I several miles westwards). The greater part of this western half is open pasture land, being so sterile as not to be worth cultivating, crops being grown for the most part only near the rivers, and in irrigated plots close to villages. Two large rivers pass through this part of the district, the Little or Damdaha Kosi, about 18 miles west of town : and the Kala Kosi, some three miles west of the town ; the former is much the larger. Both are offshoots from the Great Kusi. In the north-western part of the district there is ?i[icjiimt (EonvimutiqaiionH. considerable inosculation of water-channels between the three branches of the Kusi, and the NOTES ON AN EPIDEMIC OF CHOLERA IN whole western half of the district is more or less . cut up by hollows, dry in the hot weather, in the and full of water in the FEBRUARY?JUNE 1891. swampy cold, rains, which are the remains of old channels By Surgeon D. G. CRAUFORD, m.b., i.m. s., of the Great Kusi liiver. Several of these are Civil Purnia. OJfg. Surgeon, to be seen in and near the civil station itself, The district of Purnia, in which took place The water-supply of this western half of the the epidemic about to be described, is the most district is chiefly from wells, except actually on easterly district of the province of Behar, in the the banks of the rivers. The population of the Lieutenant-Governorship of . It lies eastern half of the district consists chiefly of between 25? 15' and 26? 35' north latitude, and low caste(Rajbansi) and of Mussulmans, between 87? 02' and 88? 35' east longitude. all semi-aboriginal, that of the western half consists of Bihari Its total area consists of 4,965 square miles. The mainly Hindus. population, according to the census of 1881, The -Darjiling Road, which, before was 1,848,687, and, according to that of 1891, the opening of the Northern Bengal Railway, some five cent. more. It is bounded on the formed the chief means of communication between per * north by JNipul, and in the extreme north-east- Calcutta and Darjiling, runs through Purnia almost the whole of ern corner by the hill district of Darjiling ; on district in its length in the the east by the districts of Jalpiguri, Dinajpur, plains from Karagola on the Ganges, near the and Malda; on the south by the River Ganges, S.-W. corner of the district to Titalya in the ex- beyond which lies the districts of Bhagulpur and treme N.-E. corner, 106 miles, on its way passing the Sonthal Parganas; and on the west by the through the civil station of Purnia. The Great Kusi River, which separates it from North Behar Railway opened some three years ago, Bhagulpur and falls into the Ganges at the south- also runs through the district in two different western corner of the district. directions, commencing at , on the The eastern and western halves of the dis- Ganges it runs almost due north for some 20 trict are physically of very different character, miles to . an important junction, there the dividing line corresponding roughly with it divides in two: one branch running eastwards the Pauar River, which is in part an offshoot past Diuajpur to join the N. B. R. at Parbati- from the Great Kusi River, from which it pur; the other passing to the N.-W. to Achra takes off in Nipal, flows down through the dis- Ghat, on tlie Great Kusi River, in the N.-W. trict from N.-W". to S.-E., dividing it into two corner of the district. The Tirhoot State Rail- almost equal lateral halves; and finally enters way meets this branch on the opposite side of the Ganges at the S.-E. corner of the district. the river. This road and railway form the chief The eastern half is low-lying, mostly highly means of communication in the district. is divided cultivated, alluvial land, watered by a net- Administratively, the district into work of inosculating rivers, and containing three sub-divisions, and thirteen thanas or police numerous marshes. The water-supply is chiefly stations. The sadr or head-quarters sub-division derived from these rivers. The western half is comprises seven thanas, Purnia, Gondwara, more high-lying, and thickly overlaid with Damdaha, Manihari, Kadwa, Amur Kasha, sand deposited by the Kusi River in its gradual and Balrampur. sub-division, in the westward movements. Less than two centuries N.-W. of the district, has three thauas, Araria, and ago this river passed southwards near, possibly, Matiari, Rauiganj, and sub- to the east of the town of Purnia, but has gradu- division, in the N.-E. of the district, includes ally worked its way westwards till now it forms three thanas, Kishanganj, Kaliaganj, and the western boundary of the district, fully thirty Bahadurganj. Of these divisions, the whole of miles west of Purnia town. (Even since the Araria sub-division, and the first three thanas of sadr western half current survey map of the district wns planned, the sub-division, form the between 1840 and 1850, the river has worked of the district; the other four thauas of the 34 INDIAN MEDICAL GAZETTE. [Feb. 1892.

