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2019

James Annesley of Madras Medical Service (1800-1838) on cholera in Madras Presidency in 1825

Ramya Raman The University of Notre Dame Australia

Anantanarayanan Raman The University of Notre Dame Australia

Follow this and additional works at: https://researchonline.nd.edu.au/med_article

This article was originally published as: Raman, R., & Raman, A. (2019). James Annesley of Madras Medical Service (1800-1838) on cholera in Madras Presidency in 1825. Current Science, 116 (6).

Original article available here: https://www.currentscience.ac.in/Volumes/116/06/1026.pdf

This article is posted on ResearchOnline@ND at https://researchonline.nd.edu.au/med_article/1024. For more information, please contact [email protected]. This published version of the article published in Current Science:

James Annesley of Madras Medical Service (1800-1838) on cholera in Madras Presidency in 1825. Ramya Raman and Anantanarayanan Raman. CURRENT SCIENCE, 25 March 2019, Vol. 116(6), pp. 1026–1030.

Published version available: https://www.currentscience.ac.in/Volumes/116/06/1026.pdf

HISTORICAL NOTES

James Annesley of Madras Medical Service (1800–1838) on cholera in Madras Presidency in 1825

Ramya Raman and Anantanarayanan Raman

James Annesley from Ireland spent nearly four decades in Madras, first as an assistant and later as a senior surgeon attached to the Madras Medical Establishment. During this span of service he published the book in 1825 on the most prevalent diseases of India comprising a treatise on the epidemic cholera of the East. This paper recounts the epidemiology of cholera and the efforts made to manage it in the Madras Presidency in the 1820s, keeping in view the life of Annesley and the contents of his book.

As ever you come of women, come in Diseases most prevalent in India. Il- Arnold’s4 (pp. 118, 119) remark on the quickly to Sir John. lustrated by Tables and Plates. By cholera epidemic in India in the 19th Ah, poor heart! He is so shak’d of a James Annesley Esq. Madras Medi- century provides a panoramic perspective burning quotidian tertian cal Establishment; lately in charge of of the intensity of the disease and its that it is most lamentable to behold. the General Hospital, Madras, and fatal effects on the one hand, and its Sweet men, come to him. Garrison-Surgeon to Fort St. George. social–historical implications on the – London, 1825.’ people of India on the other: William Shakespeare King Henry V, Act II, Scene I Thomas and George Underwood, Lon- ‘…even though the sub-continent (words of Hostess to Corporal Nym). don, published this book by Annesley in was the source of the cholera pan- 1825 (Figure 1). demics and itself suffered millions of ‘How do humans live in tropical land- Cholera was considered the classic deaths from the disease during the scapes that generally experience high in- epidemic disease of the 19th century2. nineteenth and early twentieth centu- tensities of warm temperature?’ was one The disease, strongly implicated to have ries. This silence might seem to indi- question that usually concerned several originated in the Indian subcontinent, cate that because cholera was native British medical personnel in the early spread to parts of Europe and USA in the to India it generated none of the decades of the 19th century. Seeking an- 19th century, triggering people’s unrest strong reactions that marked its ap- swer to this question1 and also to earn and consequent riots, which prompted pearance in the west and that, what- large sums of money (note 1), many Eng- the local municipal administrators to ever was its demographic impact, it lish, Scottish and Irish medical doctors implement measures of better administra- was of marginal political and social came to India to work with the English tion and public hygiene, thus controlling significance. … Cholera provides a East-India Company (EEIC). Several of cholera, eventually3. In contrast, David convenient point of entry for the them went to other tropical British colo- study of mentality as well as the nies, such as the Bahamas and Jamaica. material conditions of India’s subor- Most of them wrote books sharing their dinate classes, while also illustrating experiences in those tropical nations. the interventionist capacity of the James Annesley came to India from colonial state and the political con- Ireland to serve in the Madras Medical straints that acted upon it.’ Service of the EEIC. He wrote a few books on tropical diseases in general, Keeping the above context in full based on his long innings as a junior and view, this paper highlights the work of senior surgeon. The following an- Annesley in the understanding of the nouncement occurs in the London Medi- science of cholera during his medical ca- cal and Physical Journal, edited by reer in the Madras Presidency. Roderick MacLeod (1825, 54, 523):

