REPORT OF CHOLERA COMMITTEE ORDERED UNDER 0. 0. No, 216 OF 27th FEBRUARY 186 TO REPORT UPON THE ARRANGEMENTS WHICH SHOULD BE MADE TO GIVE PRACTICAL EFFECT IN THE MADRAS PRESIDENCY TO THE RECOMMENDATIONS AND SUGGESTIONS OF THE INTERNATIONAL SANITARY CONFERENCE, 1868. I.NTZ BROTHERS. W C 6 Ml? *(f f TABLE OF CONTENTS. Page. Subject of Report...' ... ••• ••• ... --• ••• * ••• ••• I Eesult of enquiries ... •¦• •• ••• ... ••• • •• ••• 1 Cause of delay in submission of Report../ ... ... ... ... ... ... 1 Dr. Leith's Abstract of the conclusions of the Cholera Conference should be reprinted ... ... 1 Arrangement of topics considered by the " Conference" ... ... ... ... ... 2 Scope of the Report ... ... ... ... ... ... •-. ... 2 The enforcement of the recommendations of the Conference requires the authority of Government ... 2 The questions considered, and the conclusions arrived at, by the Conference ... ... ... 2 Method adopted by the Committee to verify the correctness of these conclusions ... ... ... 8 Abstract Return shewing various points regarding the origination and propagation of Epidemic Cholera in Southern India ... ... ... ... ••• ... ... ... 8 Considerations preliminary to the present enquiry ... ... ?, ... ... 20 Different modes of origination of epidemics ... ... ... ... ?. ... 21 Endemicity of Cholera in India ... ... ... ... ... ... ... 22 Conclusions of the Conference and the importance of these ... ... ... ... 22 Alleged endemicity of Cholera at certain stations ... ... ... ... ... 22 The enquiries of the Committee do not confirm the foregoing opinion ... ... ... 22 Cholera not considered as endemic in any part of this Presidency. ?, ... ... ... 22 Cholera not endemic in Madras ... ... ... ... ... ... ... 22 Arrangement of subject of enquiry ... ... .. ... ... ... ... 23 Method of enquiry proposed in the present report ... ... ... ... ... 23 Origination of epidemics due chiefly to contagion from pilgrimages ... « ..„ ... ... 23 The subject of pilgrimages has been sufficiently discussed ... ... ... ... 23 Additional subjects to be considered ... ... ... ... ... ... 23 The results of experience regarding the transmission of Cholera claim especial attention ... ... 23 Various conditions under which epidemic Cholera is most usually observed ... ... ... 24 General considerations equally apply to all the foregoing conditions ... ' ... ... ... 25 General principled of prevention widely applicable ... ... ... ... ... 25 Conclusions of the Conference on the foregoing ... ... ... ... ... 25 How these views should be carried out ... ... ... ... ... ... 25 How to maintain the purity of air in cities ... ... ... ... ... ... 25 Water supply how to be protected from contamination ... ... ... ... ... 26 The foregoing subjects need not be reiterated ... ... ... ... ... 26 Several of the measures recommended are not novel ... ... ... ... ... 26 i 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 ... ... ... ... ... ... 27 The probable results of the adoption of these principles ... ... ... ... ... 27 Epidemic disease in crowded towns, during famine and from want of European Medical advice ... ... 27 Institution of broad streets greatly required . ... ... ... ... ... 27 11. Military Cantonments. Rules for Military Cantonments ... ... ... ... ... ... .... 27 Rules for arresting Cholera among Troops in infected Barracks ... ... ... ... 28 Measures of a preventive and curative character necessary for troops on the march ... .... ... 28 Identity of recommendations for station and marching Cholera camps ... ... ... 29 Rules for Cholera Camps ?, ... ... ... ... ... ... 29 Further suggestions on same subject ?, ... ... ... ... ... 29 2 Page. Eecommendations regarding the removal of troops to Cholera camps ... ?. ... 30 Cots in camp recommended for all troops during wet weather ... ... ... ... 30 No European sick orderlies should be employed during epidemics ... ... ... ... 30 Funeral parties should be discontinued during epidemics ... ... ... ... 30 111. Cholera among European Troops on the Mabch, Railway travelling by Military Troops ... ... ... ... ... ... 30 Kules recommended for adoption ?, ... ... ... ... ... 30 General Order regarding the marching of Troops ... „.. ... ... ?.,32 Cholera on the march ... ... ... ... ... ... ... 31 Conservancy of Camps ... ... ... ... ... ... ... 32 Families on the march. ... ... ?, ... ... „, k ., 34 IV. Cholera among Native Troops on the March. Honorable Mr. Ellis' Report on the marching of Native Troops generally approved of by Government 777 34 Details regarding the prevalence of Cholera ... .. ¦•• ••• ••• 35 Return shewing the number of Regiments attacked on the line of march after every 200 miles of road passed over, from 1820 to 1824 inclusive ... ... ... ... ••• ... 35 Return shewing the proportion of attacks according to the number of days occupied in the completion of each march, from 1820 to 1844 inclusive ... ... ... ... ••• ... 35 Return showing ratio of deaths to strength per 1,000 from Cholera in bodies of men varying in strength from under 300 to 1,500 while marching ... ... ... ... ... •••> 36 Return shewing the number of marches made and attacks of Cholera in bodies of men varying in strength from under 300 to 1,500, from 1820 to 1844 ... ... ... ... ... 36 Analysis of the foregoing returns ».. ... ... ... ... ... ... 36 Proportion of marches by Detachments attended by cholera ... ... ... ... ••• 36 Death rate from cholera influenced by numbers in camp ... ... ... ... ... 36 Duration of marches influences the liability to attacks of cholera ... ... ... ... 36 Peculiarity of Madras N. I. Regiments as contrasted with those of Bengal ... ... ... 36 Practical conclusions ... ... ... ... ... ... ?, ... 37 Arrangements already sanctioned ... ... ... ... ... ... 37 Movement of N. I. Regiments by wings and by Railways and Steamer recommended ... . ... 37 Cholera camps in the march of N. I. Regiments ... ... ... ... ... 37 V. During, or subsequent to, agglomerations of People at Pilgrimages and Fairs, The above subject already disposed of ... ?. Sketch Rules for the arrangements to be made in the management and conservancy of fairs and festivals ... 37 VI. Epidemic Cholera in Jails. Epidemic Cholera in Jails ... ... ... .. ... ... ... 39 Previous proposals on this subject ... "... ... ... ... ... ... 40 Rules at present in force generally recommended by the Committee ... ... ... ... 40 Quarantine wards in Jails ... ... ... * ... ... ... ... ... 40 Observation of new arrivals ... ... ... ... ... ... ... ... 40 Certain modifications in existing rules recommended ... .. ... ... 40 Identity of requirements of Barracks and Jails as regards cholera .. ... ... .. 40 Rules for the guidance of Officers in charge of Jails on the occurrence of epidemic cholera ... .»» 40 VII. In Hospitals. Measures to prevent the extension of cholera in, and its dissemination from, Hospitals ... ... 41- The principle of removing general sick from a Hospital and congregating therein all the cholera cases, erroneous 44 Provision of Quarantine Hospitals or Wards recommended a ... ... „., ... 45 VIII. In Seaport Towns in which the disease is directly imported by Ships. Restrictive measures for the enforcement of quarantine considered by the International Sanitary Conference 45 Conclusions of the Conference not generally accepted ... ... ... ... ... 46 Memorial on quarantine addressed to the Lord President of the Privy Council ... ... ' ... 46 Rules in force at Madras ... ... ... ... ... ... ?, lr * 49 Ennore well adapted for a quarantine station ... ... ... ... ?« ?,50 Office of Sanitary Commissioner, Madras, June 23rd, 1868. From W. Mackenzie, Esq., c.b., c.s.i., President, \ Colonel A. C. Silver, \ \ Cholera Committee ; Surgeon.-Major J. L. Banking, J Members - ) To The Honorable R S. Ellis, cb,, 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 proceedings and reports, compiled by Dr. A. H. Leith, then President of the Sanitary Commission, Bombay. We gladly Dr. Leith's Abstract 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 whick those conclusions are based. 2 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- —should be reprinted. ment Printing Press for general distribution. 7. The " Conference" divided the subjects of their enquiry into three groups. Ist. — The origin and generation of Cholera, the si^re a dSy™he t "Oo t^erenc°e l1 ' " endemicit y" and tne " 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 quarantine measures, on sanitary cordons and on Lazarets ; rules for quarantine and disinfection ; 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 importation of the disease by sea, and finally the measures to be taken against its importation by land. 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 Scope of this Report. 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. 9. There are many recommendations made by .the Conference, which are peculiarly applicable to this Presidency, and upon which, in comme e ndatS en o t f°th t e Con- our opinion, it is desirable that action should be taken by S^aS^SSSt?* 110 anthority the Government, either by means of legislative enactments, or by orders in 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. a Question Ist. — 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.