2
1006 were to be seen on the forehead ; the eyes were half opened; the arms were crossed over the chest; the right leg was slightly doubled up ; the lower part of the face on the right side was much bruised; the hair was white and long. At the necropsy the stomach was found to contain no vestige of food, and one of the lungs was absolutely congested. No fracture of the limbs. It is believed, from the above observa- tions, that death had taken place on May 2nd-that is to say, twelve days after the accident. It would appear from reports published that he had escaped from five similar accidents, but has succumbed to the sixth. In connexion with this case the following note may be found interesting. On the 2nd of September, 1836, a similar accident happened to a well-sinker, who was employed in sinking a well in a sandy soil in the Commune of Champ-Vert, near Lyons. He had come up, but had forgotten his tools, which he left at the bottom of the well of twenty metres. In spite of the warning given him, he went down to fetch his tools, but before he could be drawn up again, a falling in of the earth, which was anticipated, took place. Believing that the man was lost, his companions were about returning to the village to report the circumstance, when they remarked that one of the cords which had been drawn up from the well had been newly cut. From this they concluded that the man was alive, and without losing a moment they commenced the work of deliverance. This lasted two weeks, and it was only on Sept. 16th that the man, whose name was Dufavet, was brought to the surface. He was in a deplorable state, but with judicious care was restored to health in less than a week. He related all the details of the situation in which he was placed. For the first three days the space in which he was confined measured a little more than two metres, but after further falling of the earth it was diminished pro- gressively, so that from the third day the man was obliged to remain doubled up, and he could not even extend his arm. In this position he was threatened each moment to be crushed by a fresh falling in of the earth, and during this time he was entirely without food. He was thirty years of age. Paris, May 15th. _________________ INDIA. (From a Correspondent.) CHOLERA IN 1836. Bombay, April 20th. THE twenty-third annual report of the Sanitary Commis- sioner with the Government of India, for the year 1886, has just been issued. There has been a diminished prevalence of cholera as compared with the preceding three years; the mortality from it throughout those parts of the country where death registration is effected was 208,371, the corre- sponding figures for 1885, 1884, and 1883 being 385,928, 287,609, and 248,860 respectively. The reduction has gradu- ally been considerable. The heaviest mortality appears to have prevailed in Assam, and next to that province the Central Provinces suffered most. I further glean from the report that the urban population suffered in a greater proportion than the rural, except in the Central Provinces and Berar. In connexion with the increased prevalence in Assam, it should be remarked that there was an in- I creased immigration of labourers (coolies) into that pro- vince. There was a diminished prevalence in the North- West Provinces. The year in the Punjaub was one of remarkable freedom from the malady. The same remark would appear also to apply to the Madras and Bombay Pre- sidencies. Mr. Hewlett, Sanitary Commissioner of Bombay, remarking upon this immunity, writes: "The lessened I prevalence of cholera during 1886 was certainly not due to any diminution of filth in and around the villages and towns s in the Presidency, and the only way to account for it is by the supposition that the factor necessary for its development (probably atmospheric) was absent." As regards atmospheric and telluric influences, there is nothing special to notice in these columns from the report of Sir B. Simpson, M.D. As regards the communicability of cholera from those afflicted to those in attendance on them, the data furnished in the report before me point to a negative conclusion. Out of 161 persons who attended on 41 cases only one is said to have contracted the disease. He was what in this country is called " sweeper," who has to do with the removal of excreta, and the cleansing of commodes, chamber utensils, &c., and he was one out of seven who attended on a first case, con- tracted the disease, and died. As regards "sanitary defects," none are noted in the case of British troops; in respect to nativo troops, one outbreak is attributed to the water supply from a "tank which had a bad reputation." As regards the Presidency gaol in Calcutta, where cholera prevailed, it is reported that, the supply of water being barely sufficient, tank water was employed for cooking purposes. The prison, moreover, was overcrowded during the year, and conservancy arrangements were imperfect. At other places where cholera prevailed in gaols drainage is reported to be faulty, and in one river water is blamed, and in another the site, which was an old burial-ground. And, lastly, I come to the effects of movement on the progress of cholera. The reports again show that movement of affected bodies of men was attended, in most cases, with immediate cessation of cholera, This applies to troops as well as to prisoners. FEVBBS IN INDIA IN 1886. April 27th. I propose now to study the figures referring to fevers, In the year 1886 there were 3,470,754 deaths recorded from fevers, as compared with 3,396,239 in the preceding year. With the exception of the Bombay Presidency, the Punjaub, Assam, and Burmah, the figures were mainly con- tributed from all the other provinces, the most marked having been from the North-West Provinces, while the least had been from Bombay. In Bengal there has been a steady increase in the death-rate from fevers. In the North-west Provinces, where the death-rate has been the highest, it was equivalent to 27’58 per mille of population, against 25’48 in 1885. Fevers are only separately dealt with so far as the army of India is concerned. It appears that intermittents were less prevalent, having fallen from 471 in the preceding year to 332, a difference of 139 per 1000. There was a diminution of ague in the Bengal and Bombay Presidencies, and an increase in the Madras. Remittent and simple continued fevers were slightly more prevalent, and most so in the Bengal Pre- sidency. As to enteric fever, we find that there is no material change in the mortality, that it is no new disease in this country, but that a change of diagnosis is only the result of better knowledge. "The determination of the exact nature and nomenclature of the disease," writes Sir B. Simpson, M.D., " must be left to the clinician, the anatomist, and the bacteriologist." With regard to fre- quency and causation, the reports of medical officers point to enteric fever being the principal fever of India, and some of the cases returned as simple continued or ague are in reality mild cases of enteric. Enteric fever is quite a dis- tinct disease in this country from remittent fever, simple continued fever, and ague. The differential diagnosis is possible with patience, perseverance, and increasing know- ledge. There are cases in which this is easy, but the difficulty of diagnosis, when it exists, is when these affections shade off into each other, being due to the causa causans influenced by different circumstances, or, in other words, by a combined materies morbi. The nature and causation are the same as in Europe, but the difficulty lies in catching the cause in flagrante delicto. The disease is the enteric fever of Budd, the pythogenic typhoid of Murchison, and the abdominal typhus of Gurgensen, but the course is distorted by the intercurrence of malaria, or, in other words, very often it is a hybrid of enteric and malaria. As regards causation, opinions point to climatic and telluric influences, specially affecting the young and unacclimatised men, and if there be insanitary conditions these seem to act peculiarly on them. It is, however, a noteworthy fact that women and children of European soldiers are not affected to any- thing like the same extent as the men are, and yet they are subjected to nearly the same climatic and other conditions. There are many who believe in the pythogenic origin of the disease—i.e., origin de novo. According to them, no doubt the sanitary surroundings of cantonment are well-nigh perfect; but then the whole of India is little better than one vast latrine (and a foul smelling one), and though the barracks &c. may be perfect, they are surrounded by a vast area of insanitation. There are, therefore, manifold ways in which the enteric fever poison may be generated. The soldier, moreover, in his rambles in the bazaars and villages, has scores of opportunities of contracting in- fection. Sir B. Simpson, in noticing the post-mortem records furnished by medical officers, criticises the vague statements, such as "typical typhoid lesions," or 11 typical typhoid ulcers," being found without any trouble being taken to give a minute description or differentiation between the, typhoid ulcer and dysenteric, and I
