Females. London Calcutta
... ...
2'8 2-1
9*4 7'4
28 7 23*3
34-2 39*3
40'9 32'8
18*0 20'8
6'9 7*1
The comparative paucity of infants, children, adolescents and aged, and the excess of the middle-aged, are the most noticeable features. Among females, however, the disparity is less and the proportions less abnormal. This result is due to the immigrants being principally males. The following table showing the deaths of 1881 according to age, prepared by the Health Officer, compares instructively with these figures :?
Under, Periods.
CURRENT MEDICAL TOPICS.
Among: the honors distributed
on
one
1-4
5-19. 20-39. 40?59' 60-
year.
the occasion of the Queen
Empress's 63rd Birthday we are glad to observe that the Medical Department has not been forgotten. Deputy SurgeonGeneral \V. J. Moore, of the Bombay service, Honorary Surgeon to the Viceroy, has been created a Companion of the Indian Empire. The distinction is well merited. Dr. Moore's public and professional life has been throughout conspicuous for industry and energy sustained by a more than ordinary endowment of intelligence and ability. The vacancy in the list of Honorary Surgeons to the Viceroy, caused by the lamented death of Surgeon-Major R. W. Cunningham. M. D., has been filled up by the appointment of Surgeon-Major G. C. Chesnaye of the 4th Goorkhas, The death-rate of the town of Calcutta for the year 1881 was 30 per 1000 against 28"7 in the preceding decennium. The excess of mortality was due to a considerable increase of cholera deaths. Fevers were less fatal than in previous years ; the mortality from small-pox was considerably below the average ; the number of deaths from bowel complaints was below the decennial mean, but an excess of deaths ?appears under other causes. The registered birth-rate of the town was only 17-2 per 1000 of population against a still lower rate of 14*2 in the previous decennium. A low birth-rate is to be expected in a town in which there are 179 males to every 100 females, and when a very considerable proportion of the latter are unmarried and unproductive ; still the very low rate quoted, above has been proved by the recent census to be wrong, and taking all the circumstances affecting the question into account, it is thought that 24 births per 1000 is something like what the birth-rate of Calcutta ought to be.
London Calcutta
179 423
43 62
5-1
17-5
86 185
22-1 22-6
Both sexes. Under
Periods.
one
1-4, 5-19, 0-19, 20-39, 40-59,
year London Calcutta
... ...
3-0 1*4
10-0 5'0
29-7 20'4
60 and upwards.
42-7 26 8
33-4 48-3
17-7 20 2
6-2 4-7
44 6 23'8
32-5 52*8
17 5 19*9
5*4 3-5
Males. London Calcutta
...
...
3*2 1-1
10*6 3-8
30 8 18"9
23-1 30
It will be observed that the most striking differences are in the earlier periods, more especially as regards infants. The period 40?59 gives almost equal ratios, and the deathrate among the aged in Calcutta is actually more favourable than in London. The reason of these anomalies is probably the removal elsewhere of the dangerously ill before death actually takes place. The following instructive illustration of the influence of filth on cholera prevalence is given in this report:? " Seth Bagan is a dense collection of tiled huts, surrounding two very filthy tanks situated a little to the east of Upper Chitpore Road (No. 85). In the hot weather of 1880, I inspected the place carefully and drew attention to several glaring sanitary defects which I observed?more particularly the foul tanks, general uncleanliness of the bustee, and the filthy drains loaded with organic impurity pervading it. when the events which I Improvements had been commenced Cholera had not broken out in am about to relate transpired. to this time, though some the village or its neighbourhood up in the Jorasanko Section. 