and the whole of sndr sub-division, Kishauganj held without any sanitary precaution, but great sub-division, form the eastern half. This divi- improvement in this respect has been effected of sion is almost exact; except that part of Araria late years. The Civil Medical Officer of Puriiia in the western east Panar thana, half, lies of the in his special report on the cholera epidemic of River, and part of Kadwa and Manihari thana?, 1889, attributed the spread of the disease to the the eastern so. in half, lie west of it, it is quite crowds returning home on the break up of the The respective areas and populations (1881 fair of that year. The Deputy Sanitary Com- census) of the two halves sire as follows: west, missioner of Darjiling Circle, however, who also 2,403 square miles; 788,735; east, 2,553 square reported specially 011 that epidemic, seemed miles; 1,059,952. doubtful as to whether any blame really attach- The district of in its was Purnia, though general ed to the fair. This year, 1891, the fair later physical characteristics much more akin to Bellar than usual, from 23rd Febuary to 8th March, to endemic area of than Bengal, lies within the and it was attended by a comparatively small cholera, and has always been a district notorious number of people. And this year's epidemic for cholera prevalence. It is one of those dis- had broken out before the beginning of this year's tricts in which cholera is known to have existed fair. of and prior to the historic epidemic 1817, The epidemic of 1889, whether originating at also from the disease in thai suffered severely Karagola fair or not, began in February, the year. The earliest cholera statistics available, month in which the fair is usually held, but did 1859 out of 310 refer to the jail. In May pris- not attain epidemic proportions until March. oners were attacked and in jail 109 by cholera, In April it reached its maximum, a very rapid In March 1863 out of 551 in 60 died. prisoners, fall followed in May, and in June there were twelve 211 were of whom 124 days attacked, hardly any deaths. In January 1889 only 24 died. In April and May 1867 there were 69 deaths from cholera occurred, 9 in the western cases with 43 deaths. Since 1859 cholera has and 15 in the eastern half of the district. In in the almost been epidemic district, legularly, February there were 125 deaths, 107 in the west- the odd a verv every second year, years showing ern, and only 18 in the eastern half. In March much heavier cholera mortality than the even 6,198 deaths from cholera were registered, of ones. The chief exceptions are little cholera in which 5,572 took place in the western, and 626 1865 and 1883, odd years; and severe cholera in in the eastern half. In April 10,232 deaths oc- 1878, 1882, 1886, and 1890, even years. The curred, the western half contributing 8,150, and same total of cholera mortality, however, which the eastern 2,082. I11 May the number sank to fifteen years ago would have been considered a 625,of which 400 occurred in the western half and severe epidemic would now be considered small, 225 in the eastern. In June 65 deaths occurred, with enormous in comparison the totals registered 15 in the west, and 50 in the east. From July, the during the past few years. Part of this increase west of the district, remained free from cholera, number of no in the deaths registered, doubt, only 11 deaths being registered during the six be due to better still it is may registration; months, but a few cases continued to occur in the difficult to resist the conclusion that the epide- eastern throughout the second half of the year. of recent more mics years have really been fatal On the whole, the entire western half of the than those recorded in the earlier Re- years. district suffered very severely from cholera gistration is still imperfect enough ; indeed, it is during March and but of the eastern to April, impossible hope for anything like complete; only Kadwa, Amur, , and Manihari until it is as difficult in as it Kishan- registration , thanas showed any great mortality. is now in to of a dead England, dispose bod\ ganj sub-division and Balrampur than a, in other without the cause of Such a registering death. words, the whole of the east of the district, al- state of of is still in the dim dis- affairs, course, most entirely escaped. The meteorological re- tance. But is much less defective registration turns of the year show nothing special, the rain- now than it was fifteen years ago. fall from to iuclusive was under of February April Several epidemics, those 1869, 1875, 1882, half an inch. and 1889 were attributed to outbreaks at Kara- There was comparative freedom from cholera xnela or a jiola fair. This fair is very large one, in 1890. In and February, and from held at - January Karagola, in the S. W. of the district, July to the district was almost free where the November, Ganges-Darjiling Road begins. It is from cholera. From March to June there was attended or usually by thirty thousand people a limited outbreak almost confined to Araria more. A considerable number of these people sub-division and Damdaha thana, i. e., to the TV. are hillmen, Nipalies, Bhutias, &c., who go to and N.-TV". of the district. In all, 3,165 deaths fair and return from it the by road traversing were registered, of which 1,244 took place in the entire of the district. length They always Damdaha thana,and 1,214 in Araria sub-division. live under most and fall insanitary conditions, The chief meteorological feature of the year victims to cholera when it ont ready breaks was a long droug lit. "From 12th October 1889 them. I lie lair used to be amongst formerly to 13th May 1890 (seven months), the only rain- Map of Purnia District

refer ?HCES