— ls 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 probability, 3 ) 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 naturalized 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 sth. — 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 Gauges, 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 development and propagation of epidemics of cholera in India % n 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 Bth. — 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 distance by the atmosphere alone, whatever may be its condition. " Question 10th. — How is cholera imported, and what are the agents in its transmission % v 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 arrival 4 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 departure 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, communicate Cholera ? " Answer. — A person coining from a source of Cholera, and although suffering 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 conclusive, 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 imported by living animals ; but it is reasonable to consider them in certain cases. as susceptible articles. a Question 15th. — Can Cholera be imported and transmitted by linen clothing, and generally by things in personal use ? " Answer. — Cholera can be transmitted by articles of personal property coming 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. 5 « * " Question 16th. — Can Cholera be imported and transmitted by merchandise ? " Answer. — Until fuller information be obtained, it will be prudent to consider as suspicious, unless in particular and denned 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 Railways, 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 (agglomerations) of men on the intensity of epidemics of cholera ; also on the propagation 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 sanitary 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 individuals have already been under a choleraic influence, or if they remain uncontaminated by it ; that is to say in other words, those who have already been under the influence of a source of cholera have a kind of relative and temporary immunity that counterbalances 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 ? i( 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. v 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 ? 6 *¦ " Answer. — The assemblage in a lazaret, of persons coming from a place where Cholera prevails, has not the effect of producing a great increase of the disease among those in question ; but such an assemblage is, notwithstanding, very dangerous to the neighbourhood, as it is likely to favor the propagation in it of Cholera. " Question 23rd. — "What influence have great assemblages of men, armies, fairs, pilgrimages, &c, on the development and the propagation of Cholera ? " Answer. — Great assemblages of men, (armies, fairs, pilgrimages,) are among the most certain means of propagating Cholera ; they form great epidemic sources which, whether the people march as an army or scatter themselves, as from fairs and pilgrimages, carry the disease into the country they go through ; those assemblages after having been subjected, in usually a rapid way, to the influence of Cholera, become less susceptible of it, and the disease disappears from among them, it may be even speedily, unless new arrivals come to prolong it. " Question 24th. — What influence has dispersion on the intensity and the development of epidemics of Cholera ? " Answer. — The opportune dispersion of an assemblage may lessen the violence of an epidemic of Cholera which has appeared in it, and may even prevent its spreading ; but the dispersion would, on the contrary, cause great danger of propagation if it took place in the midst of places as yet free from the disease. " Question 25th. — What share has the pilgrimage to Mecca had, in the epidemics of Cholera that have followed one after another up to this time ? " Answer. — The part borne by the Mecca pilgrimage, as an agent in propagating Cholera in the countries bordering on Europe, has been the importation of the disease into Egypt twice, at an interval of thirty-four years, during the hot season. v Question 26th.— What influence have the sanitary and other conditions of a locality on the violence of an epidemic of Cholera ; in other words, what are the adjuvant causes of cholera ? " Answer. — Sanitary and other conditions, which in general predispose a population to contract Cholera, and consequently, which favor the intensity of epidemics, are indigence with all its consequences, the crowding of individuals, their unhealthy condition, the hot season, deficiency of ventilation, exhalations from a porous soil impregnated with organic matter, above all if that matter be from choleraic dejections. "As it appears to be shown by experience that the dejections of those with cholera contain the generating principle of the disease, it is legitimate to admit that drains, privies, and the contaminated waters of a town, may become agents in the propagation of the disease. " It seems toresult from certain facts, that the ground of a place once impregnated with choleraic matters can for a considerable time retain the power of giving off the principle of the disease and of keeping up an epidemic, or even of reproducing it when it has been extinct. " Question 27th. — What is to be understood of immunity as regards Cholera ? "Answer. — The immunity which certain localities enjoy, that is to say, the resistance, permanent or temporary, general or partial, opposed by those localities to the development 7 * of cholera within their bounds, is a fact which does not preclude transmissibility ; but which indicates that certain places, not yet all determined, are an obstacle to the development of the disease. The more or less complete and the more or less durable immunity which the greater number of persons placed in a choleraic centre enjoy, an immunity that attests the individual's resistance to the poison, is a circumstance which should be held to be of the greatest value. Viewing it with reference to epidemic development, it is corrective of the transmissibility, and, as regards prevention, it puts on the way, means fitted to restrain the ravages of the disease. X Question 28th. — From the facts previously established, and which are connected with the generation, the propagation and the transmissibility of Cholera, can we deduce any thing precise as to the generating principle of the disease, or, at least, as to the mediums which serve as vehicles, or receptacles ; as to the conditions of its entrance into the organism ; as to the ways by which it escapes from it ; as to the duration of its morbific activity ; in short, as to all the properties, a knowledge of which' concern prophylaxis % 11 Answer. — In the present state of science we can announce only hypotheses as to the nature of the generating principle of Cholera ; we know only that it is indigenous in certain countries of India, and that it maintains itself there permanently ; the principle reproduces itself within man, and accompanies him in his peregrinations ; it may thus be diffused to a distance from country to country, by its successive re-production, without ever generating itself spontaneously, apart from man. " Question 29th. — What are the vehicles of the generating principle of Cholera? ' : Question 30th. — To what distance from a centre of emission can the principle of Cholera be carried by the air ? " Answer to 29 and 30. — The ambient air is the chief vehicle of the generating agent of Cholera ; but the transmission of the disease by the atmosphere, in an immense majority of cases, is limited to a distance very close to the centre of emission. The instances cited of transport by the atmosphere, to one or many miles distance, are not sufficiently conclusive. " Question 31st. — "What are the other vehicles of the choleraic principle ? " Answer, — Water and certain ingesta may serve as vehicles for the introduction of the generating principle of Cholera into the organism ; the ways by which the poisonous agent penetrates are chiefly the respiratory, and very probably also, the alimentary, passages. Nothing has been ascertained as to entrance by the skin. " Question 32nrl — What are the chief receptacles of the choleraic principle ? "Answer. — Choleraic dejections being incontestably the chief receptacle of the morbific agent, it follows that all that is contaminated with those dejections also becomes a receptacle, whence the generating principle of Cholera may be set free under favoring circumstances. It follows also that the generation of the choleraic germ most probably takes place in the alimentary canal, to the exclusion, perhaps, of any other part of the organism. " Question 33rd. — What is the duration of the morbific activity of the generating principle of Cholera ? " Answer. — Observation shows that the duration of choleraic Diarrhoea, called premonitory (which it is necessary not to confound with Diarrhoea that exists in times 8 >. ? * 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 contamination 3 ' 11. With a view to the verification of the accuracy of the conclusions noted above, the Inspector General of the Indian Medical Depart- Method adopted by the , -, -, , ? in,-, t * *r>n*r • 1 x i i i Committee to verify the cor- ment, under date the 19th July 1867, circulated a tabular rectness of these conclusions. form of to be fiUed up by Medical Officerg hig department, and Government issued instructions that all Collectors of Districts should furnish similar information regarding the localities under their charge. 13. The following Abstract Eeturn shewing various points regarding the Origina- Dr. Montgomery, who Names of places, villages or towns in which Cholera is jp, , 10 — — epidemic and ™ , . , .