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Fun, 1904.)

CHOLERA IN PURI TOWN AND DISTRICV.

49 the occupants in the same compartment more liable to become infected, but they also infect pools and tanks at stations along the line.

Having to wait for three hours at a junction on the line, I noticed many of the pilgrims washing loin cloths and other garments in the pools close by the railway line; these pools could not fail to become infected, and, as many of the pilgrims cleansed their mouths and drank this water, they would assuredly be victims to cholera.

The number of people present in the town on the 6th and 7th July, the first two days of the festival, was as follows:--

Number by rail to Puri... 8 3 -+, 49,987

Number by rail to Sakhigopal wey ou a. $2,861

Local people from Puri, Cuttack and Balasore Districts 20,000

Total — 72,848

And if to this number be added the permanent population of Puri town, viz., 30,857, then over a lakh of people were present.

From the Ist to the 20th July there were 306 cases admitted to the Cholera Hospital from an average population of 50,000 or 6 per cent.; the mortality was 254 or 83 per cent.—-a high percentage indicating the degree of virulence of the disease.

Dr. H. Sen, in an article in the Indian Medical Gazette for April, 1903, has given a comprehensive statement showing the mortality from cholera for each month in the years from 1890 to 1901.

In the same paper there is given a diagram showing the incidence of cholera mortality in the district of Puri based on the averages of the twelve years from 1890 to 1801; from this it would appear that the disease reaches its acme of mortality almost yearly in the month of July.

It is unnecessary to reiterate here the conditions under which cholera flourishes in Puri town and district; suffice it to say, that these have been thoroughly gone into the aforementioned paper together with the measures then taken to alleviate them.

The main object of this paper is to indicate how the epidemic of cholera in July, 1902, spread throughout Lower Bengal.

What might be termed “ primary dissemination” takes place in Puri town, and more especially at the railway station, where pilgrims have to wait sometimes a day or even two days before they are allowed on to the station platform.

From July 8rd to July 20th 44 patients were admitted to the Puri Railway Hospital, of which 32 died, and of the whole number, 37 cases alone were removed from the station yard.

Then there is what might be termed “secondary dissemination,” which occurs on the Juggernath Road to Cuttack, and on the railway line to Calcutta, and from thence to the mofussil.

In the epidemic of 1901 Dr. Sen states “that polluted sources of drinking water were at the root of the spread of the disease, and could be easily traced,” and he gives an instance.

The intensity of the spread of disease depends to a great extent upon the degree to which the water of villages and towns en route is polluted by the infected amongst the returning pilgrims. Where the water-supply of such towns and villages is abundant, little cholera will prevail, as was fortunately the case in 1902; on the other hand, where the village tanks and water-supplies are low and scanty, as occurred in 1901, then pollution takes place easily and cholera abounds. There is thus a distinct relation between the rainfall and the intensity of the spread of the disease, and there is little doubt that in the year 1902 the spread of the disease was influenced thereby. In 1901, the rainfall was small and cholera spread rapidly; in 1902, the rainfall exceeded the average, and so the amount of the disease was comparatively less.

A circular letter was written to Civil Surgeons of districts from which the pilgrims came, requesting information as to the number of cases of cholera occurring in their respective districts during the period from 5th July to the 2nd August, 1902, These returns give but a rough indication of the number of cases caused by pilgrims arriving from Puri, as mainly those who came to the Civil Hospitals fur treatment are noted, not counting many who probably died in their homes beyond the cognisance of the Civil Surgeons or Registrars, Some cases of true cholera would be returned as “Acute Diarrhoea,” and so would not be shown in this return.

Statement showing the distribution of cholera throughout Bengal from bth July to 2nd August, 1908.