‘Sketches of the most prevalent Dis- James Annesley eases of India; comprising a Treatise on the Epidemic Cholera of the East; James Annesley (JA, Portrait 1) was born Statistical and Topographical Reports in 1774 to Marcus Annesley of County of the Diseases in the different Divi- Down, Ireland. He studied at Trinity Col- sions of the Army, under the Madras lege and the Company of Surgeons (CoS) Presidency: embracing also the (note 2). In 1795, JA earned his Mem- annual Rate of Mortality, &c. of Eu- bership of the CoS (modern equivalent ropean Troops, and practical Obser- being ‘Member of the Royal College of Surgeons’, M.R.C.S.). In 1799, he was vations on the Effects of Calomel on Figure 1. Cover of Annesley’s book the Alimentary Canal, and on the (1825; public domain). selected for medical service of the EEIC.

1026 CURRENT SCIENCE, VOL. 116, NO. 6, 25 MARCH 2019 HISTORICAL NOTES

He arrived in India in December 1800. charge as the Superintendent of the ‘It may be remarked as an instance of He was appointed as an assistant surgeon Madras General Hospital, until he re- extraordinary zeal in his professions, in the Native-Infantry Battalion, Trichi- turned to Britain in 1824. On leaving that, from that period to the present nopoly Corps (Tiruchirapalli, 10°48′N, Madras back to England, he was bade fa- time, he has never treated a case, ei- 78°41′E). Between 1802 and 1805, he rewell with a plate worth 100 guineas ther in public hospitals or in private served in different towns of the Madras (note 5). practice, without recording minutely Presidency. JA was invited to return to Madras in the symptoms of the disease, the re- In 1806, JA was posted as the Garrison 1829 on an assignment to examine the medies employed, and the results of Surgeon at Masulipatnam (16°17′N, medical records of previous years on the the application. His attention has al- 81°13′E). Here he got to see and treat pa- dictate from the Government of Madras ways been particularly directed to the tients suffering from various infectious that he should explore the patterns of dif- effects and the operation of medi- diseases of tropical India. He meticulous- ferent infectious diseases then rampant in cines, with reference to particular ly recorded the disease history and other the Madras Presidency. He analysed the symptoms and, in the event of pertinent details of every patient, noting archived records from 1788 to 1829. He casualties, the post mortem appear- symptoms, medications used and treat- linked the climate data of Madras Presi- ances have been looked to, with ref- ment outcomes. In 1811, he was ap- dency to disease epidemiology. His erence to both to the symptoms of the pointed as the Superintendent of a field report consisted of 12 volumes, accom- disease, and the remedies used.’ hospital established by the Government panied by 4 supplementary volumes, of Madras for native troops, which func- which pertained to medical observations. His nearly four decades of stay in Madras, tioned as a part of the Java Expedition These volumes are of considerable inter- dealing with patients suffering diverse launched by the British (for details of the est even today. He was appointed a infectious, tropical illnesses empowered Expedition, please see William James, member of the Madras Medical Board in him to get deeply interested into under- 1847, The Naval History of Great Brit- 1833 and served the Board for the next standing tropical diseases, interpreting ain, from the Declaration of War by five years. He