-it. endemic at any District or Plac ? s are T to of the places Station. Epidemic at short by PUgmns m large men tioned in Endemic. Epidemic every year, intervals, not exceed- column 5 ? ing four or five years. If so, mention their names. 1. 2. 3. 4. 5. 6. North Arcot None. Chittoor, Chendra- Gudiattam, Palmanair, Chittoor, Chendragherry, No. District. gherry, Palmanair, Wallajah, Wandewash, Palmanair, Wallajah, Vellore, Arcot, Polur. Vellore, Arcot, Polur, Wandewash, Vellore, Arnee, Calastry, Arnee, Punganur, Arcot, Polur, Punganur, Aladerpak and Tirutani Narrainavanum, Narrainavanum, Calastry, Talooks. Maderpak and Maderpak and Tirutani Tirutani Talooks. ! Talooks. Kurnool Do. Cumbum, Atmakur, Cumbum, Atmakur, Streesailem, Gundala, No. District. Peapully, Koilkuntla, Peapully, Koilkuntla, Venkatadripoliem, Chapalmadagooj Chapahnadagoo, Nullamalla and Ahobulanl Nundikotktir, Nundikotkur, hills, Narsimhasawmy, and Markapur, Patti- Markapur, at Kurnool during the kondah, Kurnoolj Pattikondah, Kurnool, Mohorrum. Calwa, Nundial and Calwa, Nundial and Sirwell Talooks. Sirwell Talooks. 9 •I 4 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 Avhich 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 Could any of these outbreaks Places that have the reputai chief outbreaks of Cholera be traced to any particular What was the usual point i tion of being free from which have occurred in sources, such as arrivals of departure of Cholera Cholera, with statement of this District within from another District % from the District % grounds upon which this the last ten years. If so, mention them, immunity is alleged. 7. 8. 9. JO. 1858 January, 1859 January, Attributable to the passage Notknowa. Certain villages in the Chen- February and December, of pilgrims to and from the draghe'rry, Punganur, Pal-1860 April and May, 1861 seat of festivals in or near manair, Tirutani, Wande- June and July, 1863 April the district, and to the wash, and Maderpak taluqs. and May, 1864 and 1865 scarcity of food and conse- The grounds for this immu- April and May, 1866 July, quent high prices of grain. nity not generally ascer- August, October and Nov., tamed ; but the situation of 1867 March. two villages in the Punganur talook on high stony ground is said to be the cause of the non-appearance of Cholera. 1859 March 2nd, April 26th, Arrivals from Cuddapah, Bel- Do. Chilkacherla — good water and June, July and September, lary and Secunderabad, soil. Bollawarum, a well 1862 April, June 9th, July the Mohorrum festival, the whose water is very good; and September 7th, 1863 Streesailem festival, and the a plant called Nemallizutta April, June, July 7th and passing of an Infantry Re- growing on the Fort walls August Ist, 1864 April, giment in 1863, and the and a tree whose flowers are June 9th, July 17th and 2nd Cavalry in 1867, were of a white color, and whose August 11th, 1865 Feb- the chief causes of the out- smell extends to about 10 ruary Ist, 26th March, breaks of Cholera in the chains. Seddapuram, no April 16tb, June, July, and district. The passing of grounds. Gopolsingawa- August 27th, 1866 April, pilgrims. ram, contains temple of May 23rd, June, July and Veukataswarlu. Bavapu- September 10th, 1867 March t ram, contains the tomb 24th, April Ist, June, July, of Shakangal Saheb. Mudand September 10th. dalate, no ground. Rungapuram, no grounds. Ahobalam, Yaparlapadu, Boganapully and Valavalsa, on account of elevation. 10 Names of places, villages or towns in which Cholera is T ~, , & Is Cholera both 1 — epidemic and n ' I f Places which are resorted to en^ mic f an y D if t lCt OT -.- •, . by Pilgrims iv large of the places fetation. Epidemic at short J u Um bers mentioned in Endemic. Epidemic every year, intervals, not exceed- column 5 1 ing four or five years. If so, mention their names. 1. 2. 3. 4. 5. 6. Trichinopoly Trichinopoly, Trichinopoly. Trichinopoly. Streerungum, Corasalem, Streerungum District. Varagany, Tottiem, Sevoyem, and Tottiem. Streerungum, Veerappoor, Andavancovil, Moosory, Thondony Hills, Kadavoor Tottiem, and Seroovachoor. Kultoopootur, Alatodiumputty, Coottapolliem, Marudy, Chettycolum, Kerramboor, Toriore. Cuddapah None. None. Budvvail, Cuddapah, Kudvi, Royachote, Culcudda No. District. Sidhout, Pullumpett, in the Voilpaud, Cottacota Junmalmadugu, in the Madanapully, and Poddatur, Pooshpagiri, Daivoony, Madanapully, Cuddapah, and Kottapata Voilpaud, Kudri, in the Cuddapah Talooks. Pulivaindla and Royachote Talooks. Tinnevelly Unknown. None. Most of the towns and Strivilliputur, No. District. villages. Sankarnainakovil, Courtallum, Tenkasi, Papanasem, Tinnevelly, Strivycuntum, Alwarterimagari, Trichendur, Nanguneri, Tirukurungudi. Nellore Ongole and Rapur, Udayagiri, Most of the towns and Runganaickaloopet, No. District. Venkatagiri. Polur, Darisi. villages. Nursimulukondah, Butchereddipalem, Sungum, Penchalahkona, Venkatighiri. Tanjore None. Negapatam,Nannillam, In only a few villages Negapatam, Nagore, No. District. Combaconum, Tanjore, in this district. Valangunni, Trivalore, Pottukottai, Trivadi, Avadayarcoil, Manargodi, Tritra- Maj 7 averam, Vedarniem, pundi, Shealli and Muthearjunum, Mayavaram Talooks. Sawmy Mullay and Manargudi are resorted to every year, whilst Combacouum is visited only once in 12 years, 11 • t -+ Mention the date of the Could any of these outbreaks Places that have the reputachief outbreaks of Cholera be traced to any particular What was the usual point tion of being free from which have occurred in sources, such as arrivals of departure of Cholera Cholera, with statement of this District within from another District 1 from the District ? grounds upon which this the last ten years. If so, mention them. immunity is alleged. 7. 8. 9. 10. 1859 in the Museri Talook, No reliable information re- Not known. None. and 1860 in the Woodiar- garding the sources of the polliem Talook, and gene- outbreaks in this district, rally in the years 1858, 61, 63, 65 and 66. 1859 April, 1860 September, With the exception of that Cholera generally appears The villages of Chiyaveram, 1862 July, 1864 October, in 1859 caused by the to cease after the rainy Vellagacherla, * Nagiriddi-1865 June, and 1866 June, arrival of the Ist Light season has commenced, pally, Goralamadugu and Cavalry from Trichinopoly, viz., in the months of Thodlopully in the Pullumthe sources of the out- August, September and pet talook, on account of breaks in this district October, being thinly populated, have not been traced. No. The minor outbreaks are be- Unknown. Pudiamputtur in the Ottapelieved to have been occa- daram talook, cause unsioned by Cholera brought known, to the villages. In the years 1861, 1865 and No. Sometimes occasioned Northwards and westwards. A few villages in the Nellore, 1866. by Pilgrim?. Rapur and Kanigiri Taluqs, some on account of being thinly populated and others on account of their elevation April, May, June and Decem- The outbreaks in 1865 and It generally disappears from Not known. ber 1865 and 1866, and 1866, are attributed to the Combaconum in a south-27th June 1867. scarcity of grain at that westerly direction. The period, and that at Comba- direction of its exit from conum in 1867, to a Brah- other talooks in this dismin woman who came from trict has not been ascer- Mayaveram. tamed. 12 + 4 Names of places, villages or towns in which Cholera is Is Cholera both. . epidemic and .¦. , Places which are resorted to en f™° f any D ' Str ; Ct ° r ?, . f ,' by Pilgrims in large of * c P la , ces Station. Epidemic at short J numb mentioned in Endemic. Epidemic every year, intervals, not exceed- column 5 1 ing four or five years. If so, mention their names. 1. 2. 3. 4. 5 6 I ~ I Bellary None. Gooty. In only a few villages! Triputti, Humpee. Unknown. District. in this district. Secunderabad City of None. A few cases among the City of Hydrabad, Bolarum No. Town. Hydrabad, Native followers of and Mowl Ali. Cantonment the Batteries. Regtl. Bazaars and Begumpett j Ganjam None. Ganjam. Unknown. Srikurman, Mokalingum, No. District. . Vomaravulli. Jaulnah Town Do. None. Jaulnah. Juttras. No. Hingolee Do. Hingolee. Hingolee. Arundah, Malliagaum, Uncertain. Town. . Magur-Doss and Pundupoor. Chindwarrah Do. None. Chindawarrah. Maha Deo. No. Town. Sumbulpore Do. Do. Sumbulpore. None. No. Town. Kamptee Do. Kamptee. None. Maha Deo and Ramteke. No. Town. Chittessgliur Do. None. Raepore, Balaspore, Juggernath and Rajim. Unknown. Town, Awing and Rajim. , ¦ j . Tonghoo Do. Do, None. Mujee, Konakoo Pyah or No. Town. seven Pagodas. 13 Mention the date of the Could any of these outbreaks Places that have the reputachief outbreaks of Cholera be traced to any particular What was the usual point tion of being free from which have occurred in sources, such as arrivals of departure of Cholera Cholera, with statement of this District within from another District 1 from the District 1 grounds upon which this the last ten years. If so, mention them. immunity is alleged. 7. 8. 9. 10. 1859 May and June, 1861 Pilgrims from Triputi are Not ascertained. Not known. 6th June, 1863 July, 1865 said to have imported the April and May, 1866 May disease into a few of the and June. villages in this district in 1863. 