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fall was 0'05 inches on 5th March, and 0'30 remove the crowds of pilgrims who had come inches between 19th and 20th April. to Manihari for the bathing festival 011 8th During the month of January 1891 only 88 February, and who would naturally be desirous deaths from cholera were registered in the dis- of leaving the place as soon as they had performed trict. There was a little sporadic cholera their ablutions. The great majority of these throughout the whole eastern half of the district, pilgrims came from the East, from Diuajpur, except in Manihari than a, and also in Araria and from Rangpur, Jalpaiguri, and even Assam, The last of thana ; while the whole western half of the dis- via Parbatipur. them, however, trict, except Araria, was free from the disease. had been despatched by the night of 12th In particular, it is noticeable that both the February. The total number carried by the rail- riverside thanas, Manihari and Gondwara, with way, I heard, variously estimated at from sixty its outpost Karagola, were quite free from the thousand up to a lakh. Not being able to get disease. In neither, moreover, was auy death away by train, some 5,000 or more had walked from cholera registered during the first week of up from the river to Katihar, about twenty February. miles, and had been assembled 011 and near the On the 8th of February 1891 a great bath- platform. There had been altogether forty ing festival took place on the banks of the cases of cholera at Katihar, besides six or seven " " Ganges, the Ardhodoya Jog," or Snail." dead bodies takeu out of the train. Of these were out of This is a festival which is said to occur only forty, thirty-seven taken the train two were friends with the sick once in thirty years, and it is also alleged that sick, remaining this was the last time it will be held on the banks at Katihar, and one was a child whose parents of the Ganges, for, after the close of the present lived at Katihar, and had taken it to the river, century, the Ganges will no longer be the pecu- where it was attacked. This child recovered, and liarly sacred river of the Hindu religion, but this 110 other cases took place among the residents character will then be assumed by the Narbada. at that time. Of the other thirty - nine cases, This bathing festival seems more or less to have five recovered,and thirty-four died,the great mor- taken everybody by surprise. The railway tality being due probably to the fact that almost were cases when first came authorities appear to have been unprepared for all advanced they the enormous quantity of passenger traffic sud- under notice. The passengers would not com- denly thrown upon their hands, and were unable plain of sickness, nor ask for treatment, being to to concentrate sufficient rolling-stock to carry only anxious to get back their homes; they the number of pilgrims applying for transport, would not even inform the railway servants of specially as this sudden and unexpected demand the presence of a corpse in the carriage. Conse- for transport was made in more directions than quently it was only those who could be detected one at the same time, crowds of pilgrims pouring as sick by the railway staff who came under treat- down the N. B. R. line to Sara, as well as along ment. The same happened at Diuajpur, I was (he Assam-Behar Railway to Manihari. Nor informed, and all the way up the line to Parbati- were any preparations made in this district at pur. least for dealing with the sickness that might be On the 14th March I went into Manihari expected to occur among the assembled masses. station. There I found that five pilgrims had Personally, I never heard of this general pil- died, and one case had been attacked on the grimage to the banks of the Ganges, until in- preceding night, the child of a railway servant formed that cholera had broken out at Manihari (died). At Manihari Ghat station, five miles sixteen deaths had occurred among the pilgrims assembled there ; though I further 011, among had seen from the crowds of pilgrims marching the pilgrims, seven on the 11th, eight 011 the 12th, down the Ganges-Darjiling Road, that a pilgri- and one on the 13th, none now remained sick. 110 cases there mage to Karagola was going on. A Civil There had been except among Hospital Assistant is always deputed on special the pilgrims. I then visited Manihari thana, near inform- duty to Karagola fair, and this year the officer the first station. The Sub-Inspector a me that deaths were known to deputed was sent there fortnight before the ed twenty-eights the fair began, that he might be present there on the have taken place among pilgrims outside the day of the bathing festival. railway premises, but added that he considered On 12th February I received intimation there was 110 true cholera, but simply bowel- to through the Magistrate, that cholera had broken complaint, owing cold, want, and exposure. on This seems out among the pilgrims at Manihari station probable enough, but, however, this whether the first the Ganges. Luckily there happened to be a may be, cases were or were not the cases at C. II. A. on supernumerary duty at Purnia at true cholera, Katihar were certainly the time, and I at once despatched him with true cholera, and they were the beginning of a medicines to Manihari. He left on the 13th, most fatal epidemic, not only in this district, in the and on the same day I went to Kotihar Junction. but also districts to the east, through There I heard that the railway authorities had which the pilgrims passed on their return jour- been unable, until after considerable delay, to I ney, Diuajpur, Jalpaiguri, and Raugpur. The 36 INDIAN MEDICAL GAZETTE. [Feb. 1892.