27 deaths had occurred On the 26th of March some sweepings were, through a mistake of the Conservancy Department, thrown into the more had southerly of the two tanks, which on not been previously using the water for de-watered, The villagers went case of cholera occurred bathing, washing dishes, &c. A fatal the tank on the 28th, and in a hut on the immediate west of another hut close by on the an old woman died of purging in Another death from cholera happened in a hut same day. to the south-west of the tank on the 2nd of April. On the 5th of April a quantity of putrid dall, which had been condemned by me, was, through a mistake of the Conservancy This material exhaled Department, thrown into the tank. went on using the water. a foul stench, but the people still Cholera seizures occurred on the 6th, 7th, and 8th in the hut next to the heap of putridity, resulting in four deaths. of the tank which reAnother case occurred to the west which seven proved fatal, covered. Thus eight cases, of broke out on the borders of this hollow immediately or had shortly after these putrid materials in been thrown into it. another part of the Two deaths subsequently took place village on the 16th and 18th of April near a foul drain which was in process of being piped. The evidence now recorded is not demonstrative, but it amounts to a very high probability that the filth deposited in this tank was the exciting cause of the outbreak in Seth of the air or water. I Bagan either through the medium investigated several other cases during the year in which filth and cholera were intimately^ associated, but none so clear as the above. On the detection of the outbreak and the circumstances associated with it, prompt steps were taken to empty the tank and disinfect the putrid heap. The tank has now been filled up, the drains piped, and the village described no report generally improved ; and since the events me." of unusual sickness or mortality has reached
sporadically
^
With a birth-rate of 17*2 and a death-rate of 30 Calcutta would soon be depopulated. Yet successive census show that the numerical strength of the population is maintained. This is due to the constant immigration of outsiders who are attracted by the industries and commerce of the town. No more than 29'7 per cent of the residents of Calcutta were born in the town. The peculiarities of the population are well brought out by the following table copied from Mr. Beverley's report of the census of the town?taken on the 17th of February 1881.
82-7 59
All ages.
June
THE CALCUTTA MEDICAL SOCIETY.
1,' 1882.J
The report contains abundant evidence that those parts of the town where sanitation is more backward, have the highest death-rate, and that those races which are least attentive to cleanliness die in largest numbers.
Evidence is adduced in the report to show that typhoid fever is not very prevalent in Calcutta. A return supplied by Professor J. F. P. McConnell, Pathologist to the Calcutta Medical College, shows that during the years 1874-81 inclusive the bodies of 14 Europeans and Eurasians who had died of fever were examined post-mortem, and of 108 natives. Among the former typhoid lesions were recognised in 2, and among the latter in 5 cases. The following paragraph touches a subject which has been repeatedly noticed in these pages :? liotheln.?Having met with several cases of an eruptive disease resembling in its features the affection known as Rotheln or German measles, I made careful enquiries among the medical practitioners of the town whether they had seen "
similar cases.
The result of these enquiries has been to prove an eruptive malady, different from has prevailed extensively during the rains and cold season in Calcutta. The subjects of this disease have been mostly children. The affection is a mild one, seldom ending fatally. It commences with the malaise, usual in the exanthemata. This is followed by a smart attack of fever of six or seven days'duration, presenting a remittent type, the temperature seldom exceeding 102? or 103 On the third or fourth day a roseolar eruption appears on the face and chest. It lasts for three or four days, spreading all over the body, and succeeded by a branny desquamation of the cuticle. There is some watering of the eyes and a loaded tongue with bright papillge at tip and sides, often a catarrhal sorethroat, and occasionally bronchitis and diarrhoea. Aphthous patches have also been noticed on the gums, cheeks, palate and fauces. The older practitioners aver that this is not a new form of disease, and that they have met with cases during the rains for the last 20 years. If infectious, it seems to be very feebly so. Instances have been observed of attack after measles, and vice versa. My own opinion is that the disease in question corresponds more closely to that which is described under the term liotheln than to any other.
beyond dispute that measles or scarlatina,
.
Surgeon-General
J.
M.