served in the Madras Pres- them and suggest effective treatment and Trace in 1793, to the Accession of idency for 38 years, barring a few management tactics. George IV, vol. IV, Richard Bentley, months of leave of absence. He was London, UK). He became so popular elected to the Fellowship of the Royal Annesley’s Sketches of the Most among the native soldiers, who were to Society in 1840 and the Royal College of 6 be recruited for overseas service and Surgeons of Ireland in 1844. He was Prevalent Diseases of India… those belonging to the ‘Madras Regi- knighted in 1844. He was also a Fellow ment’ (note 3), that they readily volun- of the Society of Antiquaries. He died in This 464-page book is presented in three teered for service in any part of the Florence, Italy in 1847. parts: (1) On the epidemic cholera of world. In 1812, JA joined the Madras JA’s publications include Sketches of India, (2) Reports of diseases of the European Regiment (note 4) and re- the Most Prevalent Diseases of India…6, army under the Madras Presidency, and mained with it until 1817. He was pro- Treatment of Prevalent Diseases of In- (3) Practical observation on the effects of moted as the Superintending Surgeon to dia, 1825; and the multi-volume Digest calomel on the mucous surface of the the advanced divisions of the army and of Madras Medical Reports 1788‒1829. alimentary canal; and on its use in the served there until the end of 1818. His The section on ‘cholera’ from the diseases of India. Each part is divided role as a Superintending Surgeon is con- Sketches of the Most Prevalent Diseases into chapters, and chapters into sections. sistently cited in different records for his of India…6 was translated into German For example, chapter 2 (pp. 16‒44) enti- zeal and skills. In 1818, JA was by Surgeon Karl Gustav Himly in 1831 tled ‘Of the symptoms and progress of appointed Garrison Surgeon at Fort St. under the title Über die Ostindische Cho- the epidemic cholera’ in part 1 (pp. George, Madras. He held additional lera, nach vielen eigenen Beobachtungen 3‒250) is further classified into four sec- und Leichenöffnungen von James Annes- tions: (1) ‘Description of the symptoms ley (On the East-Indian Cholera, Sup- of epidemic cholera’ (pp. 17‒21), (2) ‘Of plemented with Several Notes by and the early symptoms of the epidemic cho- Autopsies made by James Annesley; Ver- lera, or the symptoms of the stage of inva- lage der Helwingschen Hof-Buchhand- sion’ (pp. 22‒30), (3) ‘Symptoms of the lung; presently, Helwingsche Buchhand- second, or advanced stage of the epidemic lung, Hannover, p. 254). cholera’ (pp. 31–55), and (4) ‘Of the An 18-page biography of JA by Tho- pathognomonic, diagnostic, and progno- mas Joseph Pettigrew5 is available. JA’s stic symptoms of epidemic cholera’ (pp. interest in tropical diseases seems to 36‒44). have blossomed when he was posted as The context for JA’s volume is based the Garrison Surgeon in Masulipatnam in on his experience of treating several pa- 1805‒1810. The words of Pettigrew5 (p. tients who suffered cholera, which broke 2) quoted below summarize JA’s passion out in the Madras Presidency in epidemic to the profession and his interest in tropi- proportions in 1819‒23, particularly

cal diseases and their management, espe- when he was at Fort St. George, Madras, Portrait 1. James Annesley (Source: cially during his term as the Garrison holding additional charge as Superinten- 5 Pettigrew ; public domain). Surgeon. dent of the Madras General Hospital. His

