Correa. d'Orta, Bontius, and others, beginning from 1503. 

 An epidemic of it in and about Goa in 1543, for example, 

 is described by d'Orta, giving all the characteristics that 

 distinguish an epidemic now. He calls it "moryxy" and 

 also "haiza." It is described by a continuous chain of 

 writers as occurring in various parts of India, in the 

 interior as well as on the coast, up to the seventeenth 

 century, when, after being quiescent during the later part 

 of the eighteenth and early part of the nineteenth century, 



1 Bryden's Report (1S76), p. 157. 



it broke out with great virulence in Bengal, and has 

 remained there ever since, in what Bryden calls its en- 

 demic area, whence it spreads according to certain laws, 

 which are being worked out with admirable patience and 

 intelligence by this distinguished statistician. I cannot 

 now trace the history of cholera in either East or West, 

 nor refer even to the numerous authors who have described 

 it. For full particulars on this subject I refer you to 

 Inspector-General Dr. J. Macpherson's learned work, 

 " The Annals of Cholera." 



I need hardly insist that cholera is not a new disease, 

 or that it did not, as by some supposed, make its first 

 appearance as an epidemic in Jessore, in Bengal, in 1S13 ; 

 though no doubt since that period it has been more 

 closely investigated and described. All seems to show 

 that it is the same now as formerly, and that though wc 

 have gained much knowledge of its natural history of 

 rs, yet we are as ignorant as our predecessors ot 

 its real nature. We have, thanks to sanitary measures, 

 I it of some of its terrors, and have diminished 

 the mortality it caused; but as to treatment we have 

 gained but little, though the empiricism of to-day is more 

 scientific than it was in former days. We do not now 

 burn our patients on the soles of the feet, tie ligatures 

 round their limbs, or have recourse to other senseless 

 barbari ics ; for we find that simpler and more rational 

 methods are of greater avail, more or less according to 

 the period of the epidemic at, and the promptitude with, 

 which the remedies are applied. But we have learned 

 that local causes have a potent influence, and that clean- 

 liness, good air, pure water, and free ventilation arc all 

 powerful opponents of cholera ; that we can predict its 

 appearance and avoid it in certain places ; and that it is 

 not to be controlled by quarantine or sanitary cordon-. 

 And from the earnestness and intelligence with which 

 the subject of its etiology is pursued, it is not improbable 

 that sooner or later it too will be made out. We shall 

 then be in a position to say, not only what it does or will 

 do, but what it is. Meanwhile we must go on observing 

 and investigating. It is satisfactory to know that we are 

 daily learning, practically, better how to deal with it, and 

 how to modify its cyclical intensity and avoid its ravages. 

 For mv own part, until I know something more of the 

 mature of the cause — be it a material poison, aerial or 

 telluric, a miasm, or a dynamic agency that so perturbs 

 the vital energy, I cannot sec my way to formulate a 

 definite theory either of the nature of its origin or the 

 method of its 'diffusion. I find the highest authorities 

 at complete variance on the subject, and reposing faith in 

 theories diametrically opposed to each other. Some 

 explain all the phenomena by contagion—*.*., communi- 

 cability in some way of a materies or germ from one 

 person to another. Cholera, they say, is the result of 

 infection by a poison derived from the intestines, and 

 water or air, but especially water, is the channel through, 

 bv or in which the infective material is intensified 

 and conveyed. These arguments are supported by an 

 abundant array of facts, and have been maintained by 

 men whose very names carry conviction. Others reject 

 1 this explanation; they insist that local influences 

 are all-important, and deny that the spread of cholera is 

 due to human intercourse, that there is any poison trans- 

 mitted by the excreta, or that the disease is in any way 

 communicable from one person to another. They admit 

 the existence of a poison of some sort — a miasm or an 

 influence, though of it- nature they are ignorant. It is a 

 subtle thing that travels in certain directions in obedience 

 to certain laws, is influenced by atmospheric and telluric 

 conditions, and where it finds certain local conditions, 

 and the people prepared by them to submit to it, there 

 cholera will prevail. They deny the efficacy of any 

 enteric or specific poison in the water to produce it, though 

 they attach the greatest importance to the purity of water 

 from all organic contamination, impure water being one 