Cunningham
in
reviewing
the
history of cholera in 1880 for the whole of India, shows that the disease was remarkably mild. There was a very striking falling off in cholera mortality in every province except the North-Western Provinces and Oudh and British Burmah. Dr. Cunningham combats the idea that the diminished
mortality among tea coolies proceeding to Assam was due to improvements in the conservancy of their drinking water. His principal argument is that a similar decline of mortality occurred in the districts through which they pass-
ed. He also discredits the influence of the Hurdwar fair of 1879 in generating and spreading cholera, because the N. W. Provinces and Ou?h suffered more in 1880 when there was no Kumbh mela than in 1079. The report of the condition and management of the Jails in the North-Western Provinces and Oudh for the year 1881 has been drawn up by Brigade Surgeon W. Walker, M. D., M. A., F. R. C. S., with his usual accuracy and skill. The general death-rate for the province was 23 per 1000. This rate compares very favourably with the rates of other pro" A death-rate of 23 per vinces and presidencies in India. 1000 of average strength of the convict population, is," " evidence of fair general health Dr. Walker writes, good amongst the free population as well as of generally sound sanitary conditions in the prisons. But I regret that as in past years I have to draw attention with a feeling of shame to the high death-rate in a few notoriously unhealthy jails, these are the Meerut Central Prison with a death-rate of 40 per with a death-rate of 139 per 1()00, Gorakhpur District Jail a 1000, and Mirzapur Jail with death-rate of 70 per 1000." He goes on to discuss the conditions under which these excessive rates of mortality occurred, and ends this section of his report with the following virtuous confession and aspiration :? " The prevalence of dysentery, diarrhoea, asthenic pneumonia and cases of sloughing ulcer still warn us that the sanitary conditions under which the prisoners in certain jails live are
163
not perfect. The medical officers in charge must feel as I do that the occurrence of such cases is a stigma upon jail management, and we dare not rest satisfied until the abnormal death-rate in every jail can be proved to arise solely from the reception of old broken-down poor house cases and not from disease produced in strong men in the prime of life, simply because they liave become inmates of a jail" Dr. Walker believes that the true method of combating Asiatic cholera is to attend strictly to general sanitation- We him. Is it possible that there is are inclined to agree with a cholera microzyme after all; which having fattened on cholera discharges, acquires specific virulence thereby and retains it in subsequent developments in common filth ?
... ...
2'8 2-1
9*4 7'4
28 7 23*3
34-2 39*3
40'9 32'8
18*0 20'8
6'9 7*1
The comparative paucity of infants, children, adolescents and aged, and the excess of the middle-aged, are the most noticeable features. Among females, however, the disparity is less and the proportions less abnormal. This result is due to the immigrants being principally males. The following table showing the deaths of 1881 according to age, prepared by the Health Officer, compares instructively with these figures :?
Under, Periods.
CURRENT MEDICAL TOPICS.
Among: the honors distributed
on
one
1-4
5-19. 20-39. 40?59' 60-
year.
the occasion of the Queen
Empress's 63rd Birthday we are glad to observe that the Medical Department has not been forgotten. Deputy SurgeonGeneral \V. J. Moore, of the Bombay service, Honorary Surgeon to the Viceroy, has been created a Companion of the Indian Empire. The distinction is well merited. Dr. Moore's public and professional life has been throughout conspicuous for industry and energy sustained by a more than ordinary endowment of intelligence and ability. The vacancy in the list of Honorary Surgeons to the Viceroy, caused by the lamented death of Surgeon-Major R. W. Cunningham. M. D., has been filled up by the appointment of Surgeon-Major G. C. Chesnaye of the 4th Goorkhas, The death-rate of the town of Calcutta for the year 1881 was 30 per 1000 against 28"7 in the preceding decennium. The excess of mortality was due to a considerable increase of cholera deaths. Fevers were less fatal than in previous years ; the mortality from small-pox was considerably below the average ; the number of deaths from bowel complaints was below the decennial mean, but an excess of deaths ?appears under other causes. The registered birth-rate of the town was only 17-2 per 1000 of population against a still lower rate of 14*2 in the previous decennium. A low birth-rate is to be expected in a town in which there are 179 males to every 100 females, and when a very considerable proportion of the latter are unmarried and unproductive ; still the very low rate quoted, above has been proved by the recent census to be wrong, and taking all the circumstances affecting the question into account, it is thought that 24 births per 1000 is something like what the birth-rate of Calcutta ought to be.