pilgrims certainly suffered from cold, waut, ex- Assistant, and a sufficient stock of drugs had posure, and over-crowding. Some of them were been provided; and, above all, the number of at detained Maniliari nearly a week, instead of persons resorting to the fair was very small in a or as day so, they probably expected. If they comparison with recent years. In 1890 the had food or money with them, the majority largest number present on any one day was would not have enough to last them the whole 34,000; in 1889, 39,000; and, as there is a con- of their stay, such food as they had was probably stunt coming and going of people during the whole chura (parched rice), the most likely of all foods of the two weeks that the fair lasts, the total to set up bowel - complaints. Food was selling number attending would be much greater. This at famine prices at Maniliari, rice at four annas year, when the census was taken on the night of a seer, flour fourteen annas a seer, mustard oil a 26th February, the number present at the fair was rupee a seer, earthen dishes four annas each. The found to be 5,372. And though, no doubt, the of were the nights the 6th and 7th February total number of persons attending the fair be- coldest known for a long time, the dry thermo- tween 23rd February and 8th March was much meter going down to a minimum of 34?, the wet larger than this, it is certain that the fair to a minimum of 30?, or below freezing point; was a very small one, as compared to recent and though the night of the 8th was not so cold, years. This was due to the fact that large the minimum was still only 43?. On the river numbers of persons who would otherwise have bank it would probably be colder than in Purnia, attended the fair had come to Karagola for the and many probably spent the night in wet clothes bathing festival on the 8th February, and did after bathing. not care either to remain there until the fair At Karagola large crowds also assembled on opened two weeks later, or to return from their the 6th February for the bathing festival. How distant homes when the fair was'open. In many pilgrims marched down the Ganges - Dar- particular, I believe that the number of hill men jiling Road to Karagola there is no record, at the fair this year was very small ; as most of nor can the number be computed in any other those, who would otherwise have been present way than by the roughast of guesses. The police at the fair, had bathed in the Ganges on the officer in charge of Karagola outpost, however, 8th, and had returned home. One case of informed me that the river bank was covered cholera occurred at the fair, and proved fatal; for miles with the bathers, and I saw the road but the total number of cholera deaths registered through Purnia occupied for days by a con- at Karagola outpost was only 9 in February tinuous stream of pilgrims marching down to and 20 in March, so it is evident that there was Karagola before the 8th, and returning after no serious outbreak in this part of the district the 8th. A great number of these pilgrims until fully a month after the breaking up of the were hill men, and these men, coming from the fair. north, mostly came into the high road at Purnia. (To be continued.) Large numbers also, I believe, came down by train from , in the north of the district to Purnia, and marched from Purnia to Karagola by road (thirty miles), in preference to going bv train to Maniliari, and either bathing there, or walking across from there to Karagola some ten miles. Some also came from the north-east, marching down the road for its whole length of 106 miles. Among these pilgrims, however, no cholera was reported at the time. I visited Karagola mela on the 16th February, and was then informed both by the police officer and by the Civil Hospital Assistant on duty at the fair, that they had not heard of any cholera among the bathers on the 81h. This fair has often been blamed in previous years for starting epidemics of cholera. This year, however, there doe8 not appear to be any probability that the fair was to blame as the cause or as the starting point of the epidemic. The sanitary arrange- ments of the fair were good, latrines for men and women having been provided; and orders hav- ing been passed, and, as far as possible, enforced, that the site of the fair and the river bank should not be resorted to for purposes of nature; a temporary hospital, with a competent Hospital