1864. Attributed to arrival of tra- Do. Do. vellers from Kurnool and to the City of Hydrabad. In the years 1865 and 1866. To pilgrims returning from Do. Do. Poory to scarcity and famine. During the hot weather in No. Do. Do. 1864, and the rains in 1865. February, March, April and There is no doubt of. the epi- Unknown, Do. May 1865. demic in 1865 having been occasioned by the entering of pilgrims from Aoundah. June 1857, April or May Arrivals of pilgrims from The routes taken by the pil- Do. 1860, April and May 1864. Maha Deo. grims to Maha Deo in returning home. 1864, 1865, and 1866. Has been traced to arrivals Unknown. Do. of pilgrims from Juggernath. May 1856, February 1857, To pilgrims returning from Towards Bombay and the Do. May 1858, May 1859, Maha Deo in 1863 and to Berar Districts. February and July 1860, drivers of grain carts from July 1861, July and Raepore in 1864. August 1862, June and August 1863, January and February 1864, March 1865, and July 1866. 4th April 1860, 1861, 1862, In 1860 to cartmen bringing Unknown. Do. 1863, 1864, and 1865. rice from Nagpore, 1861 to pilgrims from Juggernathi au.d Rajirn. None. No. Do, Tonghoo, no possible grounds. 14 > Names of places, villages or towns in which Cholera is _ _ 1 Is Cholera both ___ — . epidemic and n . 4 . . Places which are resorted to eu f + mic f an y D '! tnct or i r. , •+ , , by pilgrims in large of *J? P la , ces Station. Epidemic at short J A j° urn^ ers mentioned m Endemic. Epidemic every year, intervals, not exceed- column 5 1 ing four or five years. If so, mention their names. -_ . _ , ¦ __ 1. 2. 3. 4. 5. 6. Thayetmyo None, None. Thayetmyo, Prome, None. No, Town. and a few others. Aurungabad Do. 80. Aurungabad, Kottah Ellora. No. Town. and Poodenpoorum. Bowenpilly Do. Do. Bowenpilly. None. No. Town. Mominabad Mominabad. Mominabad. Uncertain. Pundahpore and Tooljapore. Unknown. Town. South Arcot None. Cuddalore, ' Nearly all the villages Trinamallay, Chedumbrum, No. District. Villapuram, in this district. Conancoopum and Chedumbrum, Koovassum. Virdachellum, Tindevanum, Tirunamalay, Yellavasanur and Cullacoorchy Taluqs. KistnaDistrict. Do. Eundur, Gudivada, Bunder, Gudivada, Mungulgherry, No. Kepalli, Guntur, Eepalli, Guutoor, Kotappa Konda, Bunder Crossoor, Ptajapett, Bapatla, Piajapett and Town, Vellaturu, Guntoor Palnad, Vinucondah Vinucondah Taluqs. Town, Amaravate, and Bezoarah Talooks. Katavaram, Voorvakullu, Ponnoor, Bezoarah, Yellamundala, Chajerla, Macherla, Carempudi, Sungada. TrichoorTown. Do. None. Trichoor. None. No, Coimbatore Do. Do. Bhowany Perur, Bhowany, Perur, Avenashy, No. District. Avenashy, Karamady, Karamady, Chickyalur Chickyalur and Madaswaramallai and Maraswaramallai. Gurumettanputty. 15 ¦* « k. / Mention the date of the Could any of these outbreaks Places that have the reputachief outbreaks of Cholera be traced to any particular What was the usual point tion of being free from which have occurred in sources, such as arrivals of departure of Cholera Cholera, with statement of this District within from another District ? from the District 1 grounds upon which this the last ten years. If so, mention them. immunity is alleged. 7. 8. 9. 10. September and October 1858, No. Unknown. None. Autumn of 1860, May and June 1863, 27th July 1865, January 1866. June 1865 and in 1866. Attributed to the filthy state In a North easterly direction. Do. of the locality occupied by the Syces of the 2nd Cavalry Regiment stationed here . September 1859. No. Unknown. Do. In 1865. To the pilgrims returning Unknown. None, from the fairs at Punderpore in 1864. Cholera generally occurs in To the new grain, vegetables Do. None known, the hot months. and fruit which are sold during the hot season, and to the overcrowding at the Trinamallay feast. 1859 July, 1860, 1861 26th Many causes have contributed It has been ascertained to Borepaliam and Hurrichendra- May, 1862, 1863 4th April, to the outbreak of cholera leave Guntoor in a north- pooram in the Guntoor, 25 Ist May, and 29th July in this district, viz., the erly and westerly direc- villages in the Crossoor and 1864, 1865 15tl\ Janu- overcrowding at festivals, tions. Of the other district 26 villages in the Palnad ary, 2nd February, 6th the passage of pilgrims to no records exist of the Taluqs are said to be free June, 9th July, Ist August, and from the fairs at Ram- point of the exit of cholera, from cholera; but no 2nd October and 16th naad and Benares, and It leaves Bezoarah in a grounds are given for this November, 1866 16th the passing of Regiments north easterly direction. immunity. January, 22nd March, Ist through the villages. April, Ist May, 28th June, 17th July, 1867 March, 4th April and 2nd July. June 1858, July 1862, and No Unknown. None, April 1865. 1860, 1861, 1863, 1864, and To arrival of pilgrims from Do. Coonoor, Wellington and the July and October 6th, 1866. Gurumettanputty, excessive Neilgherries were free from cold and the too free con- cholerauntillastyear(lB66), sumption of newly cut Kotagherry is still so. The grain and cucumbers. ground of immunity is said to be their elevation. 16 Names of places, villages or towns in which Cholera is T„, . , ? r & Is Cholera both ; epidemic and ¦n, ? , , , . endemic at any District or Plac f wh , lc^ are . re f rted to of the places Station. Epidemic at short by V^2lvT lar§6 mentioned in Endemic. Epidemic every year, intervals, not exceed- column 5 ? ing four or five years. If so, mention their names. 1. 2. 3. 4. 5. 6. French Rocks None. None. French Rocks. Mailcottah, Nunjengoode, No. Town. Choonchanukutta, Moodoogoodoaray and Yellendoor. Ramandroog Do. Do, Humpi, Campili, Humpi, Comarasawmy. No. Town. Cumalpoor, Hospett, Cullahully, Madarahully, Comarasawmy, Soondoor, Conapoor, Bowenally,Nagalapoor, Gurgoo, Nanamdavankey, Goondoo. Hurryhur Do. Do. Hurryhur. Humpi. No. Town. Mulliapooram Do. Do, Mulliapooram. None. No, Town. Mercara Town. Do. Do. Mercara, Tala Camary. No. Poonamallee Do. Do. None. None. No. Town. Palaveram None. None. None. None. No. Town. 17 -t < I Mention the date of the Could any of these outbreaks Places that have the reputachief outbreaks of Cholera be traced to any particular What was the usual point tion of being free from which have occurred in sources, sucli as arrivals of departure of Cholera Cholera, with statement of this District within from another District ? from the District ? grounds upon which this the last ten years. If so, mention them. immunity is alleged. 7. 8. 9. 10. Two years ago (1865). No Unknown. None. 1864,1865,1866. To arrivals of pilgrims from Do. Ramandroog, on account of its Humpi and to travellers elevation, from other villages. July 1865, 9th April 1866. Persons arriving from a cho- Eastwards. None. lera-infected district. 1863,1864,1865. Attributed to the consumption Northwards. . The Military station of Mulof putrid fish, sour toddy liapooram and the lines of and the want of cleanliness the camp followers. The in the abodes of the natives. former on account of its elevation and the latter on account of the remarkably good drinking water, March 1857, May 1861, By the arrival of coolies from Cessation of disease among None. February 1862, and May, Mysore for employment on the coolies. June and July 1864. the coffee plantations in Coorg. 11th June and 26th August In 1866 cholera was brought Apparently to the westward. Poonamallee for the last nine 1866, and 4th January 1867. to this station by a child years. No grounds for this from Madras where cholera immunity. was raging. Only in December 1866. Attributed to the want of Uncertain. Palaveram. The grounds of imsanitation in the bazaars, munity are the great attenwhere the disease first tion paid to the consershowed itself and to desti- vancy of the station, the tution and famine. excellent and abundant supply of water and on account of its being removed from the route of pilgrims. 18 V V- 4 Names of places, villages or towns in which Cholera is T _.. Is Cholera both — — epidemic and Distriofc nr Places which are resorted to en f mic f au ? jjistricc or . ,-,., ... ot the places o fa+ : nTI _, . . . , by Pilgrims in large .- l, . btation. Epidemic at short J n u m k ers mentioned in Endemic, Epidemic every year, intervals, not exceed- column 5 ? ing four or five years. If so, mention their names. 1 - 2. 3. 4. 5. 6. Madras Town,. None. Perambore, Choolay, None. None. No. Vepery, Pursewalkum, Washermanpettah and Ped doonaick'spettah. Bangalore Do. Bangalore and Mysore. Sheemogah, Toomcoor, Nundydroog, Chittledroog, No. own ' ¦ Hurryhur. Mailcottah, Nanengode, Arsekaira, Subramoney. Tranquebar Do. None, In nearly all the Vydeeswaren Covil, Shealli, . No. l^ l ° wn - villages surrounding and Tiroocuddigoor. Tranquebar. Vizagapatam Do. Vizagapatam, Gajipat- Gajipattinagram, Meh-,Vizagapatam, Suuachellam, No. District. tinagram, Chipura- ringe, Bobilli ? Kur- Appikondah, Bimlipatam, pulli, Parvatipur, pam, Belgam. Kottopalem ; Kuppili,Guja- Palcondah, Gunu- ratipetta, Chepurapili, pur, Salur, Bobbili, Gumpa, Viraghattam, Pal- Koyagadda, Meh- condah, Vooppinavalsa, ringe, Kurpam, Bel- Bobbili, Seetanagram, Sitagam, Pachipenta, I rampuram,Suryanarayana- Vizianagram and puram, Oopmankah. Chenudu. S. E. Wynaad Do. None. Goodaloor. None. No. District. LuckadyTown. Do. Do. None. Do. No. PollachyTown. Do. Do. Pollachy,AnnamallaysPollachy, a halting place for No. pilgrims. Cuttack Town. Do. Cuttack. Cuttack. Boovanasur. No. 39 J -4 ₯ •*¦*¦ Mention the date of the Could any of these outbreaks Places that have the reputachief outbreaks of Cholera be traced to any particular What was the usual point tion of being free from •which have occurred in sources, such as arrivals of departure of Cholera Cholera, with statements of this District within from another District ] from the District ? grounds upon which this the last ten years. If so, mention them. immunity is alleged. 7. 8. 9. 