CURRENT SCIENCE, VOL. 116, NO. 6, 25 MARCH 2019 1027 HISTORICAL NOTES responsibility included examining those Calomel, a mercurial compound mandel (8‒20°N, 80‒82°E) in 1796 (ref. who had died of cholera as well. JA (Hg2Cl2), was popular during the 16th– 14). This record includes details of cho- strongly believed that a post-mortem 19th centuries in treating several human lera morbus coupled with spasms at the examination ‘should never be omitted illnesses. Calomel (literally means epigastrium. James Anderson, Physician- where any doubt exists of the real nature ‘good’ and ‘black’ [from Greek]; it will General at Madras, ordered that the letter of the disease’6 (p. xvi). turn black in the presence of ammonia) from Maxwell Thompson (Surgeon at- JA was deeply committed to the theory was used as a gastroenteric parasite tached to the 4th Regiment, European In- that the sporadic form of cholera is one cleanser, and a powerful cathartic and a fantry, Madras), which included details that was influenced by the climate of purgative. Early medical practitioners on the post-mortem examination of the India. The principal evidence he used to thought that calomel was useful as a viscera of a patient who had died of cho- reach the above conclusion was that cho- bowel cleanser, enabling the achieve- lera, be circulated along with the notes lera occurs endemically in certain dis- ment of a metabolic balance. The physi- made by Surgeon William Duffin, Head tricts (he does not name them) during cian–politician of America, Benjamin Surgeon, Vellore, and those by one certain seasons of the year. JA distin- Rush (1746–1813) argued that calomel Davis, Member, Medical Board, Madras guished the epidemic ‘India cholera’ was a highly useful medication to treat (note 8). Further to this, Anderson also from ‘cholera morbus’7. Rawlings8 ex- human mental imbalances10. The notoriety directed his medical staff in the Madras plained cholera morbus (which we know of calomel in that period can be read in Medical Establishment to consider the today as a gastrointestinal illness charac- Kang and Pederson11. JA was attracted remarks of the Dutch Physician Jacobus terized by cramps, diarrhoea and occa- by the usefulness of calomel, then seen Bontius (Jacob de Bonti, 1592‒1631), sional vomiting9) as a ‘summer as a panacea, and tried it in ‘scruple doses’ who practised in Batavia (presently, Jakar- complaint’ caused by food contaminated (note 6) for treating cholera in Madras. ta, Indonesia) in the 17th century15. Bon- by gastrointestinal pathogens usually He experimented with calomel in differ- tius had suggested that the ‘hot’ bilious manifesting in older children and adults ent combinations: for example, with matter irritates the stomach and intes- between July and September. JA pro- dilute nitric acid and with mild tartaric tines resulting in copious discharges vided a list of diagnostic features and acid. He was convinced that dilute tartaric from mouth and anus; this is an acute those of pathognomonic kind. Slight acid + calomel worked efficiently in disorder that requires immediate medical nausea and laxity of the bowels, he indi- draining the cystic bile (that flows attention. The principal cause being hot cated as the second stage of the disease. through the duct which joins the gall and moist air, which generally included This stage quickly transforms into in- bladder and the common bile duct) help- ‘bluish-green’ putrefying material that tense diarrhoea and rigorous vomiting, fully by dissolving the ‘dark-grey dejec- usually grows on fruits (note 9). Accord- what he described as the third stage when tions’. What JA means by ‘dark-grey ing to Bontius, these bluish-green mate- the patients usually seek medical help. A dejections’ is not clear. Perhaps he means rials triggered the production of burning sensation between the scrobicu- the ‘agents’ that induced cholera. Ac- æruginous bile in humans, better known lus cordis (the depression spot in the epi- cording to him, calomel separates the as miasmatics, wherein miasma means an gastric region) and the umbilicus was viscid matter and produces the dark-grey oppressive, unpleasant atmosphere cha- determined by JA as a significant early dejections, which is a predisposition to re- racterized by a nauseating vapour arising symptom of the disease. Based on post- covery of patients suffering from cholera. from rotting biological materials16. mortem examinations of many cholera- In the second part of the same volume, Charles Curtis17 (Surgeon-on-board, Me- induced deaths in India, he suggested he delineates the prevalence of other infec- dea Frigate, 1778‒1805) in his travelo- that epidemic cholera is an affection of tious diseases of India and relates them to gue elaborately describes cholera the nervous system, which progressively geography and climate, and how these abi- prevalent along the coastal hamlets of the alters its functions. More importantly, he otic factors influence the biological consti- then Madras (city), and has supplied derived the changes in the blood profile tutions of Westerners living in India. some case reports pertaining to a few sai- as a consequence of failure of the nerv- lors, who had contracted the disease ous system. He believed that venous when Curtis halted in Madras (pp. congestion is one common outcome of Remarks 44‒89). Among the notable names of cholera for which he suggested bleeding Madras, Thomas Munro, Governor of to relieve the heart and lungs from Suśruta Samhiŧã – an ancient Indian Madras, died in Pallikonda (12°55′N, oppression. During phlebotomy, JA medical text – indicates a violent diarr- 78°56′E) because of cholera in July 1827 recommended not relying on the quantity hoea as Viśuçika12, broadly meaning a (ref. 18). of blood extracted, but on the quality, i.e. stomach, intestinal disturbance. However, In 1818, seasons were markedly irre- until the extracted blood was bright red. the Orientalist Horace Wilson13 (note 7) gular and excessive rain occurred. JA He looked upon bleeding as ‘the sheet describes Viśuçika as spasmodic cholera. mentions that 1818 – in terms of cli- anchor in the treatment of epidemic cho- Cholera has been present in the Madras mate – was similar to 1817. According to lera’. He recommended the use of cam- Presidency long before JA’s experience him excessively heavy rainfall in Madras phor, ammonia and æther in preference of dealing with it. At an intense scale, from July 1817 to January 1818, coupled over opium, the last item having an in- the Madras Presidency experienced cho- with a great deal of thunder and fluence on the brain. He vividly spoke on lera in Arcot (presently Vellore district, lightning, followed by an intense hurri- the use of calomel as a critical remedial 12°99′N, 79°31′E) in 1787‒1789; it was cane in October triggered cholera. This component in treating patients suffering also reported from Ganjam (19°38′N, observation makes some sense, since we epidemic cholera. 85°05′E) in 1790, and along the Coro- know that cholera is a contaminated