London Calcutta
179 423
43 62
5-1
17-5
86 185
22-1 22-6
Both sexes. Under
Periods.
one
1-4, 5-19, 0-19, 20-39, 40-59,
year London Calcutta
... ...
3-0 1*4
10-0 5'0
29-7 20'4
60 and upwards.
42-7 26 8
33-4 48-3
17-7 20 2
6-2 4-7
44 6 23'8
32-5 52*8
17 5 19*9
5*4 3-5
Males. London Calcutta
...
...
3*2 1-1
10*6 3-8
30 8 18"9
23-1 30
It will be observed that the most striking differences are in the earlier periods, more especially as regards infants. The period 40?59 gives almost equal ratios, and the deathrate among the aged in Calcutta is actually more favourable than in London. The reason of these anomalies is probably the removal elsewhere of the dangerously ill before death actually takes place. The following instructive illustration of the influence of filth on cholera prevalence is given in this report:? " Seth Bagan is a dense collection of tiled huts, surrounding two very filthy tanks situated a little to the east of Upper Chitpore Road (No. 85). In the hot weather of 1880, I inspected the place carefully and drew attention to several glaring sanitary defects which I observed?more particularly the foul tanks, general uncleanliness of the bustee, and the filthy drains loaded with organic impurity pervading it. when the events which I Improvements had been commenced Cholera had not broken out in am about to relate transpired. to this time, though some the village or its neighbourhood up in the Jorasanko Section. 27 deaths had occurred On the 26th of March some sweepings were, through a mistake of the Conservancy Department, thrown into the more had southerly of the two tanks, which on not been previously using the water for de-watered, The villagers went case of cholera occurred bathing, washing dishes, &c. A fatal the tank on the 28th, and in a hut on the immediate west of another hut close by on the an old woman died of purging in Another death from cholera happened in a hut same day. to the south-west of the tank on the 2nd of April. On the 5th of April a quantity of putrid dall, which had been condemned by me, was, through a mistake of the Conservancy This material exhaled Department, thrown into the tank. went on using the water. a foul stench, but the people still Cholera seizures occurred on the 6th, 7th, and 8th in the hut next to the heap of putridity, resulting in four deaths. of the tank which reAnother case occurred to the west which seven proved fatal, covered. Thus eight cases, of broke out on the borders of this hollow immediately or had shortly after these putrid materials in been thrown into it. another part of the Two deaths subsequently took place village on the 16th and 18th of April near a foul drain which was in process of being piped. The evidence now recorded is not demonstrative, but it amounts to a very high probability that the filth deposited in this tank was the exciting cause of the outbreak in Seth of the air or water. I Bagan either through the medium investigated several other cases during the year in which filth and cholera were intimately^ associated, but none so clear as the above. On the detection of the outbreak and the circumstances associated with it, prompt steps were taken to empty the tank and disinfect the putrid heap. The tank has now been filled up, the drains piped, and the village described no report generally improved ; and since the events me." of unusual sickness or mortality has reached
sporadically
^
With a birth-rate of 17*2 and a death-rate of 30 Calcutta would soon be depopulated. Yet successive census show that the numerical strength of the population is maintained. This is due to the constant immigration of outsiders who are attracted by the industries and commerce of the town. No more than 29'7 per cent of the residents of Calcutta were born in the town. The peculiarities of the population are well brought out by the following table copied from Mr. Beverley's report of the census of the town?taken on the 17th of February 1881.
82-7 59
All ages.
June
THE CALCUTTA MEDICAL SOCIETY.
1,' 1882.J
The report contains abundant evidence that those parts of the town where sanitation is more backward, have the highest death-rate, and that those races which are least attentive to cleanliness die in largest numbers.