10. Nearly every month of the In 1857 it was attributed to In a northerly direction. None, years 1857, 1858, 1859, the arrival of . the 43rd 1860, 1861, 1862, 1863 and Eegiment N. I. from the in the months of March and Mofussil and in general to August 1864, January 1865, emigrant coolies, and in 1866. 1855, 1857, 1860, 1861. No. Westerly. None, December 1858, January To drought, scarcity, famine, Unknown. The old Danish Fort on ac-1859, June 1864. unusual prevalence of the count of cleanliness proxiwinds and to being in the mity to the sea, free ventiroute taken by pilgrims to lation and removal from the shrines in the neighbourhood. route of pilgrims. 1855 August, 1861 June, July Many causes have contributed In some places southwards, Kysala, in 'the Pachipenta and August; 1865 March to to the outbreak of Cholera at others westwards. Zemindary. No grounds. August, but generally in in this District. In some the hot months of all the instances it is supposed to years from 1859 to 1867. result from the passing of Eegiments, to the scarcity of food, to arrival of pilgrims from Juggernath and Ragapore and to excessive heat. It is also attributed to atmospheric agency. March 1864. The arrival of coolies from Unknown. South East Wynaad, the only Mysore. outbreak being that mentioned in column 7. No grounds. Not known. Np. Do. Luckady, Wynaad. Proved from records and authentic information. Do. Pilgrims from Pulney. Do. The villages situated on the Annamallay Hills. Do. Pilgrims to Juggernath. The routes taken by pilgrims None. in returning from Juggernath. 20 Names of places, villages or towns in which Cholera is j g , . , — epidemic and ¦di i,- -v i. j x. endemic at any District or PlaC ' S are re r rted t0 of the places Station. J," . :.¦ by Pilgrims m large mention F ed in Epidemic at short numbers. column 5 ? Endemic. Epidemic every year, intervals, not exceed- j£ s0 men tion ing four or five thei J. aamea# years. 1. 2. 3. 4. 5. 6. Cochin Town. None. None. Cochin. None. No. Waltair Town. Do. None. The taluqs of Budra- Budrachellum, Purnasala, No. chellum, Bakapilly. Sreeramagerry. Paumbem Do. Ramaisweram. None. Paumbem, Ramaisweram. Yes, at Ramais- Town. weram. I CocanadaTown Do. None. In the towns of Coca- Chollangi, Bhemaveram . No. nada, Jagganathapuram, Samulcottah, Bhemaveram and Karapa, & in 31 villages. Madura Do. A few villages in the In parts of Madura. Madura, Teruppuragoondam, No. District. Madura Melur, Alagarcovil, Terumungalum, Dindigul and Sevaracottai, Kullekude, Ramnad Talooks. KokalamcharyOosalamputty, Seckanoormy, Kottamputty, Melur, Tadicomboo, Pulney, Ramaiswerram, Devipatam, Terupulanni, Sadanenda], Terupachetty, Muttanendal, Mana-madura, Puducottai, &c. 14. From the above Table, column 8, it is evident that there are certain preliminary considerations that must be admitted as proved to°tre S prlsent°?naufry minary witn re g ard to tne dissemination of the disease in epidemic form : and thus one of the most practically important con- siderations coming before us may be considered as disposed of. But other questions also suggested themselves less easily decided ; to these we shall afterwards allude. We may therefore as preliminary to our Eeport admit that certain conditions tend to the production and diffusion of this disease. 21 ! ¦'¦ ' " ' . ,— . i Mention the date of the Could any of these outbreaks Places that have the reputachief outbreaks of Cholera be traced to any particular What was the usual point tion of being free from which have occurred in i sources, such as arrivals of departure of Cholera Cholera, with statement of this District within from another District ? from the District 1 grounds upon which this the last ten years. If so, mention them. immunity is alleged. ! I ¦ ——' 7. 8. 9. 10. ! ' ¦ ; — —— __ March, August, September In March 1859 to the body of Unknown. A Jail at Ernacollum in the and October 1859, February a person who had died of Cochin Rajah's territory and September 1864 and cholera 16 miles away being although overcrowded. June 1865. brought into the town, and to the arrival of persons from an infected town. In 1864 it was traced to the crew of a vessel from an infected port. May 1860, April 1865, June To the fair at Budrachel-The course taken by per- None. 1866. lum and probably to coolies sons returning from the from the Lower Godavery. fair at Budrachellum. November 1864. To pilgrims and transports to Do. from Paumbem and Paumbem, as it is visited by Manaar and Penang. Ramaisweratn. cholera only once in 10 years. No grounds given. Duringthe hot seasons of 1861, No. Unknown. None. 1865 ami 1866. Generally, from 1857 to 1866 Attributed to the passing of The routes taken by pilgrims A few villages on the hills in pilgrims through the vil- when returning home from the Puluey talook of this lages when returning from the fairs, festivals, &c, district, probably owing to the shrines at Streerungum their elevation. and Ramaiswerum, to the consumption of newly cut grain and to the filthiness of some of the villages. 15. The possibility of the importation even of a single case leading to the Different modes of origination of Epidemics. 1. By importation of the disease. 2. ? use of tainted encamping grounds or bad water. 3. ? contiguity of infected population. 4. ? use of tainted carriage and clothing. occurrence of an epidemic in a camp, city or jail, is now indisputably proved ; while the occurrence of epidemics from the subsequent use of camping grounds, tainted by previous occupation ; and the induction of cholera by water tainted by cholera dejections, are now facts in its etiology which must be accepted without dispute. Similarly, experience has sadly proved that passing near villages, where the disease is prevalent, has been a frequent means of introducing it among troops marching, or of imparting it to casual travellers. Clothing, carts 22 employed for the transport of baggage, &c. are now recognized means of the dissemination of the disease ; while the use of water which, though not actually holding cholera germs in it, is found to he largely charged with animal or vegetable impurities in a state of decomposition, has been so frequently observed to be the exciting cause of the disease, that the danger of using it can be no longer overlooked, 16. The question of the endemicity of the disease in certain places likely Endemicity of the disease to prove foci of epidemic sickness is of extreme importance, m n ia- and we believe all the evidence on this point is opposed to the idea. The Cholera Congress endeavoured to determine whether any places in India exist where alone Cholera is engendered or which are found by experience to be particularly favorable to its development, or, in other words, Is cholera endemic in all parts of India or only in certain districts which it is possible to circumscribe ? 17. The Conference were led to think, probably correctly, that places where „ , _ ._ _ _ cholera is really endemic in India are not very numerous. Conclusions of the Confe- , . .. , , . rence and the importance of If this surmise (in the supposed correctness of which we conthese. . cur) could be established as a fact, it would be of very great importance and would be followed probably by practical results of the highest importance. Once these original sources of the disease were ascertained, their peculiarities could be carefully studied and every effort of sanitary science directed to the extinction of the disease at its source. 18. The Conference named a few places, where, they were informed that cholera reigned by preference as an endemic disease, Alleged endemicity of cholera. , n i aa n ahilja-di these were, Calcutta, Cawnpore, Allahabad, at .Bombay, and Arcot in the Madras Presidency. The Conference were further informed that cholera appeared epidemically every year or nearly every year at Madras, Conjeveram, Pooree, Tripatty, Mahadeo, Trivellore and other places where congregations of Hindoo pilgrims resort, and that the disease appears as an epidemic at certain intervals which do not, for the most part, exceed four or five years in the North-west of Hindoostan ; also in all parts of the Presidencies of Madras and Bombay, and in Pegu. 19. In the foregoing conclusions we are unable to concur unreservedly. -'...-, We have carefully examined all the evidence that we could The enquiries of this Com- ... mission do not confirm the collect, with a view to arriving at a reliable conclusion reforegoing opinion. ,. . . , gaming the endemicity or cholera in any place, within the limits of observation presented to us by the voluminous returns which we have collected throughout the Madras Presidency ; and, without stating it as a fact clearly prov„. , . , , ed, the impression on our mind is, that there is no place with- Cholera not considered as r , r endemic in any part of this in this Presidency where cholera is proved to be endemic ; Presidency. J r and further that the great preponderance of evidence goes to prove that epidemics of cholera in cities and districts are distinctly attributable in almost every instance to the importation of the disease in epidemic form by pilgrims, ordinary travellers and troops marching. 