1028 CURRENT SCIENCE, VOL. 116, NO. 6, 25 MARCH 2019 HISTORICAL NOTES water-borne disease; however, the rest the same time that JA published his coupled with severe water and electrolyte need to be read with a grain of salt. volume. Orton subscribed to the climate loss. TCP is vitally necessary for V. cho- This contagious disease – occurring and miasma theories of cholera as long lerae colonization of the small intestinal and spreading principally due to poor as he was in India, but changed his sub- epithelium. In both classical and El bio- sanitary conditions – can inflict death in scription to ‘contagion theory’ on his types within O1, genes get differentially unattended patients, mainly because of return to England in the 1830s. Many of expressed between the biotypes, particu- dehydration. Before the 1820s, it was dif- the remarks made by Annesley on his larly in vitro conditions26. ficult to differentiate cholera from other understanding of cholera are not tenable In spite of such significant develop- diarrhoeal diseases. The earliest record today: his linking to climate and miasmat- ments in the understanding of the science of cholera breakout pertains to 1817, the ics, his interpretation of cholera linked to of cholera, we are struggling to effective- subsequent epidemics occurring in 1827 the nervous system are curiosity-provo- ly manage the disease even today. For and 1829, spreading subsequently via king, from the historical perspective of instance, it still continues to be a major trade routes, tourists, and army move- the understanding an infectious disease. fatal disease in Africa and Asia. Close to ments to many European countries and The report of the Madras Sanitary 40% of cholera cases reported to the America19. Commissioner23 for 1913, which also World Health Organization come from Medical diagnosis of cholera in the includes the report of the Sanitary Engi- Africa, as against 93% and 98% in 2001 17th and 18th centuries was made using neer for the same year, submitted nearly and 2009 respectively. Asia follows next features such as profuse watery and foul- 100 years after JA’s work on cholera in with 38% and the Americas with 21% smelling stools, associated with vomiting Madras, highlights a few significant im- (principally Haïti, the Dominican Repub- of clear fluids. Three names figure prom- provements made in the context of the lic and Cuba)27. There is a long way to inently in the chronology of the science mitigating damage caused by the disease go, before we can declare that we have of cholera: British surgeon John Snow in Madras. The number of deaths be- won the battle over the dreadful V. cho- (1813–1858), better known as an anæ- cause of cholera had declined from lerae and the illness it induces. sthetist; Italian anatomist Filippo Pacini 92,497 of earlier years to 37,730 in the (1812–1883), and the German microbio- report period. The Government of Notes logist Robert Koch (1843–1910). Snow Madras had reserve parties of sanitary clarified that cholera (i.e. cholera- inspectors, who periodically visited dif- 1. Substantial disparity in wages between inducing agents, although he did not spe- ferent locations to census cholera suffer- British and Indian surgeons prevailed cify what these were) multiplied within ers and advise them appropriately on its until India’s independence in 1947. This human systems and cholera spread via management. Use of potassium perman- practice existed even among those Indians contaminated water. Pacini found hun- ganate (KMnO4) was strongly advocated who had completed postgraduate training dreds of microscopic organisms in the and the arms of the government gene- and earned the memberships and fellow- ships of different Royal Colleges of Phy- intestines of the people who had died due rously applied KMnO4 at appropriate to cholera, which he called the ‘vibrions’ doses ensuring safe water supply. A cho- sicians and Surgeons in the UK (e.g., M.R.C.P., F.R.C.S.). See, for example, (Vibrio cholera). After processing the lera dispensary was established by the Valerie Anderson’s28 comment ‘Even organisms in water and saline solution, Corporation of Madras in Tondiarpet though Eurasians outnumbered Europeans Pacini isolated the vibrion, which he (13°12′N, 80°28′E) in 1914, with a for- in India (2 : 1) throughout the nineteenth clinched as the causal agent for cholera. mal name ‘Infectious Diseases Hospital’, century, Europeans were recruited at Koch was interested in the bacterium but popularly known as the ‘Cholera around twice the rate of Eurasians’ (p. responsible for cholera; so he came to Hospital’. Today it functions as the 240). However, we need to factor here Calcutta in 1883 to gain first-hand know- ‘Communicable Diseases Hospital’. The that Anderson talks of Eurasians (presently ledge of the disease20. In 1884, Koch an- note from this report23 that the Govern- Anglo-Indians) only. Indians were worse nounced that he had successfully isolated ment of Madras administered cholera off than the Eurasians. the bacillus in pure culture. The original vaccine to residents in Madras (numbers 2. The Company of Surgeons (CoS), Lon- don, was established in 1745, cleaving the binomial offered by Pacini (V. cholera) not available) is fascinating. The vaccine original organization, ‘the Company of was amended as Vibrio cholerae (Pro- used, in high likelihood, should have Barber–Surgeons’ (established in 1540). teobacteria: Vibrionaceae) in 1965 by the been the Ferran vaccine for cholera The principal role of CoS was to register International Committee on Systematic developed in 1885 (note 10). interested personnel as trainees to work Bacteriology. Koch confirmed that popu- Today we know so much about cholera with practising surgeons and to examine lations of V. cholarae living in the intes- and its intensity of damage to human them at the end of their training. Between tines and stools of victims were the populations24,25. For example, we know 1796 and 1799, CoS experienced admin- causal agent of the disease, during his that the cell surface of V. cholarae in- istrative turbulence but managed to tide visit to Calcutta21. cludes the lipopolysaccharide O-antigen, over it in 1800 and was rebranded as the Cholera seems to have been of deep which empowers us to recognize close to ‘Royal College of Surgeons in London’. This transformed as the ‘Royal College of interest among medical personnel in 200 serogroups, of which only O1 and Surgeons of England’ in 1843 through a Madras and India until recent decades. O139 are responsible for the epidemic royal charter. Many have written on this dreadful dis- cholera. We also know that V. cholerae 3. The Java Expedition, also referred as the ease. We will cite two examples here: O1 is distinguished by two of its major Java Invasion, was a successful amphi- 7 22 Whitelaw Ainslie and Reginald Orton virulence factors, cholera toxin (CT) and bious operation launched by the British in have written on the ætiology and man- the toxin co-regulated pilus (TCP). CT is September 1811 in Madras. In 1748, the agement of cholera in Madras, almost at responsible for the diarrhoeal disease Madras Regiment was formed as a battalion

