$ection of Epibemtolop anb state Tebictne. President-Dr. JOHN C. MCVAIL. The Conditions Influencing the Incidence and Spread of Cholera in India. By Sir LEONARD ROGERS, M.D., F.R.C.P., F.R.C.S., F.R.S., I.M.S. (Ret.). AT the present time the medical profession is generally agreed that the essential cause of cholera infection is Koch's comma bacillus, and that the disease is spread from place to place by human intercourse. There are, nevertheless, many facts regarding the incidence and spread of cholera in India that cannot be explained in the light of our present knowledge of the subject. These facts to some extent justified the long delay in the acceptance of the modern views regarding this serious epidemic disease, and formed the basis of the wind-extension theory, the last vestige of which was not removed until the 1894 edition of the Indian Army medical regulations was withdrawn. In these regulations the troops were ordered, when attacked by cholera, to march at right angles to the wind, and the edition was with- drawn as the result of the ridicule poured on it by Ernest Hart at the opening meeting of the first Indian Medical Congress held at Christmas of that year, at which I was present. Thus, the most striking argument of those who denied the infectivity of cholera, and the possibility of its being carried from place to place by human intercourse, was the undoubted fact, largely true to the present day, that cholera does not spread over India during the frequent epidemics any more rapidly in the era of rapid railway communications than during the first great epidemic of which we have any accurate data, 1817-18; that early epidemic, according to the great Madras authority, W. R. Cornish, having spread over the South of India to Ceylon considerably more rapidly than any of the outbreaks of 1859-1871 which he studied carefully. To the present day the regular sequence of events in Northern India is for cholera to become very prevalent in Eastern Bengal in November and December, in Bihar and the Eastern sub-Himalayan divisions of the United Provinces in March, the Southern and the Western United Provinces in April, and the Punjab not until May, in spite of railway communications uniting the extremes of this immense area in three days. Much the same is true of the relationship of cholera in Bengal and the Central Provinces and the Deccan divisions of Bombay. The frequent epidemic exacerbations of the disease in various parts of India, its complete disappearance for a year or two at a time in large areas of the Punjab, the Central Provinces, and in the Sind, Gujerat and Deccan divisions of the Bombay Presidency, in spite of daily railway communication with the endemic areas, only to be followed by further serious epidemics in these areas without any material change from year to year in the appalling insanitary conditions of the vast majority of the population living in the villages-these facts all await explanation. It seems clear that until these riddles are solved little can be done beyond the exceedingly slow general improvement in sanitation, which, in such a poor country as India, as a whole, will require centuries to accomplish to the degree necessary for the prevention of cholera. Yet another powerful, and at present unanswerable, argument of the anti- infectionist of India is that although the Hurdwar pilgrims by no means rarely JY-Ep 1 [ApriZ 23, 1926. at SAGE Publications on June 21, 2016 jrs.sagepub.com Downloaded from
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