20. We may with advantage, give an example of supposed endemicity now apparently disproved in the case of the city of Madras, where cholera has been for so Cholera not endemic in man y y ears almost continuously present, and where it is M:adras - generally considered to be almost endemic. The experience 23 of the past twelve months, as recorded in Dr. Montgomery's Mortuary Reports for that period, would tend to dissipate the idea, that the disease is properly regarded as being due, either to any inherent property in the soil or to any personal habits or peculiarities of constitution on the part of the permanent residents of the town. 21. There is little doubt that the chief points of practical importance, to Arrangement of subject of which the attention of Government may now with the greatenquiry, est advantage be directed, are those which refer to : — (1.) The primary origination of a cholera epidemic ; (2.) The method of the diffusion of the disease ; (3,) The prevention of circumstances favorable to this diffusion"; and, (4,) The dissipation of the disease when established in an epidemic form. 22. We believe that the object of our present report will be best carried Method of enquiry proposed out if e confine our observations to the practical details in the present Report. upon which the orders of Government may be required ; or in other words, if we submit a brief statement of the circumstances under which Cholera usually assumes an epidemic form, and of the regulations by which we believe that the appearance and dissemination of the disease may possibly be prevented. 23. All the evidence in our possession, whether derived from the Cholera Congress or from our own enquiries, seem to point so distinct- Origination of epidemics . . •,. , due chiefly to contagion from ly to the contagiousness oi the disease, that the most practipilgnmages. ca l ge Q we can apply this knowledge is to investigate the origination and progress of the disease, under the different circumstances wherein it has been observed, as affecting masses of the community. The frequency with which epidemic cholera has originated from religious pilgrimages and fairs, has been already sufficiently investigated in our report regarding the u Control of Pilgrimages" in this Presidency. 24. This, the most notable condition under which Cholera, would seem to be originated and propagated has already been fully reported hasten sufficiently S d£Sfs? "upon by us, and the Sanitary Commissioner has been so good ed * as to lay before us his further report on the same subject. From these papers Government will have learned the general principles upon which the measures for the prevention of epidemic cholera should be based. 25. "We do not think it necessary therefore again to enter upon the discussion of the points therein set forth ; but turn in preference to Additional subjects to be a practical consideration of the circumstances other than those connected with pilgrimages, under which this disease has been known to occur. Many of these appear to us equally to indicate means by which, possibly, the appearance of the disease may be prevented, or its dissemination arrested, 26. We therefore at once pass to the consideration of the transmissibility and The results of experience propagation of the disease. On this subject the Congress regarding the transmission of , , , ° the disease claim especial at- Stated. : — tention. a That all facts hitherto ascertained demonstrate that cholera is propagated by man, and with a speed proportioned to the amount and rapidity of his emigration 24 That it is a law hitherto without exception that cholera has never advanced quicker than man in his emigrations, and that hitherto no fact has proved that cholera can spread to a distance by the atmosphere alone, whatever may be its condition.'' " The Conference further conclude that the Diarrhoea called premonitory, may transmit cholera, and that cholera can be transmitted by articles of personal property coming from an infected place, and especially by those which have been used by sufferers under cholera ; and that certain facts prove that the disease may be carried to a distance by such articles, shut up from the access of fresh air.'' 27. All these conclusions are supported by the facts contained in the Medical records of this Presidency and are of great importance in considering the means to be employed in the prevention of the disease in this country. 28. We beg to call particular attention to the conclusions of the Conference to the 20th question, vide p. 5. "What is the influence of assemblages or congregations (agglomerations) of men, on the intensity of epidemics of cholera ; also on the propagation of the disease? and under what conditions does that influence operate ?" The reply of the Conference is as follows : — 1st, "That 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 sanitary condition, to the violence of the epidemic." 2nd, " That, 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 individuals have already been under a choleraic influence, or if they remain uncontaminated by it ; that is to say, in other words, that those who have been already under the influence of a source of cholera have a kind of relative and temporary immunity that counterbalances the grievous effect of the agglomeration. Lastly, that in a congregated mass, the more rapidly the epidemic spreads the more rapidly does it also cease, unless new healthy arrivals furnish fresh aliment to the disease and so sustain it.' 7 29. Accepting the foregoing conclusions (of the correctness of which we entertain no doubt.) we have to determine the practical appli- Various conditions under . / ' . . . ... ., which epidemic cholera is cation ot the facts here asserted, considering seriatim the jnost usually observed- . ,... , ,. , . , , , various conditions under which epidemic cholera is most usually observed, and, in connection with the subject, detailing the practical measures, the adoption of which we would recommend as being calculated to prevent its extension. The circumstances under which cholera is most usually observed as an epidemic are : — ( I ). In cities, villages and towns. ( II ). In Military cantonments, ( III ) . Among European troops on the march. ( IV ). Among Native troops on the march. ( V ). During, or subsequent to, agglomerations of people at pilgrimages and fairs. (VI). In Jails. (VII). In Hospitals, and lastly, (VIII). In sea-port towns into which the disease is directly imported by ships. 25 30. With reference to all the foregoing, we think it may be now safely asserted, that the conditions of the elements, Earth, Air and General considerations equ- . „ . * ally applying to all the fore- Water, may tend essentially to regulate the pre-disposition or soins ° ' otherwise of certain places to the reception of cholera ; and it will be found on examination to be equally certain, that the same principles must be acted upon in each instance of an epidemic, in order to dissipate the disease when once established. It will not therefore be necessary to repeat in each instance the specific reasons upon which our suggestions are based, or the detailed arguments, which point to the propriety of the remedial measures which should be adopted in each separate instance* 31. Our endeavour is, rather to lay before Government a general outline of preventive and curative" measures, the details of which must be modified so as to suit the various conditions under which this disease is witnessed, 32. The purity of the Air; its sufficiency in quantity ; its free circulation, General principles of pre- koth outs ide an( l inside all places of occupation ; the absence vention widely applicable. from it of deleterious gases, and especially those arising from Air> the decomposition of organic matters, are all circumstances conducive to a satisfactory condition of the public health and freedom from epidemic diseases. 33. "Water should be pure in quality, free from organic matter, and in sufficient quantity : a failure in any of these respects is injurious to public health. 34. The soil if impregnated by organic and more especially by excrementitious matter, acts injuriously on the health of those resid-0 ' ing upon it ; tends to render the water and the air impure ; and should, as far as possible, be avoided for occupation. 35. The foregoing considerations apply equally to all places permanently Conclusions of the Confer- occupied by men, and to them all are applicable the three ence on the foregoing- following conclusions of the Cholera Congress : — "1. The sanitary conservancy of towns is an efficacious means of opposing the reception of cholera and of lessening its ravages. a 2. This conservancy should be based chiefly on a combination of measures tending to maintain the purity of the air, to supply the town with abundance of wholesome water and to hinder the contamination of the ground with organic matters. " 3. The immediate disinfection and the removal of excrementitious matters, are sanitary measures of the highest importance, especially in times of cholera." 36. The practical measures, the adoption of which seem most calculated to _. .' t . , , . u secure the foregoing desiderata, are as follows, and are equally How these views should, foe oo > ¦ carried out. applicable to all places permanently inhabited by man. 37. The prevention of overcrowding in inhabited buildings ; the due ventilation of all cities and barracks by broad roads and open spaces How to maintain the purity of « roun^ between contiguous blocks of buildings ; the abolioi air in uiuiesj etc. o <_> />••;• tion of cesspits, heaps of sewage and surface impurities generally ; the rapid and inoffensive removal of all decomposing animal and vegetable 26 substances and especially exerenientitious matter, are all essential to maintaining a pure condition of the atmosphere. The conservancy, from impurity, of all water standing and running, and the institution of surface and subsoil drainage, must also be attended to ; the last two points being essential to prevent the emanation from the soil of deleterious gases calculated to render the air impure, and, for the same reason, the removal of all manufactories, likely to constitute nuisances or act prejudicially to the public health, must be insisted upon. 38. The provision of a water supply not liable to be injuriously affected by the contamination of surface or subsoil; the examination Water supply how to be » i ¦» 7. "In cases where the violence of the disease may render the measure necessary, Officers will halt altogether on any eligible spot within reach, or merely move their Camp for change of air, and clean encamping ground, until it may appear advisable to move on. Whenever practicable, the Corps or Detachment should be broken up into as many divisions as can be properly provided with medical aid, and separate encampments formed one or two miles apart — measures being taken to prevent communication. 