CURRENT SCIENCE, VOL. 116, NO. 6, 25 MARCH 2019 1029 HISTORICAL NOTES

with Stringer Lawrence as its commander. 2. Rosenberg, C. E., The Cholera Years: Fleet, and in the Naval Hospital at Ma- This regiment was also known as Madras The United States in 1832, 1849 and dras, in 1782 and 1783; with Observa- Regiment Sepoys. 1866, The University of Chicago Press, tions on Ulcers, and the Hospital Sores 4. The Madras European Regiment was Chicago, USA, 1987, p. 276. of that Country, &c. &c., W. Laing and formed by the English East-India Company 3. Tien, J. H., Poinar, H. N., Fisman, D. N. Longman, Hurst, Rees, and Orme, and in Madras in 1742, mainly consisting of and Earn D. J. D., J. Royal Soc. Inter- J. Murray, London, UK, 1807, p. 283. European soldiers. Later this regiment face, 2011, 8, 756‒760. 18. Thurston, E., The Madras Presidency came to be known as the 102nd Regiment 4. Arnold, D., Past Present, 1986, 113, with Mysore, Coorg and the Associated of Foot (Royal Madras Fusiliers). 118‒151. States, University Press, Cambridge, UK, 5. One guinea, valued slightly more in value 5. Pettigrew, T. J., James Annesley Bio- 1910, p. 310. than a British pound, was used in the 17th graphical Memoirs of the Most Celebrat- 19. Pollitzer, R., Bull. WHO, 1957, 16, 295– century Britain. Made of gold, it equalled ed Physicians, Surgeons, etc. Who have 430. 22 shillings. Because Guinea in Africa Contributed to the Advancement of Med- 20. Howard-Jones, N., Br. Med. J., 1984, supplied the gold with which this coin ical Science (Medical Portrait Gallery 288(6414), 379–381. was minted, it was popularly referred as Series), Whittaker & Co., London, UK, 21. Lippi, D. and Gotuzzo, E., Clin. Micro- the ‘guinea’. 1839, pp. 1‒18. biol. Infect., 2014, 20, 181–195. 6. A ‘scruple dose’ was a measurement unit 6. Annesley, J., Sketches of the Most Preva- 22. Orton, R., An Essay on the Epidemic that equalled 1/24th of an apothecary’s lent Diseases of India; Comprising a Cholera of India, Burgess & Hill, Lon- ounce. A scruple measured 20 grains, a Treatise on the Epidemic Cholera of the don, UK, 1831, p. 488. dram (or drachm) measured three East; Statistical and Topographical Re- 23. Madras Sanitary Commissioner, The Fif- scruples, an ounce (apothecary’s ounce, ports of the Diseases in the Different Di- tieth Annual Report of the Sanitary written in short form as ‘oz.’ deriving visions of the Army, under the Madras Commissioner and the Twenty-Fourth from the Italian term ‘onza’) measured Presidency: Embracing also the Annual Annual Report of the Sanitary Engineer eight drams, and a pound measured 12 Rate of Mortality, &c. of European for 1913, Superintendent, Government ounces. In common parlance, a scruple Troops, and Practical Observations on Press Madras, 1914, p. 70. dose also meant a ‘small’ quantity. the Effects of Calomel on the Alimentary 24. Barua, D. and Greenlough, W. B., Chole- 7. Horace Hayman Wilson (1786–1860) was Canal, and on the Diseases Most Preva- ra: Current Topics in Infectious Disease, a qualified physician, who worked in Cal- lent in India. Thomas & George Under- Springer Science + Business Media LLC, cutta, in the Bengal Medical Establish- wood, London, UK, 1825, p. 464. Heidelberg, Germany, 1992, p. 372. ment. He was a passionate orientalist, 7. Ainslie, W., Observations on the Chole- 25. Sikora, A. E., Vibrio cholerae: Methods who studied the languages and mythology ra Morbus of India: A