Evidence is adduced in the report to show that typhoid fever is not very prevalent in Calcutta. A return supplied by Professor J. F. P. McConnell, Pathologist to the Calcutta Medical College, shows that during the years 1874-81 inclusive the bodies of 14 Europeans and Eurasians who had died of fever were examined post-mortem, and of 108 natives. Among the former typhoid lesions were recognised in 2, and among the latter in 5 cases. The following paragraph touches a subject which has been repeatedly noticed in these pages :? liotheln.?Having met with several cases of an eruptive disease resembling in its features the affection known as Rotheln or German measles, I made careful enquiries among the medical practitioners of the town whether they had seen "
similar cases.
The result of these enquiries has been to prove an eruptive malady, different from has prevailed extensively during the rains and cold season in Calcutta. The subjects of this disease have been mostly children. The affection is a mild one, seldom ending fatally. It commences with the malaise, usual in the exanthemata. This is followed by a smart attack of fever of six or seven days'duration, presenting a remittent type, the temperature seldom exceeding 102? or 103 On the third or fourth day a roseolar eruption appears on the face and chest. It lasts for three or four days, spreading all over the body, and succeeded by a branny desquamation of the cuticle. There is some watering of the eyes and a loaded tongue with bright papillge at tip and sides, often a catarrhal sorethroat, and occasionally bronchitis and diarrhoea. Aphthous patches have also been noticed on the gums, cheeks, palate and fauces. The older practitioners aver that this is not a new form of disease, and that they have met with cases during the rains for the last 20 years. If infectious, it seems to be very feebly so. Instances have been observed of attack after measles, and vice versa. My own opinion is that the disease in question corresponds more closely to that which is described under the term liotheln than to any other.
beyond dispute that measles or scarlatina,
.
Surgeon-General
J.
M.
Cunningham
in
reviewing
the
history of cholera in 1880 for the whole of India, shows that the disease was remarkably mild. There was a very striking falling off in cholera mortality in every province except the North-Western Provinces and Oudh and British Burmah. Dr. Cunningham combats the idea that the diminished
mortality among tea coolies proceeding to Assam was due to improvements in the conservancy of their drinking water. His principal argument is that a similar decline of mortality occurred in the districts through which they pass-
ed. He also discredits the influence of the Hurdwar fair of 1879 in generating and spreading cholera, because the N. W. Provinces and Ou?h suffered more in 1880 when there was no Kumbh mela than in 1079. The report of the condition and management of the Jails in the North-Western Provinces and Oudh for the year 1881 has been drawn up by Brigade Surgeon W. Walker, M. D., M. A., F. R. C. S., with his usual accuracy and skill. The general death-rate for the province was 23 per 1000. This rate compares very favourably with the rates of other pro" A death-rate of 23 per vinces and presidencies in India. 1000 of average strength of the convict population, is," " evidence of fair general health Dr. Walker writes, good amongst the free population as well as of generally sound sanitary conditions in the prisons. But I regret that as in past years I have to draw attention with a feeling of shame to the high death-rate in a few notoriously unhealthy jails, these are the Meerut Central Prison with a death-rate of 40 per with a death-rate of 139 per 1()00, Gorakhpur District Jail a 1000, and Mirzapur Jail with death-rate of 70 per 1000." He goes on to discuss the conditions under which these excessive rates of mortality occurred, and ends this section of his report with the following virtuous confession and aspiration :? " The prevalence of dysentery, diarrhoea, asthenic pneumonia and cases of sloughing ulcer still warn us that the sanitary conditions under which the prisoners in certain jails live are
163
not perfect. The medical officers in charge must feel as I do that the occurrence of such cases is a stigma upon jail management, and we dare not rest satisfied until the abnormal death-rate in every jail can be proved to arise solely from the reception of old broken-down poor house cases and not from disease produced in strong men in the prime of life, simply because they liave become inmates of a jail" Dr. Walker believes that the true method of combating Asiatic cholera is to attend strictly to general sanitation- We him. Is it possible that there is are inclined to agree with a cholera microzyme after all; which having fattened on cholera discharges, acquires specific virulence thereby and retains it in subsequent developments in common filth ?