8. "So long as Cholera exists in Camp, a daily report of cases and deaths is to be forwarded to the Quarter Master General ; European and Native are to be separately shown, and the names of ail European Officers attacked or deceased, are to be reported. 9. "In cases of extraordinary sickness, Officers Commanding Corps and Detachments are authorized to indent upon Collectors, or the Commissariat Department, for such number of country cots as may be absolutely necesssary. 10. v "When sufficient medical aid is available, and there is no Military necessity for marching entire, Regiments will march by Wings, at an interval often days. 11. "On every occasion of halt, orders should be issued and enforced for a thorough washing of all the clothes and for the complete purification of the carts, and the matting which forms the hood of the carts. Officers Commanding are especially enjoined to see that these instructions are rigidly carried out, as it has been proved by experience that this is one of the most effectual modes of preventing Cholera or of mitigating its attacks. In the Progress Report, it should be noted that this has been done. Care should be taken that the water used for this purpose is not that used for drinking. A guard should be invariably placed over the latter to prevent its contamination. 12. " Should Cholera attack the Regiment, it is desirable that a divergence from the road of 4 or 5 miles should be made at right angles to the prevalent wind or track of the disease. But this will seldom be practicable on account of the want of supplies on a road on which notice has not been given. a: 25. " With a view to preserving the conservancy of Camps and encamping grounds, the Commander-in-Chief directs that the system Conservancy of Camps- be adopted in Camp ag is the practice in all Military Cantonments, the main principle of which is, the daily burial of all refuse matter. 26. "It is therefore to be at once established as a Standing Order among all European Troops moving in course of relief, or otherwise, that 2 trenches, each 2 feet deep, 2 feet wide, and 50 feet long, are to be dug by coolies to be employed for the purpose at a distance of 120 yards from the flanks of each encamping ground, the inward flanks of such trenches to be 120 yards from the outward flanks of the Camp, that is, in echetton ; but should the nature of the ground prevent their location according to this rule, the same principle for their location is to be observed, that is, they are not on any account to be directly in front or rear of the Camp, but in echellon on their flanks, being so placed that the prevailing wind is not to carry the effluvia to the Camp ; these trenches are never to be in such proximity to wells as to make percolation to the water possible. 27. a The Quarter Master, or whoever is entrusted with the formation of * * * * 33 ,• » the encampment, is to see that this arrangment is made daily at the advance ground before the arrival of the Troops, aud a flag or other mark should be placed to show the position of the trenches, one of which is to be allotted for the European Soldiers, and the other for the Native Camp followers, &c, of a British Regiment : the same principle is also to be strictly enforced for Native Regiments, Cavalry or Infantry, on the march. Officers Commanding are to allot a certain site or position, in the vicinity (but not too close) of each encamping ground, for the use of the Native Soldiery and Camp followers. The present practice of defiling the ground on all sides of the Camp must be strictly prohibited. 28. " These trenches are to be thoroughly filled in with earth by coolies before the Bear Guard quits the ground, and for those duties the coolies should be properly divided between the advance and main Camps, and the Officer on duty with the Eear Guard is to be required to report to the Commanding Officer that the trenches have been so filled in, and, in the case of Native Troops, that the " sites" specially selected have been properly cleaned. 29. " The Commanding Officer of every Regiment or Detachment on the march is required to place himself in direct communication with the Tahsildar, or other responsible Native functionary at each encamping ground, to arrange that effectual measures are adopted by the Native local authorities for thoroughly sweeping and cleaning the whole area of each encamping ground immediately it is cleared of the Camp, as well as the " sites" above referred to, and for burning or removing to a suitable distance all collections of stable litter or refuse of every kind, &c, so as to make the ground perfectly fit for re-occupation by any Troops marching by the same route. 30. "In the event of Troops forming a standing Camp for exercise or other duties, or halting more than the ordinary time at any Camp ground, an additional deep trench should be dug at a distance of at least 200 yards from the Camp, and to leeward of it, on the same conditions as the first trenches, for the reception of filth twice every day; coolies removing it from the Camp trenches before mentioned, and depositing it in the deeper and distinct trench, as is done from the Latrines in Cantonments, and covering over with earth each day's accumulation. 31. "Enquiries are also to be made by the Quarter Master, or other responsible Officer of the Eegiment, at each advance ground, from the same Native functionaries, as to whether the well water has been recently drawn, and the well in a state fit for use for drinking and other purposes ; if not, effectual arrangements must be made for rendering it so before the arrival of the Troops on the encamping ground. 32. "In the Progress Reports furnished by Regiments to the Quarter-Master General of the Army, a note is in future to be entered that these orders have been strictly carried out. 33. " The coolies to be employed are to be supplied by the Native local authorities on the requisition of the Commanding Officer in such numbers as may be actually required. Payment will be made on Contingent Bills vouched in the usual 34 s. T ? manner, and forwarded to the Quarter- Master General to be disposed of, as are all other contingent expenses on a march. 34. " The requisition for the coolies should he made by the Commanding Officer at the same time that he furnishes the Civil authorities with the Indent for supplies. 35. "In the event of difficulty being found in supplying coolies, a working party from the Regiment must be told off to dig the trenches and fill them with earth but not to remove the excreta. 36, Eegimental intrenching tools are to be used. 37. "The following arrangements are ordered with reference to the movement of the families of Troops, Euro- Families on the March. pean and Native, 38. " Officers Commanding Eegiments, are allowed the discretion of sending the families in advance of the men in the afternoon, or of suffering them to follow the Eegiment ; but the former course is to be preferred when it can be adopted without inconvenience. 39. "If the road is good and the obstruction of rivers, &c, does not occur, the families may generally arrive soon after the Regiment on the ground. When it is otherwise, it is better that the families should precede the men. But in either case the Eegimental Artificers and a strong working party from the Eegiment, under a Non- Commissioned Officer, should accompany the carts to assist them in case of need. 40. " The Quarter Master of the Eegiment will mark out, on the new ground a site for the families to leeward of the ground chosen for the Camp of the men, and at some distance from it. Crowding of the bandies should be prohibited, and the bullocks should be removed to the rear. No carts ought to be allowed to leave the camp durinothe night, as they create disturbance and obstruct the road for the Regiment in the morning. 41. " The Officer Commanding will take particular care that unripe fruit and other sources of disease, are not sold in the Camp nor brought to it. Frequent inspection of the bazaars should be ordered. 42. "• In order to maintain men and families in health, they should be encouraged to eat heartily, and to bring to speedy notice any attacks of diarrhoea or any premonitory symptoms of Cholera, however slight." IV. Cholera among Native Troops on the March. 55. "The question of the measures to be adopted on the march of Native In- fantry Regiments was very fully gone into by the late Sani- OSr O cMnl^^&s. ta^ Commissi ™er the Honorable Mr. Ellis. As his report,on the subject has already been submitted to Government and has received general sanction in their order in the Military Department, No. 2074. dated 3rd June 1865 para. 7 we need do little more than note the general results which were arrived at by Mr. Ellis as regards cholera. 