Letter Addressed and Protocols, Springer Science + Busi- of India. He was also interested in metal- to the Honourable the Court of Directors ness Media LLC, Heidelberg, Germany lurgy and for some time was attached to of the East-India Company, Kingsbury, 2018, p. 180. the Government Mint in Calcutta. Parbury, and Allen, London, UK, 1825, 26. Son, M. S., Megli, C. J., Kovacikova, G., 8. Details of ‘Davis’ at the Madras Medical p. 90. Qadri, F. and Taylor, R. K., J. Clin. Board are not traceable. Crawford in his 8. Rawlings, I. D., The Rise and Fall Microbiol., 2011, 49, 3739–3749. Roll of the Indian Medical Service 1615– of Disease in Illinois, Schnepp & 27. Olson, D., Fesselet, J.-F. and Grouzard, 1930 refers to one ‘Thomas Davis’ of the Barnes, Springfield, Illinois, USA, 1927, V., Management of a Cholera Epidemic: Madras Medical Board, under William p. 432. Practical Guide for Doctors, Nurses, Horseman (serial number 419, p. 285). 9. Humphries, R. M. and Linscott, A. J., Laboratory Technicians, Medical Aux- 9. This must have been either Penicillium Clin. Microbiol. Rev., 2015, 28, 3–31. iliaries, Water and Sanitation Specialists italicum or P. digitatum (Ascomycota: 10. North, R. L., Proc. Baylor Univ. Med. and Logisticians, Médecins sans Fron- Eurotiales: Trichocomaceae), which gen- Cent., 2000, 13, 45–49. tières, Paris, France, 2017, p. 245. erally grows on rotting fruits of citrus. 11. Kang, L. and Pedersen, N., Quackery: A 28. Anderson, V. E. R., Ph D thesis, School 10. Jaime Ferran, a Spanish physician and an Brief History of the Worst Ways to Cure of Oriental and African Studies, Univer- alumnus of the Louis Pasteur School in Everything, Workman Publishing Com- sity of London, UK, 2011; https://eprints. Paris, developed the attenuated vaccine pany, Inc., New York, USA, 2017, p. soas.ac.uk/13525/1/Anderson_3334.pdf for cholera in 1885, after growing Vibrio 342. (accessed on 16 December 2018). cholerae in culture media. He was the 12. Sen, S., Indian J. Hist. Sci., 2012, 47, 29. Fernández-Sanz, J. J., Asclepio, 1989, first in the world to vaccinate nearly 345–374. 41, 51‒86. 50,000 Spaniards, when a major cholera 13. Wilson, H. H., Trans. Med. Phys. Soc. epidemic broke out there in Spain29. From Calcutta, 1826, 2, 282–292. the 1990s, cholera vaccines are orally 14. Anon., Med.-Chirurg. Rev., 1832, 31, ® administered. Dukoral , for example, 497‒513, 609‒632. includes killed whole-cell material of V. 15. Bontius, J., Tropische Geneeskunde (On Ramya Raman* is in the School of Medi- cholerae‒O1 in combination with a re- Tropical Medicine), Sumptibus Societa- cine, University of Notre Dame, Mouat combinant B-subunit of cholera toxin tis, Amsterdam, The Netherlands, 1931 Street, Fremantle, WA 6160, Australia; (CTB). This oral vaccine is supposed to (first published in 1629), p. 459. Anantanarayanan Raman* is in the provide 85–90% protection for the first 16. Last, J. M., In Encyclopedia of Public six months, and subsequently requires a Health (ed. Breslow, L.), Macmillan Charles Sturt University & Graham Cen- booster dose. Reference, New York, USA, 2001, vol. tre for Agricultural Innovation, P.O. Box 3, p. 765. 883, Orange, NSW 2800, Australia. 1. Cook, G. C., J. Royal Soc. Med., 1990, 17. Curtis, C., An Account of the Diseases of *e-mail: [email protected]; 83, 38‒41. India, as they Appeared in the English [email protected].

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