35 ~i f •? t Details regarding the pre valence of Cholera. 56. " All analysis of the returns of the Native Infantry Regiments on the march for a period of 24 years is appended below. Table A. Eeiubn shewing the number of Regiments attacked on the line of march after every two hundred miles of road passed over, from 1820 to 1824 iu elusive. Infantry. Cavalry. Artillery. Sappers and Miners. Total. ~ ~ S S -2 . 1 si I jbl 1 jsl I si I .si 2 2" J iH ugg -SoP "Sg2 2U2 U Distance of each | tg J |fe| -Sc £ S | §fe march. d « £ Z \ "^ a £ rf&l 1-1 1 -i| 1 1 r fi Hi 1 .si lit .si 1 1 1 .ji I 1 1 j r~ : Under 200 Miles. 144 14 130 9722 161 1 ! 15 6-250 210 2 ... 14i 0 14 ... 176 15 161 8-522 From 200 to 400 do 222 58 164 i 26-126 28' 4j 24 14-285 6 4 2 66-666 18 3 15 16-666 274 93 205 33-944 „ 400t0600 do 83 27 56 32530 12 4 8 33"333 3 1 2 33-333 Oil l! 100-000 99 33 66 33333 ? 600 to 800 do 27 16 11! 59-259 16 4| 12 25-000 1 1 0 IOO'OOO IOJ lj ... 45 21 24 ! 46-666 „ 800 to 1052 do 6 4 2 66-666 22| 0 100-000 0 0 0., 000... 862 75-000 i _| I j__! 1 I T0ta1.... 482' 119 363 24-688 74' 15; 59 20-270 12 6 6 50-000 3414 3oi 11-764 602 ! 144 458; 23 920 ilill ' I I \ I 57. By the following table, it will be seen that the attacks progressively increase with the duration of the march, till about the end of the 3rd month ; when these reach as high as 61 per cent, in the Infantry, after which period the proportion of attacks would appear to diminish, though amongst the Cavalry and Artillery it increases. Table B. Return shewing the proportion of attacks according to the number of days occupied in the completion of each march, from 1820 to 1844 inclusive. Infantry. Cavalry. Artillery. Sappers and Miners. Total. 1 II I II | |1 1 ll 1 II Number of days on § £is a -3 55 3 -3 § the march. £ "S S, £ « * f * i! & ili :l 1 1 1 :! 11 1 1 :l 1 1 i:1 1 1 t:i Jz; <| pq p3 Jz; -sj pq pel" £ » » v \ (c.) The ground should be high with natural facilities for drainage. (d.) There should be a good supply, if possible, of drinking water. (c.) Rank vegetation is objectionable, and experience has shown that thick topes of trees should be avoided. (/.) The distance of the camping ground from the Jail must depend on local circumstances, but as a rule two or three miles will probably suffice. (g.) The site should be selected with special reference to its state during the rams. (h.) The camping ground should be measured and the number of prisoners with their guards, which it is capable of accommodating, recorded. uTo remove doubts which have arisen, as to when Cholera shall be considered to have assumed an epidemic tendency, the following rule is prescribed for the observance of the Medical Officer in charge of the Jail, with whom rests the responsibility of declaring that it has assumed such a degree of epidemic intensity as to render the removal of prisoners necessary. xv. "' If within one week after the first case of Cholera has shown itself in a Jail, three or more cases occur, it shall be considered that the disease has assumed an epidemic form.' xvi. "In the case of epidemic Cholera a portion or the whole body, of prisoners will, at the discretion of the Medical Officer, move into the camp provided for the outbreak of epidemic disease in the Jail, and be located in tents Or in temporary huts erected for that purpose. xvii. " The Officer in charge of a Jail at a station at which there is a Camp Equipage Dep6t shall indent on such depot for a supply of the tents necessary for the accommodation of prisoners, to be moved into camp. xviii. "In like manner Officers in charge of Jails, accessible by Railway, will indent by telegraph on the nearest Camp Equipage Depot for a supply of the tents required. xix. " Provision will be made for supplying tents to Jails, not within easy reach of a Camp Equipage Depot, unless from local circumstances huts can be easily and quickly constructed so as to supply this accommodation for prisoners, instead of tents. xx. "Where epidemic disease has broken out in a Jail and it may not be considered desirable to remove all the prisoners into camp, the following precautions will be observed in the Jail during the prevalence of the disease. " The prisoners shall be organized in small gangs for exercise beyond the Jail walls. " Work in factories shall be relaxed, but not entirely discontinued. " The most scrupulous attention shall be paid to the state of the privies. xxi. " Disinfecting and deodorizing agents shall be freely used, such as Mac- Dougall's powder, charcoal, wood-ashes, coal tar and earth, and every precaution connected with ' dry earth conservancy' shall be most carefully and continuously enforced. 43 V • t < r xxii. "If soiled, the cell floors shall re-made, the walls shall be scoured with a stiff broom, removing from their surface and down from the roof, every particle of dust or animal matter. xxiii. lt A wood fire shall be burned in each cell, the doors and windows being temporarily closed. xxiv. " Special attention shall be paid to the boiling and subsequent filtration of all drinking water. xxv. v A portion of the Jail establishment shall be organized as a guard for night work ; this guard should go round frequently to the cells, wards, &c, to ascertain if any prisoner has been taken ill, and to remove him to the hospital at once. xxvi. " All overcrowding must be strictly avoided, not only in the hospital, but in every cell and ward. xxvii. " During the prevalence of Cholera and Jail Diarrhoea, slight cases of colic or ordinary diarrhoea must be treated separately. They shall not be admitted into hospital until the characteristic symptoms of Cholera and Jail diarrhoea have appeared. xxviii. " The hospital floors shall be thickly sprinkled with powdered charcoal, wood-ashes and earth ; the dejecta shall be immediately removed, and the wood-ashes and earth swept up and removed when any portion becomes soiled by the discharges. xxix. " The charcoal nets in the hospital shall be increased in number, and the charcoal more frequently re-placed than under ordinary circumstances. xxx. "The same Eules apply to the sleeping cells or wards. xxxi. " The alvine discharges on being removed from the hospital shall be collected outside in an iron pan, with a suitable cover, into which a quantity of Mac- DougaiPs disinfecting powder has been thrown, they shall, as frequently as possible, be carried off to the garden trench, which shall, on each occasion, be covered over with six inches of earth. xxxii. a The hospital latrines demand the most scrupulous attention to cleanliness. xxxiii. a The utmost attention to personal cleanliness shall be enforced in the case of every prisoner : small bathing and washing gangs, to be frequently relieved, shall be organized for this purpose. xxxiv. " The hospital clothing, or clothes and bedding used by patients., shall invariably be burnt. xxxv. "It frequently happens that the hospital passage gets saturated with choleraic discharges. A layer of fine sand and ashes a couple of inches thick, should be spread along the passage. This ought to be swept up and removed as often as any portion gets soaked, and fresh sand or ashes strewed in its place. The trench for the reception of the hospital filth need not be far removed : all that is required is, that the excreta should be constantly covered with sifted earth. xxxvi. " The water in which the prisoners have bathed or washed their clothes shall not be allowed to be thrown within the Jail walls. xxxvii. " Wood fires shall, under due precautionary measures, be kept burning 44 s >» * to the windward and within the Jail enclosure night and day, on the occurrence of any epidemic, in cases where it may not be practicable to remove the prisoners either into another building or into tents. xxxviii. li Attention shall be paid to the diet which should be modified in such a manner as the Medical Officer in charge may consider desirable. xxxix. " When prisoners are moved into camp, dry straw should be procured for the prisoners to sleep on, and cots for the sick. xl, "In camp there should be two detached hospitals, one for the treatment of miscellaneous cases and the other for the treatment of epidemic cases. These should be to the leeward of, and some distance from, the camp. xli. " Careful attention should be paid to the conservancy of the camp, and the trenches should be dug every day to the leeward of the position. To these trenches the prisoners and all connected with the camp should be made to go for the purposes of nature. These trenches should be covered over with earth every evening. xlii. "If the disease continues in frequency and virulence for three or four days after the removal of the prisoners, it will be advisable to shift the camping ground." VII. In Hospitals. 75. The precautionary measures to be taken against the extension of Cholera in and its dissemination from Hospitals, as probable foci of infection, are practically the same whether applied to Military or Civil life, and comprise " inter alia:" — ¦ (a.) The separation of the sick by Cholera from the general sick, and their isolation, as far as may be possible, by treating them either in separate wards, or in distinct buildings. (h.) The most rigid enforcement of all acknowledged rules of conservancy. (c.) The disinfection of the excreta and their immediate removal and burial. (d.) The destruction of all bedding and clothing used by the sick. ( Memhers. ) j Sanitary Commissioner for Madras. V,